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0031 GENERAL PATTON DRIVE - Health
31 G'enera'l Patton Drive Hyanr�st P' ; - - -A =;2k ,115 1 h M a n I p c I' F . p o o r � a o , o Q t 1( 4Y� TOWN OF BARNSTABLE LOCATION 3 r �� £'�/�L- � ��a SEWAGE# VII LAG �� Y ASSESSOAR'S MAP&LOT R'S NAME&PHONE NO. /� N- C G SEPTIC TANK CAPACITY —S'Z 0071 c— //y�S��G"/�a r✓ LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: C6*ff%bh!WE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) . Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A6 CAn C.0 �^ � r '-, �`- coo �' a' -� vA vl .� qy. -� �c- , �a-rrd. ,�- :`�-�_�_ . � .. r {a�. �� TOWN OF BARNSTABLE LOCATION CAGrA I /a lI 4n SEWAGE # f VILLAGE HVA IRIS ASSESSOR'S MAP & LOT��a"��J -r. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) a�X 10 X NO. OF BEDROOMS BUILDER OR OWNER �Q�G,�,L, ' PERMITDATE: COMPLIANCE DATE: 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 leachin�tllae) cility) ) Feet Furnished by T n C P-WA1 0)oZ 00`� W LA TOWN OF BARNSTABLE LOCATION 0AI, SEWAGE # VILLAGE L-, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � L SEPTIC TANK CAPACITY / O "y LEACHING FACILITY: (type) 3 — '''rS. S> Xize)as—/b —62 NO.OF BEDROOMS BUILDER OR OWNER C U T PERMTrDATE: 7 30— 4 Z COMPLIANCE DATE:X= 'G` 9 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells existZL 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 ,ti, �n1 .. �. .� ' � C � � � ' .. ur fl . s� `I �. I Commonwealth of Massachusetts o? �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments n 1 ,.V 31 General Patton Drive Property Address r j Uillian Dasilva Owner Owner's Name/ infiijrmaton is Hyannis �/ MA 02601 10/08/2020 '=required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 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 key. Company Name 52 Rivers'End Road F' Company Address Teaticket Ma 02536 . City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification :..,, I certify that: I am a DEP approved system inspector in full compliance with Section 15.346 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 ...V``'' 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 - 1.0708/2020 r Inspector's Signature Date u The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 :ram• - i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is Hyannis MA 02601 10/08/2020 required for every 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 3 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding 3 infiltrators with stone. At the time of the inspection no visible failure criteria was found. �M 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"n_o_t;_._ i 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): L - ' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 2 of 18 f r Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is reouired for every Hyannis MA 02601 10/08/2020 page. Citylrown 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 FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): rfQ01 ❑ 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): rG1r(I h` 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 I,,r: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is Hyannis MA 02601 10/08/2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water Supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or ='r 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 i•�V ❑ ® 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 �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is Hyannis MA 02601 10/08/2020 requireY d for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow El ® 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 preeence 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. ,y 5) Large Systems: To be considered a large system the system must serve a facility with,a FF 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 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. Cityrrown 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? rr- . ❑ ® 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 ® El 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)] i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. CityrTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): GPD lus Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No a If yes, discharges to: r` Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: ` There has been no water usage for the past two years :(tG" Sump pump? ❑ Yes Z No Last date of occupancy: apx 5 years agoDate 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 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. City/Town 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) i Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: :L : - 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva - Owner Owner's Name L-•! information is required for every Hyannis MA 02601 10/08/2020 - page. CitylTown 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: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): t = 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.): ' I x t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i Commonwealth of Massachusetts £.. Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page: Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): t ., Depth below grade: 24feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) ` If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1500 gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness Distance from top of scum to top of outlet tee or baffle 511 13 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on.the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain).- Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date R Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural infegrity liquid levels as related to outlet invert, evidence of leakage, etc.): 'A 8. ,Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Ab- Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 181 _ - Commonwealth of Massachusetts 'a : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 pile; Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) fiW 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.): 4 *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 01. �tn 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 U leakage or solids carryover. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •, 31 General Patton Drive Property Address ✓ Uillian Dasilva a' Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): ; ; r•:..r * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .•, 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) t, 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. -Fr,r • 12. Cesspools (cesspool must.be pumped as part of inspection) (locate on site plan): Number and configuration i Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool tE 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.): t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 t i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is Hyannis MA 02601 10/08/2020 requireY d for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): e - l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 115 of 18 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal-System Form - Not for Voluntary Assessments 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is H required for every annis _ MA 02601 10/08/2020 y page. City/Town- State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately B 0 0 0 0 A A B 1 15'4" 24'3" ` 2 1915" 29'1" t,a= 3 26'8" 3715" .t d t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �, 31 General Patton Drive Property Address Uillian Dasilva I Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus 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 to show 4 plus feet of seperation." i 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 :e Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;V 31 General Patton Drive Property Address Uillian Dasilva Owner Owner's Name information is required for every Hyannis MA 02601 10/08/2020 page. City/Town 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 FLOORPLAN Hbn Dr 14' Buildng Sketch Not to Scale / Living&om y 1 A 29' • y' Bath Second Floor Not to Scale Bedroom kA 14' Z' 27' S' Bedroo Bedroom O _ ® I Bath 29 33' '� I�, First Floor Living Room to Scale Kitchen N 4' 10' 17' 7 i No. 200(0 `U$ l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for �Diopozaf *p5tem Con.5trUCtion Vermtt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System E4Tndividual Components Location Address or Lot No. G Owner's Name,Address,and Tel.No. 077-R/ `J /P,s ads s �. Assessor's Map/parcel S /.f y —31 C bV E 1r- — ooA//o t.- ��s S o g• -�roo Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �So12 1 Type of Building: Dwelling No.of Bedrooms G US f Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi and of Health. Signed Date - Application Approved by Date 3 —(7 ,, Application Disapproved by:' Date for the following reasons Permit No. g-0o t --od3 Date Issued .No. �. DUO U$3 Fee 14 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZipplicAtion for �Digogal *_ p5tem Construction Permit Application-for a Permit to Construct( Repair(Upgrade( ) Abandon( ) ❑ Complete System Lgl dividual Components Location Address or Lot No. /? G f C 19 Mf J L. Owner's Name,Address,and Tel.No. P ,4�►S��vs s � Assessor'sMap/parcel - Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel No. Q C4NC o �a Type of Building: / Dwelling No.of Bedrooms /7 G y S IC Lot Size sq.ft. Garbage Grinder ( ) ! r Other Type of Building No.of Persons Showers YP g ( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd` Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) :r Date last inspected: y Agreement: The undersigned agre s'-,to ensure the construction and maintenance of the afore described on-'site sewage disposal system in accordance with the provisions of Title 5,of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this and of Health. Signed Date 3- Application Approved by ��-� 6e- Date 3 —C) Application Disapproved by:, Date for the following reasons Permit No. L GU.6 O 3 . Date Issued ? I ------ — — ------------------- J THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance i THIS IS TO CERTIFY,that theOn-sites Sewage Disposal System Constructed ( ) Repaired ( �' Upgraded at ( ) Abandoned( )by /9 e C� ( Al C O 3.j 0 jV,4/ ti S T 44�1 at G El(--F/ 4 4 AA�A-- .�iP. 41 S- has been constructed in accordance / with the p visions of Title 5 and the for Dis osal System Construction Permit No. ,) (jU f/�j dated � Installer "- Designer #bedrooms /\)/I Approved design flow Nl,� gpd The issuance of this permit shall not be construed as a guarantee that the system will unction as,designed. Date 7. �Gi �J� Inspector l - - -------------------------------------------- No. a�U 6 -U�3 Fee/Uy THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1igpo.5a1,6p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at / �'/(/ £�/'i .9 L ,�D�2 A, ip r r . and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this�rnr /iqDate In U ( Approved by ) n��� s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r iy1M eVov 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 / TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 292—PARC 115 Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner's Name: PARSONS,STEVE Owner's Address: 140 NOISY HOLE ROAD MASHPEE,MA 02649 Date of Inspection MARCH 1,2006 Name of Inspector:(please print) JAMES D.SEARS } Company Name: A&B Canco lit. Mailing Address: 350:Main Street •;; West Yarmouth,MA 02673 Telephone Number: 508-775-2800 Q 4y. CERTIFICATION STATEMENT " I certify that I have personally inspected the sewage disposal system at this address and that the inform tion reported below is true,accurate and complete as of the time of the inspection. The inspection was performed ba ed on my-r' training and experience in the proper function and maintenance of on site sewage disposal systems. I a a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: In . Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa.'js Inspector's Signature: Date: 3-1-06 61 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments .****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS,STEVE Date of Inspection: MARCH 1,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ , _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined" please 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 complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _ Observation of sewage 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, SIEVE Date of Inspection: MARCH 1, 2006 C. Further Evaluation is Required by the Board of Health:N/A 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 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 public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance ** This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 D. System Failure Criteria applicable to all systems: N/A 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 T 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 leaching is less than 6"below invert or available volume is less than%day flow �— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface'water supply or tributary to a surface water.supply ' N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (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: N/A To be considered a large system the system must service a facility with'a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply , the system is within 200.feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following i 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,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in.:the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): N/A (if yes separate inspection required] Laundry system inspected(yes or no): N/A 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: UNKNOWN COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: NO Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1997/PERAUT#97-390 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15.12000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 16" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 20" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500-GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 27" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL,TANK&COVERS AT 20"INLET TEE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): 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.,): D-BOX IS 16"X 16"—40"BELOW GRADE. BOX IS CLEAN&SOLID,ONE LINE IN -ONE LINE OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: —7— leaching chambers,number: 3 leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damn soil,condition of vegetation,etc.) LEACHING IS THREE(3)INFILTRATORS—25'X 10'X 2'. LEACHING IS 4'BELOW GRADE. LEACHING IS CLEAN&DRY. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionxlocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Tide 5 Inspection Fonn 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS, MA 02601 Owner: PARSONS, STEVE Date of Inspection: MARCH 1, 2006 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, r a 33 Title 5 Inspection Form 6/15'2000 10 I Page 11 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 GENERAL PATTERN DRIVE HYANNIS,MA 02601 Owner: PARSONS. STEVE Date of Inspection: MARCH 1, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 22.1 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation 7— Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS WELL DATA. WELL AIW 230 22.1. BOTTOM OF LEACHING AT 4'. Title 5 Inspection Form 6/15/2000 11 U9COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION iAAP �2 PARCEL ; 1 1 5 ..07 TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 31 General Patton Drive Hyannis;MA 02601 Owner's Name: Nathianel Ketchen Owner's Address: Date of Inspection: March 20, 2004 s o Name of Inspector: (Please Print) James M. Ford o Company Name: Jaynes M. Ford X2. Mailing Address: P.O. Box 49 ::0 Osterpille,MA 02655-0049 Telephone Number: (508)862-9400 0 > Z CERTIFICATION STATEMENT ca —+ I certify that I have personally inspected the sewage disposal system at this address and that the in rmatiorke portEd below is true, accurate and complete as of the time of the inspection. The inspection was perform based� my m training and experience in the proper function and maintenance of on site sewage disposal system . I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ` Fails Inspector's Signature: Date: March 28, 2004 The system inspector shall sub ' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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 obstruction is removed distribution box.is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 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 "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 ✓ 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 ''/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 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 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. [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.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ 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: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 i FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/1NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 814197-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 ' Page 7 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 General Patton Drive Hyannis, MA i Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 BW.DING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): i SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 I A Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 General Patton Drive Hyannis, M4 Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. There were no signs of backup or failure from the leach field PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 3 infiltrators-25'x 10' (per as built card) leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): There did not appear to be any signs offailure. CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 General Patton Drive Hyannis, MA Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 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. A 134(,k e i A B O a I �10 I C 3 a yy6 ay` o Y 3 yg 3O 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 General Patton Drive Hyannis, M4 Owner: Nathianel Ketchen Date of Inspection: March 20, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 17' +/- feet I Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately 17'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 No. Fee 5 0 -0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Digpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(x)o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 31 General Patton Dr Owner's Name,Address and Tel.No. 3 9 4—4 4 7 3 Assessor's Map/Parcel Hyannis, MA John Butler PO Box 616 S Dennis, MA02660 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. In E Robinson Sr Septic Sry PO Box 1089, Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 2/3 Lot Size sq. ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic repair consisting of 1500 gallon tank, D—Box and three stonepaekP8 ; nf; ltrntnrG 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 Environmentaf Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo e�lth. 0. Signed ZI/ I ,/`� Date ��c3 Application Approved by Date 23 3,Q- Application Disapproved for the MlowiYg reasons Permit No. 7 - Z-5 7eP Date Issued tG'+':` T >�_ ''t -'•-._ - �•--if'x __.tea..f°!'y�...:.:�t-,t�r�. .• `r-••.... 7.--•-..M"'v"+„,. .....+ . —.,�--••rTr`^.'� -.a-�ct.r�.�. e No. Fee — THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: < •� Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS M T, ` • 11ppfication for 33i5tlozat 6pgtem Cowariuction Permit Application for a Permit to Construct( )Repair(xx4 Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. 31 General Patton D Owner's Name,Address and Tel.No. 3 9 4—4 4 7 3 Hyannis; MA John Butler " ! PO Box 616 Assessor's Map/Parcel #, S Dennis, MA02660 Installer's Name,Address,and Tel.No. 7 7 5„877 6 Designer's Name,Address and Tel.No. =r PP E Robinson Sr Spptic SrVt O Box 1089, Centerville, MA -0.2632 - - Type of Building: ' Dwelling No.of Bedrooms. 2 3 Lot Size sq. ft. Garbage Grinder(n� Other Type of Building No?",gr&ns Showers( ) Cafeteria( ) ,Other Fixtures ! Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Re airs or Alterations(Answer when applicable) Title '5 Septic repair consisting { of 15(�0 gallon tank, D 'Boe and three stonepacked inffi'trators_ /r 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 Bgapdo ealth. Signed Zil. ► 1 Date 12`J �` Application Approved by Date `,7 �n- 9.2• Application Disapproved for the Mlow;qg reasons ,Permit No. 7 7 - 3 yU Date Issued —————————————————————I—————-———————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Butler Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired X Upgraded t ( ) Abandoned( )by at 31 General Patton Drive, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No: dated Installer "'M E Robinson Sr Septic SrV Designer The issuance of this permit shall not be construed as a guarantee that the system Nu ll func.t�as designed. ' Date `" ��- Cf Inspector No. 'a9,0Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Butler PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi.5po0ar *p5tem Con.5truction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 31 General Patton Brive Hyannis, MA Installer: Wm E Robinson Sr Septic Sry and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: ? - fir`? ? Approved by 1 , ' r NOTICE: This form is to be used for the repair of failed septic systems only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I,William E. Robinson, Sr.,hereby certify that the application for disposal works construction permit signed b me dated `✓ d` ��p gn y ,concerning the property located at 31 General Patton Dr,Hyannis, MA meets all of the following criteria: * There are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed,septic system. r. . * The obseved groundwater table is 14 feet or greater'below the bottom of the leaching facility. * There is no increase in flow and/or change in use proposed- * There are no variances requested or needed. SIGNED: l DATE C5'e. LICENSED SEPTIC SYSTEMINSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan,should be submitted). t TOWN OF BARNSTABLE37 Q LOCAMN e io n— 17/�. SEWAGE # / / " ''- // - VII,LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �6 i ti s o � 7 s� L SEPTIC TANK CAPACITY S o v , LEACHING FACILITY: (type) 3 r s` Jes ) i NO.OF.BEDROOMS�`3 BUII;DER OR OWNER 3 C,Z PERmrrDATE: 2-3a— i `7 COMPLIANCE DATES g Separation Distance Between the: Maxim"'U Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private:Water Supply Well and Leaching Facility (If any wells exist7 Feet j on'sire or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet withn300 feet of leaching facility) Furnished by LOCATION SEWAGE PER NO VIL'-LAGE 1 N.S T A L L E R'S NAME & ADDRESS J. CRAIG ME®EIR®S T6cking & BulldoZ,in 142 Corporation Street r � �#Te�nis,-.P+1aSS TL-082 OWNER L E PERMIT. ISSdEDE C-.O,MPLIA:NCE. . ISSUED � � � •� S R1 t. � w �. �:. OT S �' �, C 6-. � .� �� �, vd\ � �. '� . ' t . W { . ., <, �, y . .., _ No.rMY_L_ Finc........... ................ THE COMMONWEALTH OF MASSACHUSE-17S BOARD OF HEALTH ...........................................OF.......................................................................................... Appliratiou for Dwpogal- Morks Tomitrurtion Errant Application is hereby made for a Permit to Construct or Repair �an Individual Sewage Disposal System at: �13 .......................................... . ........................................ ...........5..................................... ...... Location-Address or Lot No. ........................................................................................w------ ...................... ......................................................................... Own / 'L Addr�s ...................... ...... Id f................... ....... ............ Installer Address 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. Septic Tank—Liquid'''c"apac'i't'y............gallons Length________________ Width...._.__.__._.._ Diameter..._:..._._._._. Depth................ Disposal Trench—No_ ____________________ Width_._....__.._._.._.._ Total Length___.__.__._-._.._.__ Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter.__...._.._...__.... Depth below inlet__._._..___..._.____ Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................................................ Date........................................ Test Pit No. I................minutesperinch Depth of Test Pit____________________ Depth to ground water......................... Test Pit No. 2.................minutes per inch Depth of Test Pit__-._..__.__._______ Depth to ground water........................ ................................................................................................................................ 0 Description of Soil........................._ ........................................................................................................................................ . ......................................*------------------------------------ -------- 74 ............... ........... ----------------................. -------------------------- -- ------------ ........................... ...................... ............A ---- --- U - ----- I Nat Repairs o Alterat ...C.Q................ 7�.�Ylq r io Answer plica ...........................;� L 10, 677ke---L Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITiLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss Id by the board of health. 1: IS�4SII by Tl ---------- Sign . ..... .... ... ...................... .... ...... . ............. e ..............o Application Approved ... .. .. ........ . . ...... ......... ....................... ..................................... .........................Date Application Disap ove r e following reasons:...........................................................................i.................................. ............................... ..... ...................................................................................................................................................... Date PermitNo..................................i..=............ IssuedL.................. ................................. Date No......•-S-•-....... Fps........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f.... .`tiy.`n•..---"--......OF../ ,>.n..s. ` .. ....................................... Appliration for Dispoottl 3Vorko Tontrnrtion thrutit Application is hereby made for a Permit to Construct ( ).or Repair (;`) an Individual Sewage Disposal System at: , Locat ddress ....-... ......... f- ✓J C:........ .or.`�t. 0/a .�:/!ls... �' .........L' 1J.ef' 7✓ ..............• •••••-_...-•'-•.....................-_-•••----•---........................... .................. ................ Owner ,..,,Address / Gd v`11 ��l �.r ��• 17 �Ovj q U.- ha✓t c�� --1 -------- ------------------------------------------------- -----------•-••••--- � a.---------------•-------.....------... ............... a Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type'of Building ._............................No. of persons............................ Showers ( ) — Cafeteria ( ) P I Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-_------------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq, ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----•---•------•--••-••••--•••••.......................................•---..............------------.......----•-•-------------------_... O Description of Soil '' ......h.....�/--------••---•......................•-•--•......---------------••- x W ............... UNature of Repairs or Alterationsn-Answ r hen applicable.:___ _. .??_a O.!"++ -.�1''�_ _.. .J-5�..�4924 vX lq .. ...................... .. Agreement: �`� *•i �-� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLSJ 5'of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. .Sigf/ - ' ate Application ApprovZ ----• � --•---•••. ...._�._.......-•---...1_�!............•----------•----•----- Date Application Disappsr e following reasons:-----•--------•-•--•-•---------------------••••----•--•••--•----•---•----••-•------------------•----------•--. ................................ --------------•-•-•-------------•-•-•••-•--••---......---------------------••-----••-----•----•-----------••-•-•------------...----••--...----•-••. Date PermitNo...................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACH SETTS _ BOARD/I*, . ..................................OF................... ...... (9rrtifirate of (Inntplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired- by........... , = a-...... •--•-•..--- "` 'r-' Fnstaller tl •�- at............. -----•.-_............................... - ---•----- •......... ---- ; 'r' r has been-instst ed`itI a iEdance Zv i th pfov151�t��8f3I 1V51$f�Th�"'St c�-S�t ry� s� c ed in the application for Disposal Works Construction Permit No......................................... dated.......__........................................ THE ISSU/FN71CION O THIS CERTIFICATE SHALL.NOT BE CONSTR E® AS A GUARANTEE THAT THE SYSTEM1lYILLS 3FACTORY.DATE..---...-- ............••-----............................. Inspector..... ... ............................................................ THE COMMONWEALTH OF. MAS ACHUSE TS BOARD OF HEALTH -. :...........................OF .... ..............?......:....:. No......................... /tt�`>11vl l 7r �--', 5 la 1.4 FEE .. ....... 11io�roottl orko 01nnotrudion "lerntit Permission is hereby granted.•---- r"i;,:�; ,% ; to Construct ( ) or Repair ( t I'ndividua�Sewage'�Drg"os'al�system I" l 'Z1I- ---------------- Sty et �� . ... as shoat No.wn on t e application for Disposal Works Construction Per- o. __._;___ ..____ Dated.......................................... ` l� ........ -•-•------- ---------•-------•-•---••-•----••-•--•------......------_........_...------_..._ Board of Health DATE................................................................................ ' FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS. VL-/ •.`1 %/ 1&..� / If .1 i i .VI w ✓i a w -A.-. (40'W/DE PUBLIC) io 00 oyw. NAIL STAKE BIT. SET SET R=1'29. 74' DRIVEWAY L=52. 03' BIT. I / DRIVEWAY / J Of / N 16.1' 18.0' N/F UILUAN DASILVA ASSESSORS MAP 292 N./F PARCEL 116 8 3 4f S..F. YCE DONALSON 2 STORY SORS MAP 292 WOOD FRAME ARCEL 114 HOUSE #31 " GAS METER APPROXIMATE LOCATION OF EXISTING SEPTIC. AS PER TOWN OF CA BARNSTABLE a; fa' HEALTH fir. N . 'DEPARTMENT •� G 1 t SHED N/F "UILUAN .DASILVA N 'ASSESSORS. MAP 292 PARCEL 115 v co in STAKE _ SET S12.7 j g'30 105.01' STOCKADE FENCE N F �D9 SANDRA L. LONG 59 PAGE ASS PARCEL gA 2 310 �DDK 22 C 2 G'-8" EX15TING DIMEN51ON 5'-0" 8'-4" 8'-4" 5'-0" WINDOW SCHEDULE - ID MANUF. UNIT TYPE MIN. ROUGH OPENING OA O W x h =I — O ANDER5EN TW3042 TILT-WASH 3'- 2 1/8"x 4'- 4 7/8" —� 400 SERIES DOUBLE-HUNG —1v I K I J �, -IJ 3K I J 3K I J I K I J I I K I J -Iv NOTE5: BUILDINGS SHALL BE DESIGNED AND CONSTRUCTED IN ACCORDANCE WITH THE Q? I K I J HEADER: (3)2x8 I K I J G? 2015 INTERNATIONAL ENERGY CONSERVATION CODE (IECC) WITH AMENDMENTS. in O 0 in CLIMATE ZONE: 5A HEADER: (3)2xG FENESTRATION REQUIREMENTS: WINDOW U-FACTOR < 0.30 O WINDOW 5HGC: NO REQUIREMENT 2J NEW DINING 2J N GLA55 OPTION: HIGH-PERFORMANCE LOW-E4 WITH ARGON z O GRILLES: "FINELIGHT" BETWEEN THE GLA55 _ O 2 JACK MIN. STUD POCKETS(IYP.) 0 _ o WINDOW FINISH (INTERIOR): WHITE; JAMB LINERS: WHITE I K I J MOVE EXISTING DOOR TO ADDITION I K I J Q WINDOW FINISH (EXTERIOR): WHITE DOUBLE-HUNG TILT-WASH 400 SERIES HARDWARE: STANDARD: WHITE FULL CONVENTIONAL INSECT SCREENS FOR ALL OPERABLE UNITS 1 ANDER5EN ROUGH OPENING DIMENSIONS ARE THE MINIMUM AMOUNT OF SPACE NEEDED BETWEEN THE WINDOW OR PATIO DOOR AND THE BUILDING STRUCTURE. F — — — O 0 — — j LEAVE AT LEA5T 1/4"SPACE AROUND THE WINDOW FOR FOAM INSULATION. 30"VANITY 0 VENTING CONFIGURATION: 5EE ELEVATIONS I I a iIIII IIIII 1/2 BATH KITCHEN 3'x4' MUDROOM LAND IN wz II N 3-G x 8 I I in ISLAND I I z I II 0 REF. `n 5ENCI-VH00K5 z N LLJ - - -LI- - - - - - - - - GA5METER - - - - - - - - - - - - - - -n - - T a� p I N $T�R�E IUNDER STAIR II I IL L L Lx II - - 4 - - W I� - 11 I I 01 REAR ADDITION 1 2/1 7/201 9 b 00 INITIAL ISSUE 04/25/201 9 I I w NO. DESCRIPTION DATE I I � I 1 - LIVING ROOM 11 UP TITLE: PROPOSED FIRST FLOOR PLAN/ADDITION II WINDOW SCHEDULE I I PROJECT: DASILVA RESIDENCE +,-6 I,2 STEP I I 31 GENERAL PATTON DR., HYANNIS, MA 02601 PORCH I I — — — — — — — FOR: UILLIAN DASILVA J 32 GENERAL PATTON DR., HYANNIS, MA 02GO I MICHELE CUDILO , P . E . PROPOSED FIR5T FLOOR PLAN `�°I ,.� Consulting Structural Engineer 5CALE: 1/4"=1'-0" CEN TERALLE,MASSACHUSETTS 02632-1979 (508)737-8521 NORTH ;,: ;; ,�; JOB NUMBER: 2018.245 DRAWN BY: MC DRAWING NUMBER: SCALE: A5 NOTED DATE: 04/25/20 1 9 A— 2 L � 11 5I �101-0.1 I - - - - - 2J ) -1N 100 tp 6 - ANITY _j 112 BATHi KITCHEN I I COUNTERTOP RECEPTACLE: © I I DINING �9 PROVIDE ENOUGH SPACE FOR A RECEPTACLE OUTLET TO BE - INSTALLED BETWEEN THE KITCHEN " I I �3'x4' WINDOWS © 3'-G" I I MUDROOMI �LANDIN (2 JACK MIN. STUD POCKETS) I I O IN x ISLAND I II m�v N IMF' I I BENCWHOQK5 _ N GAS METER — - - - - - — 11- - - - - T1 — Y w m �=1 I N mI �TQRFlGE'UNDER STAIR -1N IL IL IL -�- Im.' . I I _ 4x4 POST UP 51MP50N ABU44 II 3'fG" A V.I.F. 5LAB=G"MIN. @POST - A-G 4x4 POST a ALL FIG. 17 STRAPS REQUIREC ,. LIVING ROOM I I UP C A II _ A-G N A _ B B -1N O d- +/-6 I/2°STEP d A-G 2J ( YP.) 2J (TYP.) PORCH I A-G OI Al-A -f�- STONE FLOOR "� 00 INITIAL 155UE 04/25/2019 - - NO. DESCRIPTION DATE . 4'-84" 3'_94" 3'_94' 4 84 4'_74' 4�-741 5 1.. TITLE: PROPOSED FIRST FLOOR PLAN i IG' PROJECT: DASILVA RESIDENCE ` 31 GENERAL PATTON DR., HYANNIS, MA 02601 PROPOSED FIRST FLOOR PLAN FOR: UILLIAN DASILVA SCALE: 1/4"=P-O" 32 GENERAL PATTON DR., HYANNIS, MA 02GO I SQUARE FOOTAGE5 . FIRST FLOOR: 83G 5Q. IT. NORTH M I C H E L E C U ® I L® 9 P.E. PORCH: 34 5Q. IT.. SECOND FLOOR: G51 5Q. IT. Consulting Structural Engineer CENTERVILLE,MASSACHUSETTS 02632-1979 (508)737-8521 JOB NUMBER: 2018.245 DRAWN BY: MC DRAWING NUMBER: SCALE: A5 NOTED DATE: 04/25/201 9 Al- 2 (WINDOW SCHEDULE 1 ID MANUF. UNIT TYPE MIN. ROUGH OPENING t OANDERSEN TW345 10 TILT—WASH 3'-G I/8" x G'—0 7/8" 400 SERIES DOUBLE-HUNG ANDERSEN CW 135 CASEMENT 2'-4 W& x 3'-5 3/8" _ -- 0 _400 SERIES. ANDERSEN AW21 AWNING 2'—0 5/8"x 2'—4 7/8" 400 SERIES ANDERSEN TW3052 TILT—WASH 3'—2 1/8"x 5'—4 7/5" 26-8 j� 400 SERIES I DOUBLE—HUNG NOTES: BUILDINGS SHALL BE'DE5IGNED AND CONSTRUCTED IN ACCORDANCE WITH THE I 2015 INTERNATIONAL ENERGY CONSERVATION CODE(IECC)WITH AMENDMENTS. CLIMATE ZONE: 5A FENESTRATION REQUIREMENTS:WINDOW U—FACTOR 5 0.30 WINDOW 5HGC: NO REQUIREMENT O O GLA55 OPTION: HIGH—PERFORMANCE LOW—E4 WITH ARGON GRILLES:"FINELIGHT"BETWEEN THE GLA55 y� WINDOW FINISH(INTERIOR):WHITE;JAMB LINERS:WHITE WINDOW FINISH(EXTERIOR):WHITE AWNING HARDWARE:TRADITIONAL FOLDING:WHITE 1 1 4 4 1 1 DOUBLE—HUNG TILT—WASH 400 SERIES HARDWARE:STANDARD:WHITE I I I FULL CONVENTIONAL INSECT SCREENS FOR ALL OPERABLE UNITS oI I BEDROOM #3 10 ANDERSEN ROUGH OPENING DIMENSIONS ARE THE MINIMUM AMOUNT OF SPACE a < NEEDED BETWEEN THE WINDOW OR PATIO DOOR AND THE BUILDING STRUCTURE. =I I )11 —IC\i LEAVE AT LEAST 1/4"SPACE AROUND THE WINDOW FOR FOAM INSULATION. bI I I� VENTING CONFIGURATION:SEE ELEVATIONS - � BEDROOM#2 SLOPE TRANSITIONS � — � — I I TO FLAT CEILING I I — Cn 1 3'-44" 5/0 1 1 EXTERIOR DOOR SCHEDULE # I I SLOPE TRANSITIONS y 1 !ID MANUF. UNIT TYPE ROUGH OPENING HEADER KING JACK I I TO FLAT CEILING 1 W x H cLosEr JELD-WEN FIBERGLASS EXTERIOR DOOR(3'-0"x 7'-0") 5'-2 1/2"x -2 1/2" (3)2xG 3 1 O 7' 2-LIGHT 2-PANEL (TO BE VERIFIED) IZ 5/0 HIGH-PERFORMANCE LOW-E INSULATING GLA55 I I W/SIDELIGHTS(1 2"x7'-0"UNIT SIZE) 1 CL05ET �� DN Ri E 0 JELD-WEN FIBERGLASS EXTERIOR DOOR(3'-0"x 7-0") 3'-2 1/2"x 7-2 1/2" - - r m 1 I 2—LIGHT 2—PANEL N I I HIGH—PERFORMANCE LOW—E INSULATING GLA55 — —I— — — — — QTTICI ACCESS N 1 CL05ET �� 22"x30"MIN. SIZE N 5/0 3'_2� CABINET LINEN 1Y =I1 II °60 1' = Ra 01 BEDROOM#I 2 1 A BATH A- -iN 00 INITIAL 155UE 04/25/201 9 =1 I 10 I I I NO. DESCRIPTION DATE B C01 1 12'-84" 9'_23" � j3,_21" B s/4 A G 4, A-Gff� UNEN TITLE: PROPOSED SECOND FLOOR PLAN CL05��� I I (CLOSET , OD OD 1: PROJECT: DASILVA RESIDENCE 8'-102" 8'-°° 8' 102" � 31 GENERAL PATTON DR., HYANNIS, MA 02601 FOR: UILLIAN DASILVA i 32 GENERAL PATTON DR., HYANNIS, MA 02GO I PROPOSED SECOND FLOOR PLAN 9 SCALE: 1/4"=1'-O" Consulting Structural Engineer ALL WALL5 ARE NON-BEARING: FRAME(1)TOP PLATE BELOW STRAPPING. ( CENTERVILLE,MASSACHUSETTS 02632-1979 (508)737-8521 PROVIDE ATTIC ACCESS OPENING TO ATTIC AREA5 NORTH NOT LE55 THAN 22"X30". SHALL BE LOCATED JOB NUMBER: 2015.245 DRAWN BY: MC DRAWING NUMBER: IN A HALLWAY OR OTHER READILY ACCE5IBLE LOCATION. 1 /� 11 SCALE: A5 NOTED DATE: 04/25/20 19 A— 3