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Home My WebLink About0090 FIRST AVENUE (HYANNIS) - Health 90 First Ave. , Hyannisport A= 7 0 31 i J r TOWN OF BARNSTABLE LOCATION 6tD {? SEWAGE# VILLAGE JA ASSESSOR'S MAP&PARCEL "-I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I 'r LEACHING FACILITY.(type) (size) NO.OF BEDROOMS O`'VNER PERMIT DATE: `t,— i�,., COMPLIANCE DATE: i I 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) MIA Feet FURNISHED BY ��U �,�1� � ' �c��r� � �� p p �— _ — — — ,� a� 0 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rltlfltation for MispoSal 6pstem Construction 3pPrmit Application for a Permit to Construct(,/S Repair( ) Upgrade( ) Abandon( ) 2/complete System ❑Individual Components Location Address or Lot No. 9G 11— y/�� Owner's Name,Address,and Tel.No.� Assessor's%ai%Pa 63 -66.N N, 0 6 Installer's Name, ddres/s,an�d/Tel.No.S,*. ,1;0S-69.Y— n� �sign_er s ame,A dress,and Tel.No. ,9 / 1tirv�i Type of Building: Dwelling No.of Bedrooms Lot Size 13,60 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3"D gpd Design flow provided gpd Plan Date OC.46 22 Number of sheets Revision Date_336 Title e 6-r�� r^ lS Size of Septic Tank /5/X &a76 Type of S.A.S.12` � �(fi¢ � � x 9,g3y, 1 Description of So' . Nature of Repairs or Alterations(Answer when a plicable) r 1 `'/ 6 s Z �h. , ki t Q 14' .2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maint of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmen ode not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date Application Approved by ' ` Date Application Disapproved by Date for the following reasons Permit No. U�- I Date Issued " No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • � Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS appl Lation for Misposal 6pStrm Construction ihniti Application for a Permit to Construct(� Repair( ) Upgrade( ) Abandon( ) ![Complete System ❑Individual Components Location Address or Lot No. 90 1-:r'�j� � Owner's Name,Address,and Tel sNo: ((,,�,--j tJ �p)1"rCC+?x,(2�r>c� �I� u�r t'i �yr Assessor's'1vlaplf le`1 + NUCPJV11Y1~ N 1 r( p� w r 4 Installer's Name, ddress,and Tel.No.5 .t$05�$2 X. Designer's dame,Address,and Tel.No. S'� y r, Rer1Q&7t �iuiorac - �' c>rxvr� .x�o�• a gi 1�1�t f.� S�. Ono a ,-,� r/i9�'//s ,r�►A vA--V, r Type of Building: a Dwelling No.of Bedrooms ✓ Lot Size ✓:3,of sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) .. Other Fixtures Design Flow(min.required) -3�50 gpd Design flow provided gpd Plan' Date W664 o'19��L}l�/ Number of sheets //Revision Date TitleJXe�ie�n� °gOY:S!• ldP9)GLL° Size of Septic Tank 1_XJqzg '4N-a6) Type of S.A.S.07` 5� .� .' i ,2a .x} X J, 11/ Description of Soilsg .k At J Nature of Repairs or Alterations(Answer when a pIicable). 4&/A?," a) /Sva&4 kx i 4 1 1ian [ X, �"�iN SIX��rc-( IPfi� CIYI1Yf t'S f �5 Y. )A• 13'l t� _SFu�i� ;2 /d�Q�tsem 6 flnn�rr �U Date last inspected: Agreement: R 3 * The undersigned agrees to ensure the construction and maintenance of the afore described on-site, 'sewage disposal system in accordance with the provisions of Title 5 of the Environmentat Code and not to place the systemi in operation until a Certificat/of. Compliance'has been,issued by this Board of HHealth.d Signe r� L. ,., _ Date �r � Application Approved by [:�Z,y� M r� �/Q/l ){ �^ 1 Date Application Disapproved by U l Date for the following reasons Permit No. Date Issued ' P --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERT/IF tt�hat the On-site Sewage Disposal system Constructed(r') Repaired( ) Upgraded( ) Abandoned( )by /{�J/"7 'i ,lJ7Sf E'l�sec+'s`e//Y at 70A � I' , f"r r^S l i/r r)U i ,ur,yla�In. has been constructed in accordance with the provisions /off�Title 5 and the for/Disposal SystemConstruction Permit No.7 o)-[ -. 91 dated I l` [L- �-tt I Installer � (`;'�z 1//+251 A t/(/t'a , 1� Designer l��1✓3 GC,fI E' Fr99 /bnr6 0Y)IQ .- DC #bedrooms Approved design flow 7Y gpd The issuance of this permit shall not be construed as a guarantee that the system will ct on as des' e Date l W.0 I Inspector f +' -- - - - -'- - - -- -•-- -- ------•----------- ------- No.. L 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ispooal 6pstem Construction Permit Permission is hereby granted to Construct( . Repair( ) Upgrade( ) Abandon( ) System o cat , Aedat . PQ 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 — Approved by NOV-25-2021 01:06 From: To:15087906304 Pa9e:1/1 Town of Barnstable Inspectional Services Public Health Division -- WAS&A°''s' r Thomas McKean,Director 163¢ a 200 Main Street,Hyannis,MA 02601 Fax: 509-790-6304 Office: 509-862-4644 --- Installer Designer Certification Form .• . . Date: I a3 �I - Sewage Permit#I y Assessor's Map�Parcel Designer: mwn av�Q�ne �y Installer: Address: q '� U Address: z� �l'1r.. �►' - was issued a permit to install a On / G. d 11 r • ( ate) (installer) septic system at �� + AV- ' W- ann is Oar based on a design drawn by (address) ICI E Pt 6 dated 10-,?-0 ( esigner stfinti V I certify that the septic ri��ude minor approved changessu installed ch asulateral rellocation f the • the design, which'may distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. system referenced above was es i e I certify that the septic eal relor on of the SAS or any verti al relocation of any component greater than 10 lat 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. 1-certify thg-the-systefn referenced above was constructed in c1NOF liance with the terms of the I1A approval letters(if applicable) 1, s, $� OANIELA• �, 4 OJAL A " CIVIL CA � ---"'' No.46502 (Instal er's Signature) 9 ss/ONAL ECG (Designer's igneture)�- (Affix Designer's Stamp Here) PLEASE.RETURN T BARNSTApE IS UEDC NTIL BOT YT II FO CERTIFICATEjW A AS- OF COMPLIANCE WIL NOT . . B I T CARD ARE REC IVED Y THE BAItNSTABL PUBLIC HE LTH DIY SION. ��to pjMEALTMbwBR wrinecPSEPTlMesigner Cenlitcadon Form Rcv lRld 13.DOC Town of Barnstable Inspectional Services Department RMMAS& � ' Public Health Division 1639. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8234 December 15, 2020 WOODRING, DEBORAH TR PO BOX 161 WEST HYANNISPORT, MA 02672-0161 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 90 First Avenue, Hyannis,MA was inspected on 07/17/2020 by Michael T Bisiencre, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Single Cesspool. Must abandon the single cesspool. Can re-plumb into other septic system or install compliant system. You are ordered to repair or replace the septic system within two years (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\90 First Avenue Hyannis.doc Town of Barnstable + BARNSfAHLE, b 4 ,�� Inspectional Services Department 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 ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located 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). T 2 YEAR DEADLINE CRITERIA VOrSingle 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 v U r��'n Stein � ' (s,fp °� o re IVMb in- u Aer SS!At, JyJ�M Repair deadline: r" �� M 1� C� '� I,H n >L ys ✓'�' Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r t a h • 7 n F I r� CI. 1-e� vCST D+f 0,,je 7"Ac- T �S Pe-Afe- Pee__ Iv ✓r3- Pi 0v'k �N d./ le��TI"'fc r c Commonwealth of Massachusetts Title 5 Official Inspection Form l; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 90 First Ave Property Address Deborah Woodring, TTEE ` Owner Owner's Name information is required for every West Hy p annis ort MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road kCompany Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system-inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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 ` 07/17/2020 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. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is West H annis ort MA 02672 07/17/2020 required for every y p page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 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. n Comments: 2) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y 0 N ❑ ND (Explain below): The laundry is now on a cesspool this should have been tied into the septic system that was installed in 1997. The town requires this to be tied into the septic system with in 2 years from the inspection date. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form f= , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave v- Property Address Deborah Woodring, TTEE Owner Owner's Name information is required for every West Hy p annis ort MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every y West H annis ort MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) , ❑ 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 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: ❑ 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 ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is West H annis required for every Y port MA 02672 07/17/2020 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 CA. Yes No e ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is required for every West H annis ort MA 02672 07/17/2020 _ y p page. CitylTown 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 310 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? ❑ ® 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. ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is every West H annis ort required for eve Y P MA 02672 07/17/2020 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedroom GP s): plus D Description: f Number of current residents: 0 Does residence have a garbage grinder? ❑ 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 ears usage d town water 9 ( Y 9 (gP ))� Detail In 2019-5000 gallons were used and in 2018-8000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is every West H annis required for eve Y port MA 02672 07/17/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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: l5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts 1= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information isequired for every West H annis Port MA 02672 07/17/2020 page. Cityrrown 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: Septic system 1997_ Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 38" septic sys/cesspool 12 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it flowed freely. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form: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 ,� � 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is required for every West HY p annis ort MA 02672 07/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 30"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: H-10 1500 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave v- Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every y West H annis ort MA 02672 07/17/2020 page. City/Town 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is required for every West H Yannis port MA 02672 07/17/2020 page. City/Town 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 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.): ` At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts jn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 90 First Ave Property Address str Deborah Woodring, TTEE Owner Owner's Name information is required for every West H annis port MA 02672 07/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* I 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: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 26 X 11 X 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: - t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave u Property Address Deborah Woodring, TTEE Owner Owner's Name information fo is every West H annis required for eve Y port MA 02672 07/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One Round Depth—top of liquid to inlet invert Dry Depth of solids layer Dry Depth of scum layer Dry Dimensions of cesspool 4X6 Materials of construction Block Indication of groundwater inflow ` ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): At the time of the inspection the cesspool was dry. I t5insp.doc•rev.7/26/2018 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 90 First Ave u— Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every y West H annis ort MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): e t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of I as' ahusetts Title 5 O ficial finspection m Subsurtace Sewage Disposal System Ftri Not for Volunta�A ry ,ssessments 90 First,4ve Property Address Owner DebOrah Wondrin TTEE -_ �vner's Name inforrrlation is required for every, West Nya;nnisyort MA Rage. City/Fown 02672 07/1.7/2020 State Zip.Code Date of inspection D. System inforrhafth (Cont.) 14. Sketchcof Sewage bisposal System: Provide a view'of the sewage:disposal system, including ties to at least,two permanent reference tIheb rks or i enchmaiks:Locate all wells within 100 feet..Locate where public<vvater supply enters the building. Check orie of the boxes.below: ® hand-sketch in the area telow [] drawing attached separately p' - 8 C A 9 q a A g C 3 1 12' 29'S'; Leachin8 2 16 9 311g,, 3 19'S" c 4 17' 29' tsinsp.doc•rev.7/2&2018 Tills S Oifida!inspectkm Farm Subsurrace S"sge.0isposal System-Rage 16 IN 18- Commonwealth of Massachusetts r = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name required for is every West H annis Oft required for eve Y P MA 02672 07/17/2020 page. City/Town 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: 10 plus feet 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: augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is West H annis ort MA 02672 07/17/2020 required for every Y p 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 all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts a O3 lv� Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 � 90 First Ave o Property Address r Deborah Woodrin , TTEE r Owner'' Owner's Name information is required for every West HY annisport MA 02672 07/17/2020 !page. City/Town State Zip Code Date of Inspection f '+ Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information � c on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road ue Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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 a�-_:!�� 07/17/2020 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts w _ 6F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is every West H annis ort required for eve Y p MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 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: This 3 bedroom home has two separate systems. The kitchen and laundry is on a cesspool. The rest of the house goes to a septic system that was installed in 1997. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c !% 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is every West H annis required for eve Y port MA 02672 07/17/2020 page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts o Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c V � 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every West Hyannis port MA 02672 07/17/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 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: ❑ 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 ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �nip Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is P required for every y West H annis ort MA 02672 07/17/2020 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,� Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cam !% 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information fo is every West H annis required for eve Y port MA 02672 07/17/2020 page. City/Town 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 310 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 an 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance.is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ►p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name requfed fo is every West H annis ort re uired for eve y P MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ 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 ears usage d town water 9 ( Y 9 (gp ))� Detail: In 2019-5000 gallons were used and in 2018-8000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019 Date t5insp.doc•rev.7/26/2018 Title 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 90 First Ave u Property Address Deborah Woodring, TTEE Owner Owner's Name information is re u+red for every West H Yannis port MA 02672 07/17/2020 paged Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No J. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave u— * Property Address Deborah Woodring, TTEE Owner Owner's Name ion is required wiredd for every West H Yannis port MA 02672 07/17/2020 page. Cityrrown 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: Septic system 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 38" septic sys/cesspool 12 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it flowed freely. t5insp.doc-rev.7/26/2018 �, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 j Commonwealth of Massachusetts �v Title 5 Official Inspection Form �I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every y West H annis ort MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 30"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: H-10 1500 Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave u— Property Address Deborah Woodring, TTEE Own@r Owners Name information is West H annis ort MA 02672 07/17/2020 required for every -y p page. Cityfrown 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 90 First Ave V Property Address Deborah Woodring, TTEE Owner • Owner's Name information is every West H annis o requited for eve Y p rt MA 02672 07/17/2020 page: Cityrrown 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 011 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. R • R . 1 t5inksp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 90 First Ave Property Address .p Deborah Woodring, TTEE Owner Owner's Name information is re tequiiir d for every West H Yannis port MA 02672 07/17/2020 page.• City/Town 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.): s * 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: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 26 X 11 X 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts �n Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every West Hyannis port MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One Round Depth—top of liquid to inlet invert Dry Depth of solids layer Dry Depth of scum layer Dry Dimensions of cesspool 4 X 6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): At the time of the inspection the cesspool was dry and no visible failure criteria was found. I • t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 90 First Ave V Property Address Deborah Woodring, TTEE Owner Owner's Name information is p required for every West Hyannis port MA 02672 07/17/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5insp.doc•rev.7/26/2018 Title 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 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information is required for every West Hyannisport MA 02672 07/17/2020 page. Citylrown 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 D q B C O Lf__ A B C D 3 3 1 12' 29'8„ Leaching > 2 16'9" 31'8" 3 1915" 33•6„ 4 17' 29' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage •Disposal System Page 16 of 18 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form I e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 90 First Ave Property Address Deborah Woodring, TTEE Owner Owner's Name information fo is every West H annis required for eve Y port MA 02672 07/17/2020 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: 10 plus feet 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: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c.. 90 First Ave u— Property Address Deborah Woodring, TTEE Owner Owner's Name information is every West H annis required for eve Y port MA 02672 07/17/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: E A. Inspector Information: Complete all fields in this section. E B. Certification: Signed & Dated and 1, 2, 3, or checked E C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed E 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 10-a-1-97 , concerning the property located at kf P0 meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will 1a91 be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: i A)Top of,Ground Elevation(according to the Engineering Division G.I.S.map) 1 B)Observed Groundwater Table Elevation(according to Health Division well map) SIGN DATE: 7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert coQ r i i i i i i i i � T .33 T T w av Cn T pp (� r T ; _-::: - N T - 10 W Co O W o � TOWN OF BARNSTABLE LOCATION 10 1!; y� J SEWAGE # 7• l r VILLAGE_ ' hQ ASSESSOR'S MAP&LOT d 6-4 INSTALLER'S NAME&PHONE NO. l,V SEPTIC TANK CAPACITY V�68 Zl�t201i LEACHING FACILITY: NO.OF BEDROOMS 3 \- BUMDER OR OWNER PERMUDATE: fb -`a 1 N°J� COMPLIANCE DATE: �a •�� ` l 7 Separation Distance Between the: Y Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by O O � • ct a v� f - No. n ( 1 Fee ( Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �. Yes PUBLIC HEALTH DIVISION ' TOWN OF BARNSTABLE,, MASSACHUSETTS ZIpprication for 30iopo.5af *pztem Construction permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a0 I S t 4vv— [�POT Owner's Name,Address and Tel.No. Assessor's Map/Parcel „_y 267_®3C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow � 30 gallons per day. Calculated daily flow 3�/ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 41_ Type of S.A.S. r.F CG_ 'y t ttirL��-S Description of Soil 0- Le= Q SEA Nature fo£�,Repairs soor Alterations(Answer when applicable) rsw v- 1`F<<U,r. oL/I'!3-- y,--,w 1/1 S (.LJ I Lk I sU e, O UL.? �y -1- L qt* ---...-.Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' is Bo Signed Date /D 9 Application Approved by Date Application Disapproved for the following reasons Permit No. f 7 - & Date Issued ——————————————————————————————————————— �^ f 1 Fee .,` 0 - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f - Y PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS es 01ppYication for Migaaf *pgtem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a°Q I ST 4V5 Pb Fr Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow -so ¢`gallons per day. Calculated daily flow -3�-1 / gallons. Plan Date Number,of sheets Revision Date Title - Size of Septic Tank S W IA- of - Type of S.A.S. \tx_ � � s Description of Soil ,, Nature of Repairs or Alterations(Answer when applicable) XU.ST`!SNN l S UU S,�-tw e_ A K VL �r✓vV- Date lasi inspected: .. J Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation.untifla Certifi- cate of Compliance has been inn h��h Bo 't Signed Date /O 4 5� "Application Approved by - Date Appl ation Disapproved for the following reasons Permit No. % 7 - ' 1 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS�i_ BARNSTABLE, MASSACHUSETTS _.. (Certificate of (Compliance THIS IS TO CERTIFY that tile On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( 1� Abandoned( )by �o 4, ®" r, at D t sr lA\! F. 1 ti C-t"t")t S 06✓ I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system willfunction a designed. Date ��'? -�_ �i - �} Inspector \� No. 7" Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Migozal bp5tem Construction Permit Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( ) System located at go rc-(;? 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 be completed within three years of the date of this permit. Date: 10 — 7+� 1 Approved by �VE Town of Barnstable �xa�• . » Department of Health, Safety, and Environmental Services Public Health Division �ED�A°r• P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health . April 6, 1098 Thomas Kneen 136A Upper Byrdcliffe • . Woodstock,NY 12498 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic.system owned by you located at 90 First Ave., Hyannisport was inspected on October 10, 1997 by Rodger Roberts, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Discharge or ponding of effluent to the surface of the ground due to an overloaded or clogged cesspool. • The cesspool was full of wastewater effluent over the top of the cover. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within(14)fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF T OARD OF HEALTH 1;oZmas;Qc2aan,R.S.,C.H.O. Agent of the Board of Health q\heal th\db6les\titles i.doc Town of Barnstable Department of Health, Safety, and Environmental Services BARNSTAHM + Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 /��' Director of Public Health TO: r5 DATE: ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at �� sr � a��; was inspected on (z- 10 , 1997 by o a Massachusetts licensed septic inspector. 14 The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to theAllowing: 0 ydr I CLq k 0 or- '=l cQP6V1 o C'6 ver- You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health cv�1hVNfi1e wucsi.aoc PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 267 031- - Account No: 168446 Parent : Location: 90 FIRST AVE Neighborhood: 58AC Fire Dist : HY Devel Lot : 21 Lot Size : . 30 Acres Current Own: KNEEN, THOMAS B State Class : 101 136A UPPER BYRDCLIFFE, No. Bldgs : 1 Area: 1912 ,Year Added: WOODSTOCK NY 12498 Deed Date : Reference: 3053/46 January 1st : KNEEN, THOMAS B Deed MMDD: 0000 Deed Ref : 3053/46 Comments : Values : Land: 58600 Buildings : 119200 Extra Features : 600 Road System: 90 Index: 543 (FIRST AVENUE ) Frntg: 120 Index: ( ) Frntg: Control Info: Last Auto Upd: 071497 Status : C Last TACS Update: 070897 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [267] [033] [ ] [ ] [ ] COMMONWEALTH OF MASSACHUSETTS 1121 i s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECT ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 (M v9 y'0 l'99`y C) ,2 CiQ F9lT,y�,9�TT9B( �. a� F WILLIAM F.W'ELD TRUDY COXES Governor L Secmary ARGEO PAUL CELLUCCI DA_ _BA STR[S Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION nnu 1 Sr A.I . H �..hr:�po"T Property Address: 'I _ Address of Owner: ��v� � Date of Inspection: I 1 i ` -7 (If different) Name of Inspector. ,,.,_ R.60-v+s 1 am a DEP approve system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: cL— S C_— Mailing Address: S Telephone Number: ` 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 _ Conditionally Passes _ s Further Evaluation By the Local Approving Authority 'Fails Inspector's Signature: Date:op "Oor a 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 the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria a5 defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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 (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web'. http:/Avww.rnagnet.state.ma.us/dep i^j Pnnted on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) � N�Arvn1 isPo>~� Property Address: S. pJc--.G �_ t 1 Owner: Date of Inspection: f o— I 7 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). 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 to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the,well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (zaviaed 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTIFICATION (continued) Property AAdddressss:�v ' S t (7 H YA WJ;,S fluKT Owner: L Date of Inspection: I G--c7- DJ SYSTEM FAILS: You must indicate ei:,,er "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 defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box-above outlet invert due to an overloaded or clogged SAS or cesspool. _ liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 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 addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. �(reviaad 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: — s 1 ME, )krANNiSPOP T n`_� � Owner: es A P Date of Inspection: f'� 1 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 part 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. All system components, excluding the Soil Absorption System, have been located on the site. _ ✓ The sew pan ck rn lts were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. V/ 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 04/25/97) Page 4 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 9 f 1% hie. NyaNIV� 3P6t2T. Property Address: � � Owner: 66 C C Date of Inspection: f cv-- (o —I 7 FLOW CONDITIONS RESIDENTIAL: Design flow:3 30 F.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: Garbage grinder(yes or no):—B Laundry connected to syste`m/(yes or no):4 ' Seasonal use (yes or no): '`t Water meter readings, if avai able (last two (2) year usage (gpd): Sump Pump (yes or no):� Last date of occupancy: '7YZ9'twl COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/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: GENERAL INFORMATION PUMPING RECORDS and source of informati System pumped as part of inspection: (yes or n )_ If yes, volume pumped: eallons a Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system 'le 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: �(✓S Sewage odors detected when arriving at the site: (yes or no)4 (revised 04/25/97) Page 5 of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ( s t S Po K T y Property Address: IJI�3� b A'�� I Owner: 19 E W f'I Date of Inspection: f O 1 v—c�7 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: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: 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.) 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 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) T u Property dress: f S E, !' y/}tj N.1SO,- Owner: I e tj Date of Inspection: TIGHT OR HOLDING TANK: r� (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.) DISTRIBUTION BOX: i I (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: / (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: � ' s- h1v�. , I� R� Owner: -b r— Pt ►S l� Date of Inspection: f J (J —q -7 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:_ 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 of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: �"— (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 groundwat inflow (cess ool must be pump as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of pjndincondition 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. (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 I S 14 y A 6 S PO Owner- #{ YVtiiE' Date of Inspection: !J—/c>-- 7 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) P• • 9 of 10 (revised 04/25/97) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner.'-(� R A3 C Date of Inspection: ) —(V— 7 Depth to Groundwater 0 Fleet 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 Use USGS Data Describe in your own words how you established the High Groundwater Elevation: Must be completed) a (revised 04/25/97) Page 10 of 10 Sj-TOWN OF BARNSTABLE LOCATION �O �� SEWAGE # VII I:AGE Y) ASSESSOR'S MAP&LOT I/6. 0 Y!� INSTALLER'S NAME&PHONE NO: ✓J9/T D G��J� 'd �l SEPTIC-TANK CAPACITY IS 0b iNl`b�.J AX 1\� - LEACHING FACILITY: (type) ��- a nc«� (sizP NO.OF BEDROOMS 3 BUILUER"OR OWNER .. .. ... . PERMTTDATE: COMPLIANCE DATE: Separation:Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet private:Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge,of Wetland and Leaching Facility(if any wetlands exist within.300 feet of leaching facility) Feet Furnished by 3 " ro� t� B ti Q 6 o 1 o 0 3 ro 7 i Q ' - '' 'n is to 1)e'lised for the iiepair of FailO • ' '�'� q NOTICE. Thrs i err ; Septic Systems Only 4 t CI?It'I IfICA-LION UC SKETCH AND ATPLICATION FOR UDIL DISPOSAL 1VUItIvS (UNS I ItUC 1 lUN 1'I ItRII f t1Vfr 1UU I DE 1 NE I, hereby certify that the application for disposal works B me dated r� `� •concerning the construction permit signed by sue ' 1 y too r c _ meets so of the property located at 9� following criteria. �'/There are no wetlands within 300 feet of the proposed septic system 6,41 There are no private wells within 150 feet of the proposed sepllc system The observed groundwater table Is 14 feet or greater below the bottom of the kaching faclllly There is no increase inflow and/or change In use proposed /e There are no varianoa requested or needed. DAM �0 J S7 SIGNED: LICENSED SEPTIC SYSTEM INSTALLER IN TNg TOWN OF BARNSTABLE NUMBER M IAllach a sketch plan of the proposed system. Also if the licensed installer posesses a cerlitkd plot Plan. this plan should be submittedl. J r= ca 4�.. ------ No. Fs c 21................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �7j ( �...O F ............RX-R.NSIABLE....................................•. Appliration -fur :41.ipl al Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal Systexn at 4�jV ••• ° ...a ---------- --- --------- ------ .......................................................... ... Locatio 'ddress t- or t Iy o dr -CA---- -------- --------- ............... Installer Address dType of Build* /S Size Lot----------------------------Sq. feet U Dwellingi No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ----- ------------------------ -... W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------.......gallons. WSeptic Tank—Liquid capacity--:.........gallons Length................ Width------.......... Diameter_---.....---_--- Depth................ x Disposal Trench—No..................... Width-------------------- Total Length------------_------ Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) �_, Percolation Test Results Performed by.......................................................................... Date---------------------------------------- 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit-----_______--__--. Depth to ground water...--.---.---.---..-.--- fi Test Pit No. 2----------------minutes per inch Depth of Test Pit--_________-__-_--- Depth to ground water_--.---_---_-----.---- a -•••-•------------------•-•-------••......................................................... 0 Description of Soil-------------------------- ='---------------------------------------------------------------------------------------------- x _ w - ----...•.-- -- -- ----- -- ----------------- UNature of Repairs or Alterations— nswer when appli le..__ ____ -------------------------------------------- --------------Agreement: The undersigned agrees to install the aforedescribed Individ Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The ndersigne urther gees not to place the system in operation until a Certificate of Compliance ha en iss ed by ea h. Si --- -- ---- - ------------ ----------- ------------• -----------•--------------_-•--- Date Application Approved By---- - '- (�, } -:_------------ t� Application Disapproved for the following reasons------------------------------ •-•-----•--.....•--•-•------•--.......--•---•-••••......•--•--------•---------•-----------------------------------•----------------•-----•---•--•-------------------- ...---•-•---•----- Date PermitNo......................................................... Issued........................................................ Date —------------------------------------- ----------------------- ------- -------------------------------J No._ .,................. _ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH f ....oF....._............AAgNS.T_A_BLE............................... Appliratiun -for Biiipoiial WorkS 1Tonstrnrtion Vrrnfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal - Syst at: Q. ------- - Locatio 4d,ress or of i--�!a . .... _____ - �'"7�� O r� Address �,fp//1 W -----!•7-`-• l-- --b:_v _. _ _!°�i"a'�-'-x-�= •--•-_----_-_____- -��_ !e. ! •+ate'._rs".p_ /!%rTa--- }mil er'� � �F7-_(._.(7tr-- ,&l/ __.._._____C___.R»_.___ 7e Installer Address Type of Building Size Lot.................. -------Sq. feet Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ). Garbage Grinder ( ) p-, Other—Type of,Building ____________________________ No. of persons_-------------___:_-------------------Showers ( ) — Cafeteria ( ) Ga Other fi tures ----------------------------•--- - W Design Flow.............................................gallons per person per day. Total daily flow......................._.______-------------gallons. W Septic Tank„—Liquid capacity-------------gallons Length________________ Width..___....._._.. Diameter................ Depth.-.--.--_-_--- ... x Disposal Trench—No...................... Width-_----------------- Total Length-------------------- Total leaching area------------.-------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet___________.________ Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-------- ----------------------------------------------------------------- Date---------------------------------------- a Test Pit No. 1---------------_minutes;per inch Depth of Test Pit..._._______________. Depth to ground water-------- --------------- Cz Test Pit No. 2................minutes per inch . Depth of Test Pit-------------------- Depth to ground waten..------------------_- ----------------------• -- ---------- ------------ ODescription of Soil----- ------------------ :- =' "`=------------------------------------- -------------------------------------------------------- x -------- - §' - It--- --------------- -- U Nature of Repairs or Alterations—Answer when apple _- - 1----------------------- -'-------------------------- a ---- Agreement The undersigned agrees to install the aforedescribed Indivi Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The ndersigne urther .grees not to place the system in operation until a Certificate of Compliance h e is d by a h. Si f . . Date Application Approved BY r ! :------------- Application Disapproved for the following reasons:..:...............------------ -•------------------------------------------------------------------------- := '= --------------- ------ ------------------- PermitNo......................................................... Issued---___ ------------ 7 -- ------ _____-,. Date THE COMMONWEALTH OF',MASSACHUSETTS _ BOARD. OF HEALTH EMMSTABLE ........... •. ......oF......I..................... . ....................... Tntifirate of 011nmplinnrr f7is I TO CY'7? ®Y, Tha �Individual Sewage Disposal System constructed ( ) or Repairedb § r ---------------------------------- y4a --- ��--------------------- �.. Installer at-_-- ...........-- ° .".e,.nitar' has been installed in accordance with the provisions of :article o. T.he Statev Coe as descri ed in the -` `b application for Disposal Works Construction Permit No._. dated '-_.-__-_, �+ l '. ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA TEE THAT THE SYSTEM Vrl F CTION ATIS FACTORY. DATE-----:- -----�- �,----------�---- ------------------------ Inspector--�------------�------------------•---------------....�_.._...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ....... -•�-< .::....of................ A IS`1fABLE.. ... No......................... FEE =------------- ° ; i� >a ,ttl 4rk� nn trn #ion Pj amit Permission. is hereby granted_.__-! _� `" ' -- to Constr c�t�) 'r"Repair e'?) an Ind' idtyal Sewage Dig- OsAal System as shown on the application for Disposal Works Construction _ ermit No-:_---- �Dated--,.__. +�. ................. Ems++* x+ Board of Health DATE----.,............. ........7............... ------ ......................... ° FORM 1255 HoeBS & WARREN_, Nc.. .PUBLISHERS Thomas B.Kneen RE) Bx135 al�eg�Pa-. 6$tk 2I sT Avg wC.sr eU(S. l:Q1-I> Ukle-re-.' rA �F74-r ..m-�,_-g9r3a 'TO -`l�Yi'LEt-IENT ,t>Ppt ICATi�al �r P�F_►1t_,T_ _A�Ir.• �,.t?[73 i i - - 7-4.•7 t Sri:V�S I SIeI't �6:J O1 ?C:6:.� t c�oru�: ..wassacF� LEA-4 Ma7] Al ii i �_.�.s...._�..�...._.. J/ AL:'C=C TO � !•�•� `..GIL:LI•n:`r � � I i �� / Fqucl!y x!'noa9 /��• '33'3 ---;.. I. OV6ZYSc*; j I '2 0' NI i E /��✓G W. 1-i`/A W Q t �- ----- ----- -� -------------- - ---- ---- ------ -----.�. ---. --- - ----- -- - - -- - - -- -- - - i SYSTEM PROFILE MA SYSTEM COMPONENTS T SHALL BE NOTES � MARKED WITH MAGNETIC TAPE ORTO WAE) NOT COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS o t CONCRETE COVERS TO WITHIN 3"' GRADE VENT W/ CHARCOAL FILTER $ �� o eR ACCESS COVERS TO WITHIN 6' OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING �a TOP FOUND. EL. 32.T FILTER FABRIC OVER STONE 3. MINIMUM ,PIPE PITCH TO BE 1 8" PER FOOL � 32.0' 2% SLOPE REQUIRED OVER SYSTEM 30.5-31.0 � MINIMUM .75' OF.COVER OVER PRECAST a PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST 29.3T*RisERs (TVP) MIN. 2" WALL THICKNESS BLOCKS OR UNITS TO BE AASHO H-� 2'0 4"OSCH40 PVC PRECAST RISERS F;� a a PIPES LEVEL 1ST 2' qD MORTAR ALL H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. 4, COMPONENTS ' ? 10" 1500 GAL H-20 14" ENDS° (TYP.) i11 INV'S EL 28.0' SIDES 29 0' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE e TEE SEPTIC TANK o 0 28.75' TEE 28.5' o°°°°oo° - odo arREAP, - o°o" °° WITH 310 CMR 15.000 (TITLE 5.) Y o 0 0 0 0 6" MIN. SUMP ®®®® ®®®® °°°°�° 0" OOo°o°o ) O ° °°GAS BAFFLE ,90000000009 12 MIN. INT. DIM. 0000°o°o oo°o°07. THIS PLAN IS FOR PROPOSED WORK ONLY ANDo 0 0 ° ®®®®®®®® ®® ®®CJ®®®®®� o °° ° ° ° ° ° ° ° ° ° CraiavilleBeocRd.°° °° °° ®®®®®® ®� °°°°°° �®®��®®®® `000000°° NOT TO BE USED FOR LOT LINE STAKING OR ANY 4' LIQ. LE1/EL ACME OR EQUAL 28.27' 28.1' oo°000°o° ®® oo°°o°o 0000000°( ):; o 0 0 0 ®®®®®®®®®1�® o o ®®E�J®®®®�® ; ° o 0 o OTHER PURPOSE. �, M l ° o o ° o0 0 ° °°°°°°°° 26.0' _ ° o d o •ft• o ;, ,._ .« ..•;,.: } :.e':•'.:: .r V4 �0o0o0000 "°°000,° r 0 0 0 0 1 000000000000000000000000o000000000o00l. °0000000 a oo�o�oo�a�o�o�o�00000000000 0�0000000. L 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. Locus COMPACTION. (115.221 [2]) 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' HEALTH AND PERMISSION OBTAINED FROM BOARD (2.6% SLOPE) (-!-X SLOPE) ( 1 % SLOPE) q OF HEALTH. ros FOUNDATION- 24' SEPTIC TANK 23' D' BOX 12' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY CALLING DIGSAFE (1-888-344-7233) AND** LOCUS MAP NOTE: INTERIOR PLUMBING TO BE VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF*THE INSTALLER SHALL VERIFY THE REROUTED AND CONNECTED AT ELEVATION 21.0' BOTTOM TH-1 WORK. SCALE 1 =2000,± LOCATIONS OF ALL UTILITIES AND ALL SHOWN ON PLAN VIEW. PLUMBER TO No GROUNDWATER FOUND BUILDING SEWER OUTLETS AND CONFIRM FEASIBILITY PRIOR TO INSTALLING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 267 PARCEL 31 ANY PORTION OF THE SEPTIC SYSTEM BE REMOVED BENEATH AND 5' AROUND THE ELEVATIONS PRIOR TO INSTALLING ANY PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001C0583J c E E SAND. DATED 7/16/2014 D a DD x 99 EXISTING CONTOUR X 99.1 EXIST.' SPOT ELEV. �, 110•Q ZONING SUMMARY 08,30"NI ' ED E .OF CLEARING -[991-- PROPOSED CONTOUR 579� _ SE BACK X 33 N EXSTIN� 5 5 ZONING DISTRICT: RF-1 RESIDENTIAL DISTRICT f9s.4 , --( DP D D EXISTING PROPOSED ] PROPOSED SPOT EL. TH1 d i`r_ _� PR I OPOSED 8.7' MIN. LOT, SIZE 43,560 S.F. 13,200 SF 13,200 SF -+- i ADOITI MIN. LOT FRONTAGE 20' 120' 120' TEST HOLE J I LOT AREA MIN. LOT WIDTH 125' 119.71' 119.71' i LINE 13,200 S.F.t R 2% SLOPE of GROUND REROUTE WATER -INV 29.7± ' 'DEC MIN. FRONT SETBACK 30' 48.5' 30.7' D , oeNORa MIN. SIDE SETBACK 15 24.8' 15.1' UTILITY POLE BENCHMARK: N MIN. REAR SETBACK 15' 8.7' 15.2' IRON PIPE GR TH1 _ _ w r MAX. BUILDING HEIGHT 30' FIRE HYDRANT -32.8 NAVD88 Rid W - NOTE: NOT Al SYMBQLS MAY APPEAR IN DRAWING Ww 'O - .PLUMBING TO M CAUTION w-- G . G 2 0� BE REROUTED- ►!� -29.3T GAS . LINE , G O `" EL D K o ' � '- W EXST. DWELLING Z SYSTEM DESIGN. TOP, FNDN EL.= '< TEST HOLE LOGS PROP. T CHARC AL w W O 32.7' FILTER A B TH,Gs ' ' GARBAGE DISPOSER IS NOT ALLOWED ENGINEER: CRAIG J. 'FERRARI, SE #13871 CO ATRAC o-WITH Y 1•4' H o ER CONSUL TION) W ' INV 30.5±-, ' v, DESIGN FLOW' 3 BEDROOMS ® 110 GPD = 330 GPD WITNESS: DONALD DESMARAIS ; : 15'2 �' USE A 330 GPD DESIGN FLOW I DATE: LO 5/4/2021 '-� 14 < 2 MIN INCH SEPTIC TANK: 330 GPD (2) = 660 PERC. RATE N �'� PROPOSED CLASS I` SOILS P 21-108 o , ADDITION USE A 1500 GAL. SEPTIC TANK � 48.5' PROP;.GA ;, LEACHING: ELEV. ELEV. ' SLA SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD 4 32 4 .0' o' M _ D 0» 32.0' p» ' - ;PERGOLA A q BOTTOM 30 x 9.83 (.74) = 218 GPD J Q.c LS LS tTl 3 i�x- .►�' TOTAL: 454 S.F. 336 GPD 12" 1OYR 3/2 » 1OYR 3/2 0�� 31 x x - USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) TITLE 5 SITE PLAN 10 B B 4"E PROP O DDITION OF WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' -T2 O E TO $ CK. BETWEEN UNITS LS LS 1 ,00 MOR SEPARATION R MME 'DED #9O FIRST AVENUE 30" 1OYR 5/8 29.5' 24» 10YR 5/8 30.0' °�� 29 ELOCATE/EDMOVE �� L-��--� WEST HYANNISPORT, MA OF MgS3 S [Oiti�1 Z� DANIELsy�yGN �� DANIELA.9cy�m PREPARED FOR o p OJ BORTOLOTTI CONSTRUCTION PERC � OJALA � CIVIL No,40980 �No.46502� Ms MS e ��s o' ,�� `� MARY CONATHAN SSA y XLss o DATE: OCTOBER 20, 2021 2.5Y 7/4 2.5Y 7/4 �fs DAANIEL vD �D DANIE I� OJALA `� CIVIL � off 508-362-4541 No,40980 No. 46502 fax 508-362-9880 Op ss�° p�D�c �� ., I downcope.com 132 21.0' 120» 22.0' down cape enginerfng inc. NO GROUNDWATER ENCOUNTERED Scale: 1 20' ?F � .._z', civil land surveyorsgiengineers EA W 939 Main Street ( R to 6A) LICE #21 - 1 , J 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 i 21-119 BORTOLOTTI-CONATHAN SITE & SEPTIC.DWG i