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HomeMy WebLinkAbout0064 GEORGE STREET - Health 64 GEORGE STREET, HYANNIS - A f ii e r o I ° YOU WISH TO OPEN A BUSINESS? For Your,Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ®®�® DATE: Fill in please: APPLICANT'S YOUR NAME/S: 32o d1C.(t7"r .S�rl�fZ'S Aj I'<'ri�Z dM BUSINESS YOUR HOME ADDRESS: & 4 (fir'n ('�f_ Sikpe f ttya all i S 1-iff AZ D! TELEPHONE # Home Telephone Number ,41.E c- 9gag: .. NAME OF CORPORATION: NAME OF NEW BUSINESS C Y) • Ce TYPE OF BUSINESS o ' ' I'I"l� IS THIS A HOME OCCUPATION? YES AD I �jJ1 J ADDRESS OF BUSINESS r 148 MAP/PARCEL NUMBER(�3 Q (J (Assessing) When starting a new business there are several things you must.do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISS[ NER'S O ICE This individ all h eje n rnloqfngof y p rmit requirement that pertain to this type of business.,,,jS-1 COMPLY WITH HOME OCCUPATION j.!::S AND REGULATIONS, FAILURE TO ho Signs re** .�,. -�;-'4` MAY RESULT IN FINES. OMMEN :4 0-�L.J C--- 12!:�l tf U4,A )i ( n 2. BOARD OF HEAVTH This individual has be i formed of the it re it ments that pertain to this type of business. c: MUS'-C �IP.LY WITH ALL: Au orized Signature** :HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS[LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: I g I Q TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: �,5 C� i ,cts BUSINESS LOCATION: 13 19 QQV INVENTORY + MAILING ADDRESS: , `hm oxc� Cyp VP TOTAL AMOUNT: TELEPHONE NUMBER: V-313 -C3& 05 oWn. Q bona CONTACT PERSON: - ekLL x±G= �S��tnS �••( ; lrc�,n c�. EMERGENCY CONTACT TELEPHONE NUMBER: 5� 30-7- 1 49 D MSDS ON SITE? TYPE OF BUSINESS: CDYYIMec c�W CL-eCtdl r ocC INFORMATION / RECOMMENDATIONS: Fire District: 4 Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) -� - ❑ NEW ❑ USED _ Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Q ctt - Spot removers&cleaning fluids • (dry cleaners) ' Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials 1 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments P Property Address — C, ) e 4,e 0w ner Cw ner's Name ,�j/ information is 1#4 Q�2 g 0/ required for every #771 C^Ill page. City/Town State Zip Code Date of Ihs&ctioli 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. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Vj C 7ol-jr e— use the return Name of Inspector key. Company Name Company Address 5:-J, A c� / / �� City/Town o� C� ^ _ n� State �D n� Zip Code Telephone Numbex, License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection r was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority sSgnature Date Theystem i 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 god 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, I *""*This report only describes conditions at the time of inspection and under the conditions,of use at that time. This inspection does not address how the system will perform In the future-'under the same or different conditions of use. �I l� t5i(t4 3/13 Title 5Official Inepeed or suos rtace sewage Disposal System,Pagel of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 e.o ✓ 2 Sf Property Address ON ner ON ner's Name information is / �� ('d G Q/ required f or every page. City/Town State Zip Code Date of I pec on B. Certification (cont.) .Inspection Summary: Check A,B,C,D or E I alwayscomplete all of Section D A) System P S. 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: / om-e 41 J1,P W-7. Of oW Flow- 401 �e 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Healt h. * 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): tsm•W13 Me5Official Inspection Form Subsurface Sewage Disposal System-Page 2of 17 I Commonwealth of Massachusetts 52 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address ----� IJ Cw ner Cw ner's Name information is HOLA required forevery v1✓lr J /7 page. Cityfrown Stale Zip Code Date g(InslIection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) .System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑. N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 15.3030)(b)that the system is not functioning in a mannerwhich 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 lam•3113 Titlo5016cial iris pac bon Form subsuiaco sevageoisposai system-Page 3o117 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments fr-T-le or C S� Property Address y--e—��✓ ino ner Owner's Name / "�� O Q/ information is (o/ required for every ✓►✓1 r! page. CA yfTown State Zip Code Date ol I pe lon B. Certification (cont.) 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 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or ---clogged SAS or cesspool ❑ �/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded /or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ny.3113 Tide 501AciellmpectlonForm Subsurl ace Sewage Disposal System-Peg a4o117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r3le- 19r �4- Property Address 4e �- / --- Ow ner ONner's Name //��f information is a4k4l ///I doh 60 / �� required for every P page. Cityfrown State Zip Code Date of spefton B. Certification (cont.) Yes No ❑ equired 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. ❑ 2z Any portion of cesspool or privy is within 100 feet of a surface water supply or —/ tributary to a surface water supply. ❑ I� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [9 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ EEI� 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 wateranalysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system ems. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 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. lire,y13 1*10050lflcial inspecbonForm SUbSurtace SewageDlsposal Syslom•Pe9e 50l17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address � Ow ner Information is AN ner's Name required for every "/G vt✓t rJ page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No �❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ 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? L7 �Q Were all system components, excluding the SAS, located on site? u ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has / been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)j D. System Information Residential Flow Conditions: 2 Number of bedrooms (design): Number of bedrooms (actual): 33� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Ons-Y13 Title 5 01 ficlal Inspection Form Subsurface Sewage Disposal System•Pago 6 o(17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments P 6 y Property Address Ow ner CW ner's Name information is N I s D; 6 (2 required for every Gl page. City/Town State Zip Code Date of I pectlo D. System Information Description: N01015 J.") V 1 /l am G�C 014, a Number of current residents: Does residence have a garbage grinder? El Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection [I Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes Ci-No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes No Last date of occupancy: Date � ✓�tw Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 151ns,3113 Title 5 Official Inspection F orm Subsul ace Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts =v Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Ow ner's Name information is required for every page. Cityrrown State Zip Code Date of lKspection D. System Information (cont) Last date of occupancy/use: Date Other(describe below): General Information 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: Type of S em: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool i ❑ 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 (descn be): 150s•3113 Title 5 Offlcial Ins pectim Form Subsvfoco Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address e Cw ner ON ner's Name information is 1'1 4 ��6 p� 1� / required for every G y► `�1 I S page. City/Town State Zip Code Date of nsp ction D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Dept h bel ow g ra de: feet ;ers ofconstruction:cat iron �40PVC other(explain): / 1 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: \ ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title50flicial Inspection F orm:Subsurface Sewage Disposal System-Page got 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ory ner Ow ner's Name information is va 6 0 required for every N �f page. City/Town State Zip Code Date of In pecti n D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4- Distance from top of scum to top of outlet tee or baffle , Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): G�+ h/ vo COn�/�ro✓+ � 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 purr ping: Date t5im.WZI Title 5 Of ficial Iris poc ton Form Subsurlace Sewage Disposal System-Page 100l 17 ,<C\1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dlsposal System Form - Not for Voluntary Assessments p 6 � eo✓ S� Property Address 4%" -e Ow ner ON ner's Name 1 information Is G f f 4 Qd&0 required for every page. Cityrrown State Zip Code Date of Ins ectio D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per dad Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes ❑ No l Date of last pum ping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Ons•3113 T&SDlficial InspoctionForm Subsurface Sewage Disposal System-Page 11 0l 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments S Property Address ^ ory ner Owner's Name information is _ r �/ required for every page. City/Town State Zip Code Date of spec on D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): !tee r�1 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): /4� L� �f i i Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ns,3113 Title 5 Official Ins pec lion Farm Subsurface Sewage Disposal System•Page 12 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address TQ �- ON ner ON ner's Name Information Is A� j required f or every a,'N 11 Zip Code Date of� sp ctlon page C1ty/Town State D. System Information (cont.) Type' �Q p ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number` ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of i vegetation, etc.): ae CK O �� ✓t O G1 �-• �r L G Iy Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Ons 3113 Me5010cial ins pec6mForm Subsvlace Sewage Disposal System•Page 13 of W Commonwealth of Massachusetts Title 5 Official Inspection Form V Subsurface Sewage Disposal System Form Not for Voluntary Assessments �o!� �f s Property Address ,fie�-e �Ow ner Cwner's Name information is required for every /�L7 a 4 1 { Q 2 6 q page. City/Town State Zip Code Date of I pecti D. System Information (cont) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I l , t&ns•3113 Me Solhclel InspectionForm Subeurlace Sewage Disposal System•Page U d 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61( cre© f S Property Address 3—le Orr ner ON ner's Name Information is G.�N� s Q� required for every State Zip Code Date of Ins ertio page. City lTown D .._Svstem l.n_formation..(cont.) 6 in STONE BASE I _40 25 q - 5.90 rr (END VIEW) _ss.zs GALLON I i _ i 12.5 FT i SEPTIC TANK A f' 5 - ADJUSTED GR O UNjSVr•A � o�nl�f 4� Lo /Y. 53 N v` C 1 L i � tit N �q M3 — 1Sp p �/ C� -A - A 1A �- 1 ` , 73 o o m m v o r 0 AM 117 mow+ �,�. ••,yr:..... .i9fsy,.•,F Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Cw ner Owner's Name . information is ( 6�� ��Ilk required for every h j page City/Town State Zip Code Dat Insp clio I D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ! Estimated depth to high ground water: feet l I 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 /local Board of Health -explain: '( .✓1s f ins Ht%s ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: I �7 ns ll� -e✓ ,a/� Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ns-3n3 -riue5ot6ciaiinsDectlonForm Subartace SewageDisposel System-Page 16of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form — b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 'e 0✓S49 Property Address oN nerrm Cwner's Name /�i� Oo� 60� information is required for every G K page. Uyrrown State Zip Code Date of I spection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 2/"System Information— Estimated depth to high groundwater MI Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 1 tNns-3113 Ti0e 3 Of Add ins poclion Form Subwi ace Sowage Disposal Systom•Pago 17 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form 9-j Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address Owner Owner's Name information is required for State Zip Code Date f I pection every page. City/Town 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: A. General Information 1,iL When filling out forms on the computer,use 1. Inspector: Only the tab key T.tiff .to move your cursor-do not Name of Inspector use the return L key. ` Company Name�O m Company Address , 21—�sftia� tl City/Town State Zip Code Telephone Nu er J License B. Certification LG 3 "® RECD I certify that I have personally inspected the sewage disposal systeddres� and that the information reported below is true, accurate and complete as of thea Inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails 1 , ❑ Needs Further Evaluation by the Local Approving Authority Gti'UL Inspecto s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system 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. ****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. 15ins•09r08 Title 5 Official inspection Form:Subsurface Sewage Disposal system•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address v D o 4ot Owner Owner's Name J An information is H � �d 6 o l Orequired for �fevery page. City[Town State Zip Code Date action B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09ios Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address �+ i✓O o ��1 Owner Owner's Name information is (,O/ required for State Zip Code Date of In pection every page. Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i 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. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•09/08 Title 5 official Inspection form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments S�- Property Address Owner Owner's Name information is 4Datof required forState Zip Code spection every page. City/Town B. Certification (cont.) 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, j 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ El/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Cl Er Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow 15ins•09ro8 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address IL CO 0 I Cl Owner Owner's Name �� I information is VA Qot 6 v required for State Zip Code Date f in pection every page. City/Town B. Certification (cont.) Yes No ❑ 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 u tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ U Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis i and chain of custody must be attached to this form.) he system is a cesspool serving a facility with a design flow of 2000gpd- ❑ 10,000gpd. i ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 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. t5ins•Moe Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is Q h S 1'� Oa 6 0/ //V required for Ci /Town State Zip Code Date f Inspection every page. tY C. Checklist 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 LuJ 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: 2-X0 Existing information. For example, a plan at the Board of Health. C U` ❑ Determined in the field (if any of the failure criteria related to Part C is at issue ' approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): �30 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): [Sins•0910E Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (re o ��- Property Address Co Owner Owner's Name information is /L/[ ��� �f (Jo2 6 V required for State Zip Code Date o Inspe lion every page. City/Town D. System Information Description: / /SOO 61,110, ,j DO U G A Number of current residents: Does residence have a garbage grinder? ❑ Yes ff No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes No Cc Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- [Sins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments p` �� tie o►� � S� Property Address Owner Owner's Name/� information is required for State Zip Code Date f In ection every page. CityfTown C71- j D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes to If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy Septic tank, distribution box, soil absorption system ❑ Single cesspool i ❑ 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): 15ins•09109 Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments (D T CTC Or ST r Property Address Owner Owner's Name A hh r f Aj�4 ®� O gWi/spe�ction information is /,/required for State Zip Code Dat every page. City/Town D. System Information (cont.) Approximate age of all components,-date installed (if known) and source of information: a 00 ,CCSS ,7 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): O ,� Depth below grade: feet �e �aonstruction: cast iron 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): % Depth below grade: feet Material nstruction: 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: 6 X /0 Sludge depth: — 15in9•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Cr e 0 P" i Property Address / 0 � Owner owner's Name information is f //"/� 0. 6��ol / ��required for State Zip Cde Dat of in pection every page. City/Town D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 3 Scum thickness it I Distance from top of scum to top of outlet tee or baffle O Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7V#7' fiol f)4e.--4C/ 41j, -hoiz-, a P'% 4ee to - 5,00 C/ Co,./, 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: Dace t5ns•09*8 riUe 5 officiai Inspection form:Subsurface sewage Disposal System•Pagei10.of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address o O Ci Owner owner's Name information is N h rr Od-6 t71 required for State tip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ms•09ro8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page i 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address o ff p Owner Owner's Name / information is h/ G ran fs W Oa 60 q 0 required for State Zip Code Date n every page. City/Town D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): � Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): oLe��e '�'/ cjs 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: (Sins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Zf s�- Y Property Address Co 0 I Owner Owner's Name information is Qa60 / Pspedbon Aq required for a Hritevery page. Cityrrown State Zip Code Date of D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: (� s00 �o ❑ 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.): GN C� Ad,�•�i� Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins-OW08 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �! Or,°�Ce Co'Wo A) Property Address ) Owner owner's Name /� 11 information is A�N f r 1'!1_ � G 0� (/ required for State Zip Code Date of I Spec ti n every page. CityfTown D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t&ns•09/08 Title 5 offi iai inspection Form:Subsurface Sewage Dsposaf System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments P Property Address O Olei Owner Owner's Name , I Q information is Z� required for State Zip Code Dat of In pection every page. CitylTown D. System Information (cont.) 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: E'drawinwing d-sketch in the area below attached separately i Lh� i5ins•09M Vile 5 Official Inspection form:Subsurface Sewage Disposal System-Page f 5 or 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Vololuntary Assessments '4� (-r-eov,� e- Property Address O p/Gt Owner Owner's Name 1 p information is required for N every page. Cityrrown State Zip Code Date of spe on D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells / Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with al Board of Health - explain: �Gh /-eS� I7�4PS ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Ile- S-, 4. ol/0ti Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09r08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 16 of 17 iCommonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments `� �e O 41 — Property Address / O Fj ( `, Owner Owner's Name , information is c 0 N�J i� fir required for State Zip Code Date o Ir p ction every page. City/Town E. Report Completeness Checklist ff"Inspection Summary: A, B, C. D, or E checked [inspection Summary D (System Failure Criteria Applicable to All Systems)completed VSyketcmhof sInformation — Estimated depth to high groundwater Sewage Disposal System either drawn on page 15 or attached in separate file i5ins•owe Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 o—j< qq :1? �z0 PLAN BOOK 272 E 5f DV> = ASSESSOR'S MAP: I��b owe LOT: 196 <Nc� t12.25 {t *0-0 ' N TP-l40, TP-2 \ CLEANOUT� PL UG 3 � � N u, �\ P p.V E�� �. T tO 1� D C > " pR,VEw ;1 PP L L� C L w N o�GRETE \ 1500 G`Al \ SEPTIC •1 X�S� ROOM o-BOX 3 gE�JOG `' TEST PIT \ DBE FN°N ?EXISTING � F k :k o 44 \ 1OP O AA-S� CESSPO 43 WA TER L L 0 T 6 ,y rn \ AREA - 14631 A TREE IINUMBIEcSRiticB6 m O-OAK M-%lk w T. 2,1 z o Z _ 43 —_ w 1 too,9 {, SEW, -J F— �� �. AVE� - 1 FL o a- S / * In � � �N 04, 'M 64 Of q l -� ,� DAViD r► TOWN OF BARNSTABLE „� ^L&CA110N � ' ? y SEWAGE # �Z. MLAGE ASSESSOR'S MAP & LOT — v W-STALLER'S NA ME&PHONE NO. I . SEETIC TANK CAPACITY LEACHING FACILITY: (type)A y� o� (size) i NO.OF BEDROOMS .� BUILDER OR OWNER PERMTTDATE: 0� 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 leaching facility) Feet Furnished by e �.J �v i • LII �W No. a r ;e8 0 0 .0 0 V I - K THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEa MASSACHUSETTS ftplication for Migpool *pgtem-Congtruction permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) O Complete System O Individual Components . Location Address or Lot No. Owner's Name,Address and Tel.No. 7 9 0=1 6 9 4 6a 5eo�ge. S H s Florence Cappola Assessor s p arce 96 64 George St, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 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 Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to plans of Eco-Tech. Date last inspected: Agreement: The undersigned agrees to ensure the con u�n maintenance �thefore described on-site sewage disposal system in accordance with.the provisions of T 5 f e Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed o Sign Date Application Approved by' D Application Disapproved for the following rea Permit No. Date Issued NN No. I 4W. 1y0 0 0 0 Fee 'J'j 'kV2_`� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �Ye i PUBLIC IHEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, Ztppliiation for Migpooal *potem Construction Permit Application for a Permit-to Construct( )Repair( 4Upgrade( )Abandon( E)-Complete�System 0 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.NO. 790-1 694 Florence Capppla ,? 1"' Ae, rge t H s Assessors ap 6-4 George St, Hyannis W Installer's Name,Address,and Tel.No. 775-8776 Designer's Name,Address and Tel.No. 36.4-0894 Wm E Robinson Sr Septic Eco—Tech. . PO box 1089, Centerville 43 Triangle Cir, Sandwich IN of Buildin_g: �Dwelling No.of Bedrooms Lot Size—sq.ft. Garbage Grinder 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' Nature of Repairs or Alterations(Answer when applicable) Install anew Title 5 septic system to plans of Eco—Tech. --Ddte last inspected-.' A&ement: The undersigned agrees to ensure If Tit eco s u n maintenance of the afore described on-site sewage disposal system in accordance with the provisions 0 1 t Environmental Code and not to place the system in operation until a Certifi-, cate of Compliance has been issued-by t s Signe A /7 , Date Application Approved'by Dat Application Disapproved for the following re:s6s Permit No.. /10 Date Issued THE COMMONWEALTH OF MASSACHUSETTS Cappola BARNSTABLE, MASSACHUSETTS Certificate Of Compliance TO CEM14.that thi -site Sewage Disposal System Constructed ( ) Repaired ( X)UpgrAded( -A ��w Septic Service IS I' y (ZIT LW - -bh Sr Aband. ��I( 1)lb _,/E Dbin at 64 George Street, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer ion The issuance of thist sha�l guarantee not be construed as a guantee that the syS Date Inspector rr ct as 4v. No. F,$100.00 Cappola THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �.Dizpoe;al 6potem Cone;truction�_Permit Permission is hereby granted to Construct( )Repair( �Upgrade Abandon System located at 64 George Street, Hyannis 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: C ( ict us becompleted within threeyears yes of the date of tj e i Dater qj n ,, h A Approved by tHE Town of Barnstable p Tp� Regulatory Services Thomas F. Geiler,Director BARNSTABM 9� 6'9. per Public Health Division AlFD1A0�A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i Installer & Designer Certification Form Date: ,>, v E . Designer: Eco-Tech Installer: Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Wm E Robinson Septic was issued a permit to install a (date) (installer) septic system at 64 George St, Hyannis based on a design drawn by (address) E ' -Tech dated ,. ,l �� (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. yZH OFMg,9. DAVID �yGN o , f D. `�► (Installer's Signature) " COUGHANOWR No. 1093 L.S T ERGO (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE i OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form t Notice: This Form Is To Be UsedFor the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 0W� UG H A N ,hereby certify that the engineered plan signed by me dated se ��, �60.s� concerning the property located at Cj edr p-p_ S H Y 4 i S meets all of the following criteria: •. Two soil evaluations excavated for detailed examination(no hand augering)and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances.requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 44, 36 B) G.W.Elevation ��' +adjustment for high G.W.4,3 = 2.7, 3 0 DIFFERENCE BETWEEN A and B SIGNED : DATE: ��� ? 20d S✓ NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc 1 , LtJl ;;_�' z[ IP:1 4 350 MAIN STREET 1I WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 291 ,PARCEL 080 Property Address: 64 GEORGE STREET HYALNNIS,MA 02601 Owner's Name: COPPOLA,FLORENCE Owner's Address: 64 GEORGE STREET HYANNIS,MA 02601 Date of Inspection AUGUST 25,2005 Name of Inspector:(please print i JAMES D.SEARS Company Name: A&:B Canco Mailing Address: 350 Ivlain Street West Yarmouth,MA 02673 Telephone Number: 508-'773-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: �` �" os- 411117 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 21000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CNM 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 r. 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: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 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. j 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 R R 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: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A 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''/Z 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 y 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (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 y 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 i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 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,including the SAS,located on site? Were the manholes uncovered,opened,and the interior inspected for the condition of the 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(3Xb)] f, I Title 5 Inspection Form 6/15/2000 5 I , Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design):- 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES 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: PRESENT COMMERCIALAN DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 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: N/A 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 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: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection:. AUGUST 25,2005 BUILDING SEWER(locate on site plan): N/A 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.): SEPTIC TANK(locate onsite plan): N/A Depth below grade: 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: Sludge depth: Distance from top of sludge to the bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP(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 scion 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 i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 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 Continents(condition of alarm and float switches,etc.): I DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): I 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.): I � 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: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 OVERFLOW SOIL ABSORPTION SYSTEM(SAS): J (locate on site plan,excavation not required) If SAS not located explain why: i Type leaching pits,number: leaching chambers,number: leaching galleries,number leaching trenches, number,length leaching fields, number,dimensions: overflow cesspool,number: 1 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.) OVERFLOW IS ONE BLOCK POOL WITH COVER AT 4"BELOW GRADE.POOL IS FULL AND NOT LEACHING. MAIN CESSPOOLS: (cesspool must be pumped as part of inspectionXIocate on site plan) Number and configuration: 1 Depth—top of liquid to inlet invert: 2" Depth of solids layer: 4" Depth of scum layer: 2" Dimensions of cesspool: 6' Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): MAIN POOL BLOCK WITH CEMENT COVER AT GRADE. POOL FULL TO OUTLET LINE. 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.) Title 5 Inspection Form 6/15/2000 9 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 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. 0 O 37 � f Title 5 Inspection Form 6/15/2000 10 i Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 GEORGE STREET HYANNIS,MA 02601 Owner: COPPPOLA,FLORENCE Date of Inspection: AUGUST 25,2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 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 Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE AT 12'NO WATER.TEST HOLE AT 6'BELOW BOTTOM OF POOL. BOTTOM OF POOL AT 6'BELOW GRADE. e 7 A Title 5 Inspection Form 6/15/2000 11 r ;a i Commonwealth of Massachusetts r' *4 Executive Office of Environmental AffairsDepartment of 4XV lEnvironmental Prtotection,. Wllllam F.Weld �l $ owemor Trudy Coxe t3eeretery,EOEA David B. Struhs Commissioner -- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 64 George Streets, H.yann . Address of Owner: Date of Inspection: T'_1 2 (If different) Name of Inspector: -.__,.10•;.1 +` � t.�:�:���� Company Name, Address and Telephone Number: Straight Flush Septic Co . 48 Greern100.1' Avet :.yann%s 790-8944 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X. Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: I,: Date: April 25 1996 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design floe• of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CONDITIONALLY PASSES: l One or more system components need to be replaced or iepaired. The system, upon completion of the replacement or repair, i passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank-is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street • Boston,Masaachusetb 02108 • FAX(617)SS6-1049 a Telephone(617)292-5500 . t �,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 George Street , Hyannis owner: Carla Raratore Date of Inspection: 4./25/GE, B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a•broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced 'obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect th( public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THA-: THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface wales supply or tributary to a surface water supply. _ 'The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank,and.soil absorption system and is less than 100 feet but 50 feet or more from a private watt supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than ppm D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined In 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be.contacted to determine what will be necessary to corre� the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 n t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:. E.4. George Street, Hyannis Owner: Carla Raratore Date of Inspection: 4/25/96 DI SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in'a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. -(revised 8/15/95) 3 e f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:64 George Street , Hyannis Owner: Carla Raratore Date of Inspection:4/25/96 Check if the following have been done: _X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or a5 part of this inspection. NJAAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow g The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. g The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.. X The size and location of the Soil Absorption.System on the site has been determined based on existing information or approximated, by non-intrusive methods. X The facilitt owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Addressb4 George Street , Hyannis Owner: Carla Raratore Date of Inspection: 4/25/96 FLOW CONDITIONS RESIDENTIAL: Design flow: gall ns Number of bedrooms: Number of current residents: 2 Garbage grinder (yes or no):_.y_ Laundry connected to system (yes or no): Y Seasonal use (yes or no): Y Water meter readings, if available: Water Department Print out attached. . . . o. Last date of occupancy: 4 2 /96 COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 1 O: pumpings on. record. System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: ' -Sys em n.ot pumpe as part of inspection because there. TYPE OF SYSTEM was only about a foot of wattr in the main :pool. Septic tank/distribution box/soil absorption system Single cesspool X — Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components; date installed (if known) and source of information: 20 + years Sewage odors detected when arriving at the site: (yes or no) N (revised 8/15/95)' S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION"FORM PART C- SYSTEM INFORMATION (continued) Property Address:64 George Street, Hyannis Owner: Carla Raratore Dale of Inspection: 4/25/96 SEPTIC TANK:_ (locate on site plan) Depth below grade: , Material of construction: _concrete _metal _FRP other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Corments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP —other(explain) Dimensions: Scum thickness: r Distance from top of scum to top of outlet tee or baffle: Distance from bottom of corm t- bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) r (revised 8/15/95) 6 i J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: •64 George Street, Hyannis Owner: Carla Raratore Date of Inspection: 4/25/96 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution i, equal. evidence of solids car,\•n\,Pr, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:•(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 a 1 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 George Street, Hyannis Owner: Carla Raratore Date of Inspection: 4/25/96 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: 2/ 6X8 Depth-top of liquid to inlet invert: oe Depth of solids layer- No- soli la er Depth of scum layer.N Dimensions of cesspool: bX8 Materials of construction: Indication of groundwater: NO inflow (cesspool must be pumped as part of inspection) Comments: (note condition of oil, signs of hydraulic failure, level pf ponding, condition of vegetation, etc.) . System in good working- order. . . . PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 9/15/9S) 8 f' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 64 George Street, Hyannis Owner: Carla Raratore Date of Inspection: 4/25/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i 3 , �1 DEPTH TO GROUNDWATER i Depth to groundwater:.$ '6 u feet method oLd ination or a proximation: Town of Barstable monator'n Barnstable Town Hallewo.e. (revised 8/15/95) 9 TOWN OF BARNSTABLE CATION �, /��®/�y` SEWAGE# a► LAGE / ASSESSOR'S MAP&LOT 'S NAME&PHONE NO. lUeO SSE TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS BUILDER OR OWNER C DATE: 'sr-op-7 -ate COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �=� AI lr� a •�• . � O � � �' w O �a � �. ;,. �. ��� � 71 TOWN OF BARNSTABLE LC^ATION 64-'Ge6rge Street SEWAGE # VILLAGE, Hyannis ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. - SEPTIC TANK CAPACITY ' 2 Cesspools 6x8 LEACHING FACILITY: (type) (size) NO.OF BEDkOOMS 5 BUILDER OR OWNER Carla Raratore ) PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 3 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) NA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NA Feet Furnished by "Ti rn&ik v V Cash, XUS r' w i O o` �o a i ' FLOW PROFILE TOP OF FOUNDATION RAISE COVERS TO WITHIN jEL - 44.57 6 in OF FINAL GRADE 44.00 n 2- LAYER OF 1/8- /D BOX MAX-BOX STONE 3" DROP / FLOW LINE TEEA 3/4--1 1/4' O l P- la PRECAST STONE 48' GAS�� F DRYWELL L43.15 BAFFLE 6 in BOTTOM OF 41.75 STONE LEACHING SOIL ABSORPTION BASE 40.38 SYSTEM a2.0o 6 m STONE BASE _ 4o.ss GALLERY 40.25 I500 GALLON (END VIEW) 3s.zs 5.00 r► a a of 21.8 ft SEPTIC TANK 8 ff al 5 fr 12.5 FT bl 35.6 ft bl 13 f1 ' 27.50 Q ADJUSTED SEASONAL HIGH GROUNDWATER 1} 6 V90, gym. '} vo m--4 z m >-a0 n zUD _ D N 2x V ' m Z 3 C) Ul 3 m lid M�nl�a N V o m R1 —A oz „ . . -A o I o m u 0)m � Oz, 1f000 4. V J000 ' / eZ 9Z1 COIN,yO 0 N� ZS 3m z pb o z w y y �D� < -n Vfr Z_x ,A �zp o a A mZ > 3- n cn ao Z S11�S�� --AA � 'G) � m o � o off + r3V -n Z C °,Q :70 y nx m � mo �.. = 7O m -n , rT-1 3 y A x �, FTI G' m Z v � � Om o m00 yZ J, n cn o� °om V ; G Ll j� pZ cn m m r � rmm M ' I M se W m m x o ° r 3AV 3NR/3H1VD 1S w, m v v C m ® p< mo Z I / Z Q v, G) nO Z A . �o 2 o r p = 3 m m N 1N0 > zm-4Se? 3 m Z p r 3 Y m � v z Z 3 z —v oo z o v�m I j D Z m Z VM 53SaV39 M O� r DATE OF TEST': SEPTEMBER 10. 2005 ,SOIL TEST LOG SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN CALCULATIONS WITNESS REQUIREMENT WAIVED NO VARIANCES SOUGH T NO GROUNDWATE TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD ELEVATION - 44.49 .- PERC AT 58 in 2 MIN/INCH IN C SOILS SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 44.49 DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 0-8 Ap LOAMY SAND 10 YR 4/3 NONE FRIABLE 8-38 B LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 fi LEACHING GALLERY CAN LEACH 4132 38-144 C MEDIUM SAND 10 YR 5/4 NONE LOOSE A b o t - ( 2 4 x 12.5 ) - 300 s f 32.49 A6dw - ( 24 - 24 12.5 - 12.5 ) x 2 - 146 sf Atot - 446 sf NO GROUNDWATER ENCOUNTERED Vt 0.74 x 446 - 330.04 GPD TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION - 43.36 +- PERC AT 56 in 2 MIN/INCH IN C SOILS USE A 24 f t x 12.5 f t "x. 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 43.36 0-6 Ap LOAMY SAND 10 YR 4/4 NONE FRIABLE 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 40.36 36-136 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 32.03 GROUNDWATER ADJUSTMENT LEACHING GALLERY 500 GALLON DRYWELL DIMENSIONS AND DETAIL EXISTING GROUNDWATER LEVEL CONSTRUCTION DETAIL llSE `10 L"T BASED ON TOWN OF BARBSTABLE _ INSTALL ONE INSPECTION GIS DEPARTMENT RECORDS. DRYWELL UNIT STONE RISER TO WITHIN SIX 8'-6'x 4'-10-x 2'-9' INCHES OF FINAL GRADE INDICATED GW 23.00 2 h EFF. DEPTH AND INDICATE LOCATION INDEX WELL AIW-230 24.0 ft ON AS-BUILT PLAN ZONE D --77 —f:: READING DATE AUG. 2005 0 READING 23.7 M ADJUSTMENT 4.3 0 Q 34 NOTES ADJUSTED GW 27.3 Ot7 in N o N o 0 00000000a DU M o000000�00 00 ,\� 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN �� a 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3.5' 8.5' 8.5' 3.5' 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24.0 ft NOT To ��2 in SCALE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOL TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED SEWAGE DISPOSAL SYSTEM PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR;- 0-N BEFORE PITCHING DOWN -TO SERVE EXISTING DWELLING 8) ECO-TECH ENVIRONMENTAL RECOMMEND$/fHE4,,INSTeALL�ATION OF LOW FLOW FIXTURES FLORENCE COPPOLA AND APPLIANCES. AND BIANNUAL PUMPING OF, THE4 SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAAND-V°EHI'CULAR"L`'OADING. DO NOT 64 GEORGE STREET HYANNIS. MA PARK OR DRIVE VEHICLES OVER SEP,TIC�SYSTEM , i 10) INSTALLER TO OBTAIN DISPOSAL WORKS. PERMIT.BEFfO;RE STARTING WORK. ECO-TECH ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL'+-A`ND' yTRUE TO GRADE ON A LEVEL 43 TRIANGLE CIRCLE SANDWICH MA 02563 STABLE BASE THAT HAS BEEN MECHANIC°ALLY:'COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED. TO MINIMIZE UNEVEN SETTLING ETE-2187 SEPT 15. 2005 2/2