Loading...
HomeMy WebLinkAbout0006 FRESH HOLES ROAD - Health 6—8 Fresh Holes Road ' 'Hyannis A = 292 187 Lot 4 i a t i 0 0 0 q . ° I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c 6&8 Fresh Holes Road Property Address t f Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis ✓ MA 02601 03/31/2021 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. Imng outf rms A. Inspector Information cSl p �5311 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 rQ Company Address Teaticket Ma. 02536 Cityrrown 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 03-31-2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the.buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c� Commonwealth of Massachusetts - Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is Hyannis MA 02601 03/31/2021 required for every y 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. Comments: This 4 bedroom home has an H-10 1500 gallon septic tank with a D-Box feeding (3) 500 gallon leaching chambers with stone. 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form `j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. City(rown 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: tsinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is Hyannis MA 02601 03/31/2021 required for every y page. CityrTown 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 Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison & Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. City/Town 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 1/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 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison & Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 - page. Citylrown 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. ® ❑ 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 �Ue Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 &8 Fresh Holes Road Property Address Richard Murphy and Alison & Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms,(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: Number of current residents: 7 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 2020-77,792 gallons were used and in 2019 - 72,556 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate 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 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. 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 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 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 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: 11/28/2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 32'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 came freely. t5insp.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 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is Hyannis MA 02601 03/31/2021 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I 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 gallon Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 10" 5"Distance from top of scum to top of outlet tee or baffle 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. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. Citylrown 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 j 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): i 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 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison & Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. Citylrown 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. t5insp.doc-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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 6&8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 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* 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: I ❑ leaching pits number: ® leaching chambers number: (3) 500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: El leaching fields number, dimensions: ❑ overflow cesspool _ number: ❑ innovative/alternative system Type/name of technology: 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6&8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is Hyannis MA 02601 03/31/2021 required for every y 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 no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 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.): I I i l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 1 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 &8 Fresh Holes Road Property Address , Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is Hyannis MA 02601 03/31/2021 required for every Zip Code Date of Inspection page. Cityrrown State 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 ,essing As-Built Cards https://townofbamstable.us/Departments/Assessing/Property_Valu... TOWN OF BARNSTABLE man-ON r4 6 SEWAGE B oZdO/ 7 09 VILLAGE YA MV/ ASSESSOR'S MAP&LOT a 1`I 1^ INSTALLER'S NAME&PHONE NO.AA CAI 6 -St SEPTIC TANK CAPACITY ! S O O 6�4 LEACHING FACU-I Y:(type 3 0o C�i—sets (,iu) NO.OF BEDROOMS--Y— BUnDER OR OWNER 6'4 E Si 6!/6.vS PM MITDATE: // (3 C/ COMPLIANCE DATE: I J a yo: Sepuation Distance Between the: Maximum Adjusted GroundwaterTable to the Bottom of teaching Facility Feet Private Water Supply Well and Leeching Facility(If any wells exist on site of within 200 feet of leaching facility) Feet Edge of Welland and Leaching Facility(B any wetlands exist . within 300 feet of leaching facility) Feet Furnished by i .371, PD � � 3-3 s- 3 / 8Q � / Soo 64ff e2 up `Q 3 � BLL oZO . • o r t �A,rK qvµ 0 Fray- I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6& 8 Fresh Holes Road Property Address Richard Murphy and Alison &Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 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: 12 plus feetfeet 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 & 8 Fresh Holes Road Property Address Richard Murphy and Alison & Gera Kennery Owner Owner's Name information is required for every Hyannis MA 02601 03/31/2021 page. City(rown 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 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System,drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 YOU WISH TO OPEN A BUSINESS? FoP Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. ' Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE::Q/lb ��° Fill in please: r.' APPLICANT'S_ YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number 4 0 NAME OF CORPORATION: e (f a O NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO � ADDRESS OF BUSINESS !� D C' ` G�,a-;Jl MAP/PARCEL NUMBER /�S �-- (Assesslng) When starting a new business there are several things you must do In order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.Information you may need. You MUST GO TO 200'Main St. -[cprner•of Yarmouth Rd. & Main Street) .to make sure you have the appropriate permits and licenses required to legally operate your business..in,this town. 1. BUILDING COM ISSI NER'S O IC This indlvldu I e " fo e o ny permit r qulrements that pertain to this type of buslKS T COMPLY WITH HOME OCCUPATION AND REGULATIONS. FAILURE TO A ho ' d Sig r ** COMPLY MAY RESULT IN FINES. ' OMMEN I i C .2. BOARD F ALTH Q u,i rrie(1 This Individual has,been Informed e It quirementa that pertain to this type of business, � • MUST MPLY WITH ALL Authorized Slgnatura * HAZARDOUS MATERIALS REGULATIONS. COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] This Individual has been Informed of.the licensing requirements that pertain to this type of business. Authorized Slgnatura** COMMENTS: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM a NAME OF'BUSINESS: Pf czd�d BUSINESS LOCATION: $ '�� ,;�f0��-� ,Q� INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: IS-0,9 a � qO ' CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: vj O MSDS ON SITE? TYPE OF BUSINESS: ra-PCa yid aSo�yS� INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS , The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas O,ve Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please,list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature. Staff's Initials �� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) r Fad, T.. •-�,! ,� ,•, DATE: Q I cJ Fill in pleas �,y, ���.1P;Y1� ��.44„ 'x' ' APPLICANT'S YOUR NAME%S: i )►') S Ong n�C2ZctS l '�' `� F f BUSINESS YOUR HOME ADDRESS: -,1r1 O •u n f ,�� NE a{a�I.w. iN'([i'��� �� fill.I�r'✓,` )3f�ifn' TELEPHONE # Home Telephone Number e::7 O p 4unmu.Wwt'9'r7.4(�YJ�i� NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS ( - IS THIS A HOME OCCUPATIOW YES NO // a 9�- ADDRESS OF BUSINESS c� MAP/PARCEL NUMBER / (Assessing] ct/r�n' When starting a new business there are several th�gs you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Ind. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has n informed e per it equirements that pertain to this type of business. uthorized Signature** MUST COMPLY WITH ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: TOWN OF BARNSTABLE Date: F/ /;7 /s OXIC AND HAZARDOUS MATERIALS REGISTRATION,FORM NAME OF BUSINESS: VI� � �/ BUSINESS LOCATION: ` / INVENTORY 1 MAILING ADDRESS: p �/�,y �. �J TOTAL AMOUNT- TELEPHONE NUMBER: . ./—p Q ?g� 4� CJO CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: _��g �o ��5��— MSDS ON SITE? TYPE OF BUSINESS: la,&- INFORMATION // RECOMMENDATIONS: Fire District: Zi��r_e� meice/ Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, - Paint&varnish removers, deglossers - hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry Soil'&stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash "t /i►? (] n �Iantr's,:S:gnature �WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Staffs Initials Y\ !I YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. / DATE: �� 7 / Fill in please: Lion LiG7r-aj f APPLICANT'S YOUR NAME S pC�CJC�d '�'" I / BUSINESS YOUR HOME ADDRESS: Z C AW // j5m TELEPHONE # Home Telephone Number O CJC7 NAME OF.CORPORATION: Gz�/ /,4 NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPAT ON? YE NO q c ADDRESS OF BUSINESS CYe� h/O/� AZ Lrt//2 MAP/PARCEL NUMBER / /D (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO R'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individ I ha e inform d f ny er r quireme� its that pertain to this type of business. RULPS AND REGULATIONS. FAILURE TO LT IN FINES. ut oriz Si nature** CONIPI.Y MAY RESU OMMENT 2. BOARD OF H ALTH This individual has been informed of the pe rem is at in to this type of business. MUST COMPLY WITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: )/ bs / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �c%��/ z- " / j',/��] BUSINESS LOCATION: % Gt i INVENTORY MAILING ADDRESS: �'eze.—> h Ilale Rd TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: (e ��c� ! MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) #,H�draulic fluid (including brake fluid) Refrigerants or Oils Pesticides ❑ N� ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with."poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1�FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: L Fill in please: APPLICANT'S YOUR NAME/S: r SC Ilk o r %� BUSINESS YOUR HOME ADDRE S: y ---r u� •���r�rcy -��:�; �� � eS o s Gz. d I-�-< <-I . h- In irl i NINO " TELEPHONE # Home Telephone Number 7� c-, & ; 6-, NAME OF CORPORATION: NAME OF NEW BUSINESS ti�� 1' . 422 V-)-L,Y'S TYPE OF BUSINESS G eS, tAu"h-- IS THIS A HOME OCCUPATION? YES NOS_ ADDRESS OF BUSINESS s MAP/PARCEL NUMBER o� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate our usiness in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: C2) BOARD OF HEALTH This individual has been i armed of the per"requir ents that pertain to this type of business. MUST COMPLY WITH ALL ..A h ized Signature** KAIARDOUS MATERIALS REGULPJ'^ COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: /0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY_ NAME OF BUSINESS: PCWOL i s _,, BUSINESS LOCATION: �a F r fbK k-h\-e "U a tJQ"t S MCL- 091601 INVENTORY MAILING ADDRESS: 5a' TOTAL AMOUNT: TELEPHONE NUMBER: �8. CONTACT PERSON: (VC- < ,OCLOL �uU /4 94Z.• I EMERGENCY CONTACT TELEPHONE NUMBER MSDS ON SITE? TYPE OF BUSINESS:cAeo Qwg INFOR ATION/RECOMMENDATIONS: Fire District: 5 r` � Waste Transportation:. Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 3T, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes . Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers -- : - (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS • /I Hazardous aerials Inventory Sheet Checklist ate hysical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to . / clean brushes all count as hazardous materials-no blanks) r/ Storage Information - location of storage, how long is storage for? If none, note that. . Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and ti explain it Attach the Business Certificate with your sign off and comments �ventory form should explain what the business consists of and the procedures ping. Notes need.to be left to explain what you discussed with them. 7771 TOWN OF BARNSTABLE ��sS SEWAGE #02�61 oL Aid,✓S ^^ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. IZ 77 SEPTIC TANK CAPACITY S� c c� 6 i! /110 LEACHING FACILITY: (type 3 SOS c�� l�2S (size) 3-3 X !.3 . NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: I a v Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by W Q� c o� Q r\ � � f 9 �' yyL No,o;' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatton for Mi5pooal *pMem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( Abandon El Complete System ❑Individual Components Location Add or Logy Nq., / ^ /j i/y A N Owner's 9 Address and Tel.41 A A-� /7 /1 RS /,/© ,es 5 .�T t Assessor's MIV ap 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. D".92 R g mot/ 01-r 2 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A/ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow e;125_ - �? gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S s o e 9 ­8 2-S" 1 ! Description of Soil, 3IS A / Nature of Repairs or Alterations(Answer when applicable) /J� S 7- 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 issued by this Board of Health. Sign Date/v Application Approved by Date Application Disapproved for the following reasons Permit No. �� Date Issued - niW:..v.+U-.�E:.i�-.r�...•1 ,w+•."'�+:,:�-•-,};.iyi:,.it;r .a�[ny+,gs,.+'i...•b1e..•.�:.vxrs-K�.. .i.- ,�' w•...�'- _ -.-'-�•"'.. __ No.09 010! �l/ = " j K Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Kes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS' ZIppYication for Migogat �bpgtem Congtruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( Abandon 0 Complete System ❑Individual Components Location Adddss or Loj No. / n� /y A N �S Owner's Name,Address and Tel.No. �F /!6s/1 yvES „ /� (1� �5 ST� lir_ �S ` Assessor's Map/, 1� / � • Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. - D�11 st� �✓ ��'y s 2 A r 3C ;L Type of Building: t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other' Type ofBuilding No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e7z y y gallons per day. Calculated daily flow yS 5 . `7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .S Type of S.A.S(3) s o v C,4 4 -4 •6 E 2 T Description of Soil 3 3._S ' X 131 9 1 Nature of Repairs or Alterations(Answer when applicable) /J 6 S 7 a O 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 issued by this Board of Health. Signed Date i Application Approved by r _ Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by 6e��ST at 4�� ya le-r has been constructed in agordance with the provisions of Title 5 and the for Disposal System Construction Pern i dated Installer /q 2 e-�' �v •-s % Designer /7.t 4 G �✓ /Y/��'E 2 The issuance of thi ermit shall not be construed as a guarantee that the sys will f nction a esrg ed. Date 28 30b I Inspector (iU�tV �^' - — — No.rC F!/A �L/� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &gozal *potem Construction Permit Permission is hereby granted to Constru!,c�( )Repair( )Upgrade'( Abandon( ) L System located at 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 of4ts rmit. Date: // `� ���`� �/ Approved�b � d F r� b El ya�1 4 4 A2 1 ay.°.�.O:q'0::-a..ce,,,•r.4.•t �y .a,.... ,. =a .u, v• a _ - . - C+^.:" �'^:7-" ° i�'v 'S Sf4t h�RV .C�:.ia,: 'T h elm' 7. T ♦� *•� 1.9L ti - ,i,�sv.�ti.-s •1 y °'y ""'�..x ,y 'a ,tom - �r Y .�a its•- V. .7/'4y"'�5� � ';I- }"ri�y�'. Xs .... *lY° . 1 �a � 3*G� � a- } r F. .+•s _'tea^�yt>x'" LOCATION RST. SEWAGE #c2�61 h7 a:y is a VII LAGS `:,; s ' ASSESSOR'S'MAP.& LOT A°I INSTALLER'S'NAME&PHONE NO. 2 Yi` S SEPTIC TANK LEACHING FACII,ITy:,(type�3 .fOb �/14>++ 6t 25. ..(size) 33 NO.OF BEDROOMS --- -- BUILDER OR OWNER G2 141 S7,e uj'.ais x ; P. C ERMTT DATE f/ !•3 O/ OMPLIANCE DATE: Separation Distance.Between the: " Maximum Adjusted•Groundwater Table to the Bottom of Leachmg.Facility Feet:, ' Private Water Supply Well and Leaching Facility (lf any wells'ezist on site or within;200 feet of leaching facility) _ Edge of Wetland and Leaching Facility(If any wetlands east ;„ ,.*. within 300'feet of leaching facility) Feet Furnished by 4 t , .f i .,� !t , r t:- :• x r' t.�c j r� -tt ' •�.. S ''L 3= ' _ r t rl 4 �. F.;,� T S•t.t'.i•r y S� St�, :td..V} L k 1 t• 1 i- i .��s�' Y - i... • -y � 1 S -� t 4..y iL' i s - o-.: d. j3 7 G �Al COMMONWEALTH OF MASSACHUSETTS ✓ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r r I d 1F7 . .,e TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 FAILED INSPECTION Owner's Name: GREG STEVENS Owner's Address: 37 GREENVIEW,WEST BRANCH,IOWA,02358 Date of Inspection: 7/30/01 Name of Inspector: (please print) JOHN GRACI RECEIVED Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 A(JG'� 7 2001 TOWN OF BARNST CERTIFICATION STATEMENT HEq�TH°EPTae�E 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 4 _ Passes _ Conditionally Passes _ Needs Furt valuation by the Local Approving Authority X Fails Inspector's Signature: Date: 7/30/01 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the;buyer, if applicable,and the approving authority. Notes and Comments j THE SYSTEM FAILS TITLE V INSPECTION.THE CESSPOOL IS FULL LIQUID IS OVER THE PIPES. THE SYSTEM 1S IN HYDRAULIC FAILURE. ****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. Titlo 5 IncnPrtinn Fnrm rill S/1000-1t; 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS, MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM FAILS TITLE V INSPECTION.THE CESSPOOL 1S FULL LIQUID IS OVER THE PIPES.THE SYSTEM IS IN HYDRAULIC FAILURE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or ,ppair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)'in°the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break ouf or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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 Boa'r'ii of Health): _broken pipe(s)are replaced _obstruction is'removed ND explain: n/a " Page 3 of 1 1 i OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS, MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment: 1. System will pass unless Board.of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 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 n/a "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM Il' SPECTION FORM PART A CERTIFICATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS i. Date of Inspection: 7/30/01 D. System Failure Criteria applicable to all systems: y You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool br privy is,less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that nwother failure criteria are triggered. A copy of the analysis must be attached to this form.I' X _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails:The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nifrogen sensitive area(Interim Wellhead Protection Area—I W PA)or a mapped Zone II of a public water siipply welt If you have answered"yes"to'any question in Section E the system is considered a significant threat,or answered " es" in Section D above the Inr e s sleiii has'foiled. The owner or operator of any large s Stem considered n si nificnnl threat Y � � Y� p Y E� Y� 6 under Section E or failed under Section D�shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. n .. Page 5 of I I 1 V, • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6/8 FRESH HOLES.ROAD HYANNIS, MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 Check if the following have been done.You must indicate "yes"or"no"as to each of the following: Yes No X _ Pumping information was provided.by the owner,occupant,or Board of Health D X Were any of the system components pumped out in the previous two weeks`? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? r X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field('f any of'thei failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] ^tL Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 FLOW,CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 8 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CM 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or h6.): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a i.GENERAL INFORMATION Pumping Records s�z Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption"system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 30 YEARS, IS YEARS ON I)I(LCAS'1' Were sewage odors detected when.arriving at the site(yes or no): NO 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 BUILDING SEWER(locate on site plan) Depth below grade: 16" Materials of construction:_cast iron =40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X locate on site Ian ( plan) Depth below grade: 12" Material of construction: Xconcre(e_metal,`fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 6' X 8' BLOCK CESSPOOL" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN CESSPOOL AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND.THE SYSTEM IS IN HYDRAULIC FAILURE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlei and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage','etc n/aa ( Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a e Page 9 of t 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: 0 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: nla n/a leaching fields, number: n/a 6' X 8' BLOCK CESSPOOL overflow cesspool, number: 2 n/a !j•; innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs ofhydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): OLDER OVERFLOW CESSPOOL IS 6 X 8 PIT. NEWER OVERFLOW PIT IS PRECAST 6X6 PIT. LIQUID IS OVER THE PIPE AND SYSTEM IS IN HYDRAULIC FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a t Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS,MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ` f C A � a � t A4 3� 1� 6C 17 in Page I 1 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6/8 FRESH HOLES ROAD HYANNIS, MA 02601 Owner: GREG STEVENS Date of Inspection: 7/30/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database--explain: n/a . r You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET i II - L- COXIMO\`"TALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS PC DEPARTMENT OF ENVIRONMENTAL PROTECTION O\E RI\TER STREET, BOSTOK DL9 0210E (617) 292-5500 TRUDY CORE Secretan ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Propertyaddress: 6/8 Fresh Holes Rd.. NameofOwner Jeffre Weiner H n3s, MA AddressofOwner_p,0 , BOX 9, FerPstd.ale , MA Date of Inspection: Name of Inspector:(Please Print) Q. E . R ob ins on 1 am a DEP ap oved systgrn inspector pursugnt to Section 15.340 of Title 5(310 CMR 15.000) C,mpa„yN�: WMT. Robinson Septic Service Mailing Address: P.O . Box 1089, Centerville , MA Telephone Number: �r7 K_R 7(, 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: asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails 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 thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS s 1p A ROMEO 2 1999 TO���� revised 9/2/98 page lortt +.6 Pnrted on Recycled Paper I ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ~ , PART A j CERTIFICATION (continued) 'ropertyAddress: 6/8 Fresh Holes Rd. , Hyannis , MA Jwne►: Jeffrey Weiner Date of Inspection: J--3—p J INSPECTION SUMMARY: Check 0 B, C, or D: A. SYSTEM PASSES: (/YS I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTE CONDITIONALLY PASSES: One r more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon com etion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, n , or not determined(Y, N, or NO). 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 complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced 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 I I 4 h 40� � u I a revised 9/2/98 Page 2of11 . I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:6/8 Fresh Holes Rd.. , Hyannis , NIA owner: Jeffrey Weiner Date of Inspection: 3-3-F It C. RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. i t 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS.is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) THER • I revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ° PART A CERTIFICATION Icorronued► Property Address: 6/8 Fresh Holes Rd. , Hyannis , MA °""1er` Jeffrey Weiner Date of Inspecbon: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No 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. E. RGE SYSTEM FAILS: You ust indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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 ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office o the De artment for further information. I I • revised 9/2/98 Page 4ortt I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address: 6/8 Fresh Holes Rd.. , "Hyannis , MA Owner: Jeffrey Weiner Date of Inspection: 3..3_9 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 septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, 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)] _ The facility owner(and occupants,if different from owner) were provided with information on the proper maintanan".0f SubSurface Disposal Systems. revised 9/2/98 Pagc5ofII ' a ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION hopertyAddress: 6/8 Fresh Holes Rd.. , Hyannis , MA Owner: Jeffre ner t . Date of Inspection: 3- FLOW CONDITIONS RESIDENTIAL: Design flow: cr_6 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms (actual): Total DESIGN flow4l S Number of current residents:AZIA Garbage grinder(yes or no):-Z d Laundry(separate system) (yes or no)/I,n; If yes, separate.inspection required Laundry system inspected (yes or no) Seasonal use(yes.or no): .,0 #6 1998 45, 700 gal. Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no):A 40 r gal. Last date of occupancy: #8 1998 55, 500 gal 1997 51 , 750 gal. COM ERCIAL/INDUSTRIAL: Type o stablishment: Design fl w: grid ( Based on 15.203) Basis of esign flow ` Grease t ap present: (yes or no)_ Industri Waste Holding Tank present: (yes or"no)_ Non-sa itary waste discharged to the Title 5 system:(yes or no)_ Water eter readings, if available:. Last to of occupancy: OTHE :(Describe) Last a of occupancy: GENERAL INFORMATION PUMPING RECORD andrrce of information: JJ System pumped as part of inspection: (yes or no)Sl)YS If yes, volume pumped: 16 co—t) gallons Reason for pumping: C O TYPE OF SYSTEM Septic tank/distribution box/soil absorption system gle cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: - 8 S % ' s o Jv Sewage odors detected when arriving at the site: (yes or no)L revised 9/2/95 Page 6(if II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropertyA res : 6/8 Fresh Holes Rd.. , Hyannis , MA Owe: tef frey Weiner Date of Inspection: -3—� BU ING SEWER: (Coca on site plan) Depth Blow grade:_ Materia of construction:_cast iron_40 PVC_other(explain) Distanc from private water supply well or suction line Diamet r Comm ts: ondition of joints, venting, evidence of leakage,-etc.) SEPT TANK:_ (locate site plan) Depth bel w grade:_ Material o construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is etal,list age_ Wage confirmed by Certificate of Compliance_(Yes/No) Dimension Sludge de the Distance f om top of sludge to bottom of outlet tee or.baffle: Scum thic ness: Distance f om top of scum to top of outlet tee or baffle: Distance om bottom of scum to bottom of outlet tee or baffle: How dim nsions were determined: Comm ts: (recom ndation 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 b ow grade:_ Materiel construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimension Scum thick ess: Distance fr m top of scum to top of outlet tee or baffle: Distance f om bottom of scum to bottom of outlet tee or baffle: Date of I t pumping: Comm ts: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid ce of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropertyAddress: 6/8 Fresh Holes Rd. , Hyannis', Ia Owrw: Jeffrey Weiner Date of Inspection: ,3-3-QS TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loca a on site plan) Depth elow grade:_ Materia of construction: _concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensi ns: Capacity gallons Design ow: gallons/day Alarm p esent Alarm I vel: Alarm in working order: Yes_ No_ Date of previous pumping:. Comm nts: (condi ion of inlet tee, condition of alarm and float switches, etc.) DISTR UTION BOX:_ (locate site plan) Depth of I quid level above outlet invert: Comments (note if lev I and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) - PUMP CH MBER:_ (locate o site plan) Pumps in orking order: (Yes or No) Alarms in orking order(Yes or No) Comments: (note condi on of pump chamber, condition of pumps and appurtenances, etc.) ' revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'rop"Address: 6/8 Fresh Holes Rd./, Hyannis , MA Owner: Jeffrey Weiner Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, 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 hydrauli$,4ilure, level of ponding, damp soil, condition of vegetation,/etc.)_ l—��6 f3 C:Es l �R rG GS � �...�� �'� o GPI �o)► Gam/ 'd' � ��S ) s CESSPOOLS:_ (locate on site plan) Number and configuration: — Depth-top of liquid to inlet invert: l'' Depth of solids layer: )epth of scum layer: Dimensions of cesspool: ,y Materials of construction: AS l� n S Indication of groundwater: ;li p inflow (cesspool must be pumped as part of inspection) Vk C3 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation c.l PRI _ (locat on site plan) Meter' Is of construction: Dimensions: Dept of solids: Com ents: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) f revised 9/2/98 Page 9ofII - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Nop"Address: 6/8 Fresh Holes Rd.. , Hyannis , -MA t Jwrw: P Aeffre Weiner f Jate of Ins on: SKETCH OF SEWAGE DISPOSAL SYSTEM: +include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100"' (Locate where puolic water supply comes into house) �s '7 I 3 i revised. 9/2/98 Page 10ofII i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ropertyAddress: 6/8 Fresh Holes Rd.. , Hyannis , MA Owner: Jeffrey Weiner Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells x Estimated Depth to Groundwater�Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page 11of11 o s� U ,.N M _ a , W M n ca N \ Cn 3 W W Z 44 W W � W t Z N V Z z ; Z O 4 . \s� o� Z IL �r v v1 Cl .......... FRic......5...7 ..................... THE COMMONWEALTH OF MA5SACHUSETTS BOARD/q�.� EA L�T H� ...........................................OF.......................................................................................... Appliration for Di ipaoul Morks Ton'idrurtiVit. rvrutit Application is hereby made for a Permit to Construct"( ) or Repait­<) an Individual Sewage Disposal System at: ................ . ....... .................................................. ............. ................................... ...... ----------------- L catio 0159-1 ........... ....... ...................................................... oaf e .............n........ ./...Lot .W...No... ........ ............. ...... .......... ^... caner Addres _ V ............. ...... .... ............ �_l Installer Address 9Q Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons__.._..__.._._.__.____._._.. Showers Cafeteria ( ) Other fixtures ------------------------------ - Design Flow________________________ __________________gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid'capacity............gallons Length................ Width._.....____.___. Diameter-_.--________-__ Depth__._-____._..... Disposal Trench—No_.................... Width____...._..__.._.___ Total Length_________..._.___._. Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter_..._......._.-_.... Depth below inlet__._._._____.._..__. Total leaching area..................sq. f t. z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date____________.__.________.._____.____._.. Test Pit No.-I________________minutes per inch Depth of Test Pit_.__..._._.__..___._ Depth to ground water........_...._._..._._.. Test Pit No. 2................ nutes per inch Depth of Test Pit...._...____________ Depth to ground water...._.__._..__.___.._._. --- ------------------ .... -v---------- --------------------------------- ---------------U------------ De ritioof Soil_____________ ................. ...... ............. ................................ ------- ------- ------------ --- . ................. ........................................................................... U .. ... .......................................................................................................... ............................................................................................................................. ... ....... ... . . ........ - -------------- U NaMtf Repair or Alterations—*A&LsAver wh9n applicabl ---- -------- ------------ ------ t q;? , - ----------- ...........................6.Z. / 41(_� .&.................................. .T ............ Xt-t ...................a............................... Agreement: . 10 The undersigned agrees to install the afo described Individual Sewage Disposal System in accordance with the provisions'of TL 1ITLE 5 of the State Sanita Code— The tind�Aig�ned furthf.agrees not to place the system in • operation until a Certificate of Compliance has n issue by the oar of healtA. . ......... ... ...... ...... ............................................. --- ....... Date L To 1\ 2............... nutes per... ................ _of Soil..... . . ........... ..... ............. Application Approved By......... .. ... ...... .. ... ... .... .... .. ...... Date Application Disapproved for the fo,to ng reasons:............................................................................................................... .......................:.................................................................................................................................................................................. Date Permit No............................... Issued_....................................................... ................... Date N .V.. .. /J .... Fes$ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA TH Appliration for UhipasFal Works Ton,strurtion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ><) an Individual Sewage Disposal System at: .-fl.Ge(� ...--• ......... ......--•---••• •••..•--•-• •.....-- ;........�................. j o Locatio -�ldd AA ................y .............. ........ ....... /(.....,.�------ •-•----•-- --............. R �yOT-LOt•NO.... �_ 1.......... W fw�etLA'l O //++ /' n Addresses ---•..........................................................^__.._. - . . ......... ......_---••-•-•-••------- ............................ ......................... Installer Address Y Type of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( )--- Cafeteria ( ) Otherfixtures ...................•----•-----•---•--..........----......---•--•--•---------•---•---...._.....---•-•------•-•••---•- ------•--- 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 ( ) aPercolation Test Results Performed by.......................................................................... Date......................................... ..l Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.___._____._-._---_.__. fi Test PiLT ynutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --•---- --. ..-- ODescri do --------•----�--------------------------•---------•. U •-- •... .....--•••••••-••-----• ---------------------•------------------------------•-------------------------------•---------------•---------------•------••••••••. V Nat e of Repair or Alterations—' er wh ap licabl _ .... ................................ ............._._.__.........__. . . ...... ....... ............ ------ - --- ---------- ------------------ Agreement The undersigned agrees to install the afo described Individual Sewage Disposal System in accordance with the provisions of A.i:' p 5 of the State Sanita Code— The and igned furtl er agrees not to place the system in operation until a Certificate of Compliance ha n issue4 by th oa of heal .. ... Date Application Approved By...... .r.. f Date Application Disapproved for the f o,1zaring reasons: -----•-------------------------•----------------------------••---•---------.--_.. ................•••_........•-•-••-•--•_....••-•---••••--•--••-----••--••-------•-•-•-------••-•••-•-•-•.---•-•-•-••--•-••-••••-----••••------•••-------•-••-•--••--•---•••----•--•--•-----••----------- f Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT ....... ............O F........ ..........W Trrfif iratr of TontpliFana T S 1 O C FY, That the Individual Sewage Disposal System constructed ( ) or Repaired at- c Install ± ala1 � 6 i..I -.;, .. ---•-----------------_----•- has'been installed in accordance with the provisions of T 5 of The State Sanitary Code as descri ed in the application for Disposal Works Construction Permit No ..__..rz-_�S"� _.___..._._. dated._... '.+. . .-__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS I BOARD O HEALTH. . -, .............. .........OF...------... . ... .. _..f ......... ..................._-. .......... N ..2.!!�rL� FEE....1/-J•.----- Disposal o o rnr ion rrmii Permissionis hereVante -• --- -- L ---------•------------------------------------------••-------•--•----........ to Construct ( ) orr ( n I di i�iu Sewag Disposal at No... 0` G�II',,. ....t •-••ICI StreEt�...-•;-••--•-•.. ......................... /..... as shown on the application for Disposal Works Construction P t No. !__ ated......� ._._.t . .. _ .- -•.------ 7 r1� Board"of Health �.. DATE...- .... (/.._.. .....--•--•------------------•••-••-._..... FORA 1255 HOBBS & WARREN. INC.. PUBLISHERS - 1 ASSESSORS MAP : TEST HOLE LOGS NOTES: Fs 'b PARCEL: 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH . S/1� FLOOD ZONE: C SOIL EVALUATOR : )��;. 1 THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF T WITNESS : ke43 T '� ��5 � � prQLE BOARD OF HEALTH REGULATIONS. REFERENCE:N'{� DATE: a4rKE•.0- 6Ct 1 ,_ 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, o PERCOLATION RATE 4- 1, " 9l SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO eI,w Sm, L`V4- 0.7V a. INSTALLATION. n TH- I �L,S � TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION -- ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE W�M'O DETERMINATION. f r y Sd 4T'• 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS � � SArJC� SPECIFIED OTHERWISE) rr �oy�-S1� LOCATION MAP � � 4775 �I �.- 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A MEiyUM �j GARBAGE DISPOSAL. C, (0��6�� 46,Zs p d� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) O TT fl MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON C0� EU _ A BASE OF 6"OF CRUSHED STONE. �v Z,5y 7/y 7. a !S7 ram6css__.. Poo1.S ._ ._ _._PuMt� �D w2trU�?DW � 8 t:-:CiSTIw 5HE-0 To 1w aLoo . S E P l C SYSTEM DESIGN �).1�p� owl PQ!� .w�~u s w/,a /sb FLOW ESTIMATE /0, Alo F vl!►_T?Z / O,±Z 8fh2�5T19 •�BEDR)OMS AT I10 GAL/DAY/BEDROOM -446 GAL/DAY SEPTIC TANK 40GAL/DAY x 2 DAYS - ?90 GAL / USE I SGD GALLON SEPT I C TANK..)J�oj 1 SOIL AB!ORPTION SYSTEM o S I )E AREA:E33,,5) 7- t/3)2-, '7-- x 0. 71: - 137, 61 ���_� BO I TOM ARC A: 33-$ X 3 0 74 - Z2. 7 6S r'N� '` SEPT I C : SYSTEM SECTION > 4,f 0po 1'egW �' S2 ° /10 BENCHMA�2.IC.. I '1 $ r I 1Z S1 xS a �r �ov�s 4 w ter GL. �r�,za' n q q I M � 0 j° 14 (a at P�t 'C �6"MR tZ a 3,S ,.._ ✓ tom, X E1 - ,7S / Da �rc1s ,Sm '�. • • / ` �'� °e• (o"S�'�e HST u� to rr. 1►t /. �j w GAL 4-9.Z Est �$r d7 z1 z� l ti s aC It T�u L 12 rr2" . S I' SEPTIC TANK Grtc r r.75 a �c3 EX15' `A,l OV,07ZF5a xo W677E Jul 1GOIlNG)9170w S tJ//A/ � v � � a Zo aF Pr�� L€r1U�tAY , ® SITE AND SEWAGE PLAN } DA LOCATION ,: YERla S � � otgs � a fi� #1140 Yi9'/uN�s L' PREPARED FOR rLVE1V dub (_ 01 /{7 O ® RRUMBAo/tIS7"�2yC-170N rr / r DARREN M. MEYER, R.S. SCALE / - l 43 VINE STREET DATE• / Z D Z r-3- DUXBURY, MA 02332 W DATE HEALTH AGENT (781) 585-0293 W