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0043 GREENBRIER LANE - Health
43 GREENBRIER Hyannis A = 268 — 078 — 010 r SMEADO No.2-153CR UPC ti7734 smead.com c Made in USA y SFI �SAP ,�aU �� CERTIflED SOURUN6 VJVJVJ.SFIFRdGFy1MLOR3 pp- 00 VIA � 12,z ��b �o = X: ✓ uz TOWN OF BARNSTABLE LOCATION 43 Gr t P,)#3t ,or �h`e SEWAGE# 2ko/(a —0/:7 VILLAGE .. ASSESSOR'S MAP&PARCEL 16$-07$ -©10 INSTALLER'S Nt&PHONE NO. SEPTIC TANK CAPACITY I~ 1�K�YTl N@- LEACHING FACILITY:(type) 34'00 C661^t 0&k-S (size) C3�K 3;X A'Fllft NO.OF BEDROOMS $77bpvELtA/'C4 OWNER 001 M lgrt:S I$ &CAJA PERMIT DATE: I I a'a I`(o COMPLIANCE DATE: 7 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 c Vet ' c ' t Al 3 H3 u e r IU,�e, � ' � �3dw aTl 13- 3 o 4 r, J No. —to Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Disposal e6pstem Construction Permit Application for a Permit to Construct( ) Repair(✓) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 43 t„r) Owner's Name,Address,and Tel.No. '7 ty nin /00/9,19 432. Ivi t�y�.�N$ Assessor's Map/Parcel `�9'7n✓� M'q �80 016 Installer's Name,Address,and Tel.No. 4clk-36 &a3 7 Designer's Name,Address,and Tel.No. 7 7y- (o p 3�0O_ 3311 , Type of Building: Dwelling No.of Bedrooms �I Lot Size ( /3 )0 sq.ft. Garbage Grinder Other Type of Building 2 t Y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 14 40 gpd Design flow provided 44 gpd Plan Date 1113116 Number of sheets Revision Date Title Ne(, /p5ekj/�,2 Size of Septic Tank l DO0 Type of S.A.S. 3 �90-B An C, 4-%/l tom^ Description of Soil ��-P Soo '� � 0/ Nature of Repairs or Alterations(Answer when applicable) S-6P "tom Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. S' d Date ( 1 Application Approved by Date , Application Disapproved by Date for the following reasons Permit No.?o I A—0 Date Issued �'`',�--*"' a—••`.�i � +� A No. �`/J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Misposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair(4Upgrade( ) Abandon( ) ❑Complete System Vdividual Components Location Address or Lot No. 43 CC.e P n 6l/'F r i-r) Owner's Name,Address,and Tel.No. -7)!1- 413 - 7-/W Assessor'sMap/Parcel "fe,f)n ISM M'1 ��G .crO 1)y"Tr'S 4 S,�9cR /�CU�� 43�. t,, r��yn�S�GrF �(p�a , Installer's Name,Address,and Tel.No. ScV 3 6A '(v a 3'7 Designer's NIame,Address,and Tel.No. y 714- y 13 -9,y(,p y ) ' 'rs�d SSAc= c SC, 3�00- 33j) i Type.of Building: Dwelling No.of Bedrooms 9 Lot Size f' 3 )O sq.ft. Garbage Grinder((Ll)j Other Type of Building Res" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 U gpd Design flow provided 4 L gpd Plan Date 1 113 /(o Number of sheets 2 Revision Date Title /i/P(G, Size of Septic Tank l 000 Type of S.A.S. 3 SGo /I C 6"R*k-ell Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date-last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. ll S' d � Date /to Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 70—( ^Q!?- Date Issued 1 -7-2,� ! L --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Ceftifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by E 1 1 I S 65 roj-1 - r C C rl S� at �-} 3 �C P f n r3 r �o �y�r h h►Wf has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7ab_o) dated u / . Installer �� I I S 66'c7 ke/-S CGA S , Designer 6 p�j plf �n #bedrooms Approved design flow !y O gpd The issuance of this permit shall not be construed as a guarantee that the system wi fu coon as desigjn�ed.. Date 7 � ' �„ Inspector ) / I,-/ --------------------------------------------------------------------------------------------------------------------------------------- No. &1 b 01�4 oU Fee ton _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at u 3 6(-p-Pn '^ Y ,P/ �— �► I �,a 1, °�1 � r i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date f �r�n/ �, Approved by i Town of Barnstable Regulatory Services Richard V. Scali,Interim Director nnnxsrnaLF, M^ Public Health Division ses�• �� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# 17 Assessor's Map\Parcel*71 610 Designer: n -R_N yylJ 4L, Installer: Address: Yy �� 1 Address: 3 CWTS-� M _. On f 127Z11 was issued a permit to install a (date) (installer) septic system at G��✓�5,��'�✓ L�✓ �- S based on a design drawn by (address) YL-S dated (designer I certify that the septic system eferenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was cons eo; ce with the terms of the IAA approval letters (if applicable) c� J. VVV (Installer's Signature) �� . signer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN1 ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL N BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc i AFFIDAVIT I, PHILLIP L. TERPOS, of 68 Leslie Road, Rowley, MA 01969 after being duly sworn do upon oath state as follows: 1. I owned property located at 43 Greenbrier Lane, Hyannis, MA from January 18, 1980 until September 20, 1991, when I sold it to Damaris and Mark Skala; 2. When we purchased the property in 1980 there were 2 unfinished bedrooms; and 3. Prior to 1986, I finished the 2 unfinished bedrooms and I remember this as we had rented the property out as a 4 bedroom home until we sold it in 1991 to the Skalas. 1 Witness my hand and seal this day of January, 2016 LIU,1 G. af�s PHILLIP L. ERPOS COMMONWEALTH OF MASSACHUSETTS County of SS January Z O , 2016 Then personally appeared before me, the undersigned notary public, the above-named PHILLIP L. TERPOS IK who proved to me through satisfactory evidence of identification, which were d� �Y'M s UC.P✓ _ 0 who is known by me and to me known to be, the person whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his knowledge and belief. lSUSAN G. HAZ8N e Notary Rublip COMMONWEALTH OP MASSACHUSETTS. Notar PUb11C My Commission Expires y April S.M16 My commission expires r!o f t i 7 P S� "yICY NO � P h {4 h (�` / � ! � - - . �-- - - �:� . | � [ � | _ - � � �?�� { \ « . ! �� � � . . � ! �� � � { � \ � � � ` �� . , � - � w �y . � � - �, �: ! � { ! . �� | � . � � _ � /� . . _ � . � �� ! \ � { { | � ` � � � � �: ��\ ! : . �% � ! = $ � ` . , , �� � � � : |�={\i - ��-��.g . ! � , | | } y � �} . � ! |�� , �\ . . [ _ �\ - 1 � �� . � %2 _ � . �� � �/ ^ } . � � �� �«= ( - . � � { � �G . { { . � �i �: � : AFFIDAVIT I, PHILLIP L. TERPOS, of 68 Leslie Road,Rowley,MA 01969 after being duly sworn do upon oath state as follows: 1. I owned property located at 43 Greenbrier Lane, Hyannis, MA from January 18, 1980 until September 20, 1991,when I sold it to Damaris and Mark Skala; 2. When we purchased the property in 1980 there were 2 unfinished bedrooms; and 3. Prior to 1986, I finished the 2 unfinished bedrooms and I remember this as we had rented the property out as a 4 bedroom home until we sold it in 1991 to the Skalas. Witness my hand and seal this ' day of January,2016 PHILLIP L.#FERPOS COMMONWEALTH OF MASSACHUSETTS County of hs January Z L , 2016 Then personally appeared before me,the undersigned notary public,the above-named PHILLIP L. TERPOS kwho,proved to me through satisfactory evidence of identification, which were ❑ who is known by me and to me known to be, the person whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his knowledge and belief. SUSAN G. HAZEN e Notary Public COMMONWEALTH OF MASSACHUSETTS. " My Commission Expires I Notary Public .Aprii 8,2016. My commission expires ter^ Town of Barnstable Barnstable .�. ; Regulatory Services Department A p Cft U STM p MASS. Public Health Division Q��6�A1� m •FC 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7088 . November 30, 2015 Damaris A. Skala PO Box 432 West Hyannisport, MA 02672 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 43 Greenbrier Lane,Hyannis,MA,was last inspected on 9/19/2015,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Sandy soil, signs of hydraulic failure. Leach pit was full at the time of the inspection with stain lines up in risers. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTHd Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL #7006 2150 0002 1042 0002 Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\43 Greenbrier Ln Hy)ct 2015.doc Town of Barnstable Barnstable. �O* Regulatory Services Department nmericaC�► BARNSfABL)r . g rY p -•.,. , 1 9 MAC' $ 1639. Public Health Division ATF°M 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 595937 October 21, 2015 Damaris A Skala PO Box 432 West Hyannisport, MA 02672 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 43 Greenbrier Lane,Hyannis, MA was last inspected on 9/19/2015,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with High liquid level,<12" below inlet (per Town Code 360-9.1). You are ordered to repair/replace the leaching pit or cess- pool system within TWO (2)YEARS. • Distribution box has rotted; needs to be replaced. You are ordered to repair/replace the distribution box within ONE (1) YEAR. You are ordered to repair or replace the septic system within two (2) from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PE R OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Further Eval\105 Beechwood Rd Cent Oct 2015 . "� Town of Barnstable + lARN3IAHLE, ' b 9 ,�� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year.not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation ` of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER J d—box- Repair deadline: e f Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc LOCATION SEWAGE PERMIT NO. INSTA LLER'S NAME i ADDRESS Cw ry oak 1/0 B U I L D E R OR OWNER DATE PERMIT ISSUED DATE C 0 M P L I A N C E ISSUED 2 .. ' , ^ , �� ��i O '""\ �� �� ., ., ,. I - Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Z Owner `_z Owner's Name �X information is M, required for every West Hyannispopt MA 02672 9-19-15 page. Citylrown State Zip Code Date of Inspection ""j) �;K•t 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 �� �p.,,tttrtttr' /'SS on the computer, ����� 1N�F use only the tab 1. Inspector: -0 4 '•9c key to move your cursor-do not James D.Sears JAMES ;m use the return Name of Inspector c c�i key. _ Capewide Enterprises,LLC l'• On O :Q r� Company Name '� 153 Commercial Street ��441111H,Nms4% `` Company Address few Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number 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 was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-12-15 spector'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. �o��' VS t5ins•3/13 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 �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every West H Yannis post MA 02672 9-19-15 page. City/Town State Zip Code Date of Inspection 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: Failed system - leaching. The system is a 1500 Gal. Tank D Box and pit. 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-3/13 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 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is West Hyannis ost MA 02672 9-19-15 required for every p page. City/Town State Zip Code Date of Inspection 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 15.303(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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every West Hyannispost MA 02672 9-19-15 page. City/Town State Zip Code Date of Inspection 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 is less than 6" below invert or available volume is less than '/day flow /�, t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every y West H annisp ost MA 02672 9-19-15 page. CityTTown State Zip Code Date of Inspection 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 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. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria"indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is West Hyannis ost MA 02672 9-19-15 required for every p page. CitylTown 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? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every West Hyannispost MA 02672 9-19-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D. Box and pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-67,500Gals g ( y g (gp )) 2014-75,750Gal's Detail: Sump pump? ❑ Yes ® No Last date of Present 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information fo is every West H annis required for eve Y post MA 02672 9-19-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M s 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every WestY p H annis ost 'MA 02672 9-19-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1979 Permit # 726. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" feet Material of construction: ❑ 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.): Pipeing is 4" PVC SCH 40 & SCH 20. Septic Tank(locate on site plan): Depth below grade: 10" 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: 1500 Gal. Precast H-10 Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is p required for every y West H annis ost MA 02672 9-19-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and cover's at 10" below grade. Inlet tee, No outlet tee or baffle. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every West HY p annis ost MA 02672 9-19-15 page. City/Town State Zip Code Date of Inspection 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M ,•�''� 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is West Hyannis ost MA 02672 9-19-15 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-18 Below grade w/one line out. Wall's are gone on box. Need to replace D Box. 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: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every y West annp H is ost MA 02672 9-19-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ 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.): Leaching is a 1000 Gal. precast pit. Pit and cover at 16" below grade. Pit is full, not leaching. Need to replace leaching. 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 J Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is required for every West H Yannis 0 p st MA 02672 9-19-15 page. City/Town State Zip Code Date of Inspection 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.): M t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is West Hyannis ost MA 02672 9-19-15 required for every p page. City/Town State Zip Code Date of Inspection 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: ® hand-sketch in the area below ❑ drawing attached separately 66 yo, El 0 3 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is West Hyannis ost MA 02672 9-19-15 required for every p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N© Estimated depth to high ground water: 10'-6" feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Auger T.H. 10'-6" No G.W.. Bottom of pit at T 4" below grade. Bottom of pit at 3' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I , . ter, • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 43 Greenbrier Lane Property Address Damaris Skala Owner Owner's Name information is p required for every y West H annis ost MA 02672 9-19-15 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i Town of B• iInstable P# — Department of Regulatory Services • Public Health Division Date�Z _ v "ADM S . � i659, $ 200 Main Strem Hyannis MA 02601 Date Scheduled Tune Fee Pd. — I oil suitability Assessmient fog- Sewage Disposal do Performed B t/li Y V C/t^ �i Witnessed By: MUJI/If. 1 ' i LOCATION & GENE I L INFORMATION n Location Address 3 no O �}/ Owner's Name S�/d\ :(-y��fJ 1Cisi�jt A;,� ' Address t°�/1/ Assessor's Map/P4rcel: V(o 1 J•®7 8 �ol O I Engineer's Name r �-f'�v S ►j /Yl ' NEW CONSiRUtON REPAIR 1 Telephone# 57,08' 360 —3 l 1 Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet!Area ft Drinking Water Well ft btainage Way ft. Property Line ___.___.ft Other ft � SKETCH:($treet name,dimensiods of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to holes) : i • I i I , i I - Parent material(gedlogic) ""� u V �S Depth to Bedrock '• Depth to Groundwater. Standing Water in Hole:' Weeping from Pit Face Estimated Seasonal ifth Groundwater N �� DINE TION FOR SEASONAL HIGH'WATER T"LE Method Used: ! __in, Depth td SGII mot[h9: In. Depth Clbserved startling in obs.hole: I in ©roundwater Adjustment tt. Depth toiweeping from side of obs.hole:, i _ A� fVtor-•.,,�-� Adj.Groundwater Level— Index Well# - Reading Date Index Well levrl - - PERCOLATION TEST Date T4fie Observation Tinte at 9" Hole# i tt Time at V Depth of Perc 2 . 1OO J i' Time(9"-691 Start Pre-soak Time.@ / -- 1 End Pre-soak Bate MinJlnch Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed Site Failed; Original:.Public Jialth Division Observation Hole Data To Be Completed on Back— -- ***If percola>yibn testis to be conducted within 100' of wetland,you must first notify the Barnstable C41J servation DiNision at least one(1)wedk prior to beginning. D VS DEEP OBSERVATION HOLE LOG Hole# .; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel �8N Ua Mnn r�Y�3fv �i a q�► b -31 rh An e (0/10 1-5 ti, < DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) boa&1 ,na 6 DEEP OBSERVATION HOLE LOG Hole# A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ravel) .r Flood Insurance Rate May: Above 500 year flood boundary No Yes _ Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification ' I certifythat on 10 5 (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the require n ,expertis and experi nce described in 3:10 CMR 15.0 7Signature Date 3 Q:\SEPi7CVERCFORM.DOC C7F 7�? ................ ........ THE COMMONWEALTH OF MASSACHUSETTS —,---BOARD OX HEALTH _!...............4&�---.....OF...-.... V ................................ Appliration for Bispoiial Works Tomtrurtion ran fit Application is hereby made for a Permit to Construct l< or Repair an Individual Sewage Disposal Sys3t9m)at: d5pzd--- 4.. ........................... ......... ....c47-A-1Z.Ove� Location- Lot No. -7zj, 4 4;�Wlefe . e ��/�!Y 4 � 1� ............ .................. .... .........3�zg� Ow Addres.r.. Wa .................... cr................ ..................................... .. ......... .......................................... Installer Address Type of Building Size Lot.//Vj. ....Sq. feet U Dwelling—No. of Bedrooms----------�---------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ......................................................................................................�.......................................... Design Flow............................................gallons per pers6ii--per day. Total daily flow--____--. 30..................gallons. W Septic Tank—Liquid capacity/50M.gallons Length________________ Width-_-_---_________ Diameter---_----____--_- Depth_._..__.___..... Disposal Trench—No. .................... Width...... /----------- Total Length...........7...... Total leaching area.._...........___ sq. ft. Seepage Pit No-----------/..... Diameter.... ........ Depth below inlet...4�........... Total leaching area..O. q. ft. z Other Distribution box � Dosing tan Percolation Test Results Performed by---------- ......... Date...... ........ Test Pit No. I-------;?-----minutes per inch Depth of Test it---AR......... Depth to ground'water.......Vaw..o Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...__..............._... ................. Description of S 7 f 0 oil........... ......................��0410,osf ............................... ....... . ------------------------------------------------- -------------------------I------------1-------------!�............d-4-e-W-5.c...... ................................................. ............................................. —----------c�4�_ 1=------- ................................................................................. U Nature of Repairs or Alterations—Answer when applicable---........................................................................................... ................................................................................................................................................................................;....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Test provisions of'TTIE, 5 of the State Sanitary Code— Ye undersigned furth grees not to place the system in 'ur"'operation until a Certificate of Compliance has been issujVby the 0 d of heal Si ,ed ............r .. . .. .... ........... .... Application Approved By........ .. ............. . .. . . . ... .. . ........... ---- Date Application Disapproved for the following reasons:....................Y..................................................................................................... ---- ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date tNo,.. 7(�.... Fps • 1�............... -...- THE COMMONWEALTH OF MASSACHUSETTS Of HEALTH l - __.f .. 0�.........OF.........,...,...... ...0007..5..: . ! .......................................... Appliration for Disnogal Works Tonitrnrtion Prrmit Application is hereby made for a Permit to Construct �) or Repair ( ) an Individual Sewage Disposal Y st at• 41 ----- -------- ....... ,r Location- ddress N r Lot No. rrr-4 . ... z -•..... ................. .... %° ........ j � t. ._ Owner Address at '.. '.. ! ? . '. ... ....:: �. ..................................... . Installer Address f ++}}rr Q Type of Building Size Lot_l _. '. .....Sq. feet U Dwelling—No. of Bedrooms.__..__.. ________________ Expansion Attic Garbage Grinder�6 �+ -•-- PL4Other—T e of Building No. of persons............................ Showers — Cafeteria 04 WDesign Flow.Other fixtures -----.....gallons per person per day. Total daily flow_______ ��....................gallons. WSeptic Tank—Liquid capaciA, WO_gallons Length................ Width................ Diameter_------------- Depth................. x Disposal Trench—No. .................... Width..._.__........... Total Length__.....__7....... Total leaching area------ sq. ft. Seepage Pit No........../...... Diameter----1�........ Depth below inlet..-........... Total leaching area.. I�.sq. ft. Z Other Distribution box Dosing to }� `" Percolation Test Results Performed b -•_:_�� ! f-!rr .__..0 t!Sl+--•---_-- Date... � �� ... . minutes per inch Depth of Tes pit . _._...... De th to oun,d"water-.___._,,-a Test Pit No. 1..... ._._ p p p gr (14 Test Pit No. 2................minutes per inch Depth of Test Pit__:___•-:............ Depth to ground'water........................ --------- -------•-------•------•---•--------------------•-- D Description of Soil.............6•�._."'� � ����'`��d '�`'"?�...a . --- -- ----- /"------------------------------------------------- Vic" - UNature of Repairs or Alterations—Answer when applicable._____________________________•_____-•••_-.. -__--________--_______._-------___-__.-__•_-______- ••••----••-•-•--•--••--...-••--•--••--•-••-•-•••-•-••••-•••-•-•-•----•••••.............••----•-•••••---•.....•-•-•-•••----•--•---••-•......••-••-•-•.................... ........................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f.i:I"the provisions o 5 of the State Sanitary Code— e undersigned furtl agrees not to place the system in operation iihtil a.Certificate of Compliance has been issue y the d of Ilea ar "' /a S e .�. AY f ..' Date Application Approved By...... f t :.......................... ---r . . Date Application Disapproved for the-following reasons---------=-----------------------------------------------------------------------------------------••----•••-.... • ------------------------------------- ............ J Date Permit No...........................................ti '- Issued.-�[.°� l .' _-,I° . Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD QF HEALTH I. 1 ,.....::. o F...., ..... . ` ...... (90fifiratr of TP utfiaftrr ; THIS Iby S T,0 CERTIEK, T �e Inu vid al Sewage Disposal System constructed, y�or Repaired ( ) ................ i ! 023 in ller Via; j�jo. has been installed in accordance with the provisions of T 1. j of The Stat/Sanitary Cf(de as described in the application for Disposal Works Construction Permit No -----7-9_,1............. dated..... __-________--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS. UE®_AS A GUARANTEE THAT THE SYSTEMWILL FUNCTION SATISFACTORY y DATE...••. �. ....7 / Inspector-•...... <.^�1�. 7 ----------------- `T1 t COMMONWEALTH OF MASSACHUSETTS 7f BOARD HEA TY � 7- ...........��2.an..........OF..... ��T''l`�3 L�....�� .............. ......... 7 ,bd No.. .......... ..... FEE.34)..- Dispooal forkv Tanotruxtion : anti# r� 4 Permission is hereby gra ------------_ __._ --...•-• ------ to Construct or Re air ) an Indiv�lual �ewage isposal StemLoh ' Street , as shown on the application for Disposal Works Construction PritNo ated_.�� ZA 7 71 .......... Board of Health DATE...... % ............. ......................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - 1rt-rU',i&%,.,-","4 s�'��: �:' 1`.+°,¢"Oe'S'!y hr .4ry Il.,m; "S I,G. 11J t ! j1:17 F,:.at,: '`lr a-.. r .�d rt �f .,,1, ,,n. t.#. , °:S -.�;';n'./M JS `� K �" i ,�`f f.. .°� r ,`Jr' .. !,! r y4., l 1 .4 1 t ..:. ,. 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R r +;, t 5 ! �RMOJTti MASS 4IHYANNdS, MASS. �,,, _... �' SQ°"'� '" r SHEET:�L OF.'2- DA E REG LAND SU VE.�OtI! 1,.an ..pr11,.. r -7 v &FLO .-jc"A 'PAP 14 5� le r AO "�4� -_- � �Z 710 AMe.NA.4 CONGRGTE -be M.,-ve, pi pz so I e-4 V Y CA S77 o Tc Y- COPER5 -7-- k- C4AAAl -TAN,0. Ape - X&I- 7 e� IM Un � ,&AC 2"LAYER S7 r A P/re,# J/8 dop to f 0 0 WASHED 5M. . NE JlmrO.t�/e-0. rAAO'I< D157. p jw 314— p WA SN.4=,p 177 I .- PRECAST S...&RA&C I I.all P/7 OR JMVIV. 'IAWMA"r ZARVA77 0 1AM. ZAT AT ffUll-DIMC, r INLc Z-7* SEPTICr4M.AC -!!L� r- E TAB , . OUTLET SF 741 C.7A I VJK., r T`�� GROUND WATER TABLE :1NXFrD157R1A'31'710N BOX--=7, SECT/ON OF. 04'rLEr 5'rlTJr,&&-rlON 41 C7 PS7- ICACHIM4 -)CV77-z-,',�� agAVA AVISROSA L S P. MM INLET PIT 7 sul-ATION 4LF-ACHIlVa- j017 $CALE - /OAI A 4 F7 Al -1Z 'T,4,L UNIT SOILLOG 'r4gE '- TEST 0 1;C 714-5 r SOIL dFr *2 ST 'AE577� NUM&AW Owsr L.MCNINZ; P/73 GATE:OF �Sbl "7 SIDZ A.,-.AcNjAcp PER R - ISO JRESIVAr.S PVJ 7-,4�,&SSR10 BY A10 R 00 rro"LaqcYlAlcr PER P/ r 7-0 7A lZACHIW6 AqRA. 7.' ��OF GA M z Aj A/ R OBER - -,p a .-BUNMIS C3 No 2 �2216 3 " 0'4AfAfi,.* V4 C.Z, 4P �9 LOCATION /l . SEWAGE PERMIT NO. /.T,#lo �.(E'e�✓��iF�L VILLAGE v�6�_�� 0,16 Y I N S T A LLER'S NAME i ADDRESS ��o�y G. le%•vim 1l U BUILDER OR OWNER G4j( v DATE PERMIT ISSUED d - � - 7Q DATE COMPLIANCE ISSUED vpp i v13 J LEGEND HYANNIS ' J PROPOSED CONTOUR 1 ® PROPOSED SPOT GRADE MgIAI r ——98 —— EXISTING CONTOUR ST r Q + 96.52 EXISTING SPOT GRADE LOT 11 W— EXISTING WATER SERVICE L� TEST PIT OHO LOCUS r SCALE: 1"=20' 1V i 68 ) 63'25 LOT 10 S GQ- i O AREA=11,370t S.F. \ / N i �10 ! Z l ni \ vo / �_32 pp. �` ' 3g LOCUS MAP � r p LP 10 . o\� it PLAN REF: 337/29 o� „`��\ o TITLE REF: 17787/6,^ T p PARCEL ID: MAP 268 LOT 78/010 ^� 1 TP- ZONING: "RB" r� 2 I J ` �'---_ 1 ' OECK r DR/VE _ FLOOD ZONE: "X" r(� TP-1 ' -y AY 1 j COM. PANEL: 25001CO564J DATED:07/16/14 1, �O OAK I SEPTIC SYSTEM r`r N 32. W-- ' J EXIST. 1 000G #43 w _ ; LLJ REPAIR PLAN N84723 01 W o.Oo � SEPTIC TANK o (� LOCATED AT: TOF • �/ S � rz] 43 GREENBRIER LANE r EL=42.0 HYANNIS, MA. I Lu PREPARED FOR E !W DAMARIS A. SKALA i BM: F ' JANUARY 13, 2016 COR BLHD � EL=42.0 OF A LOT 9 63 25 oy� DA R M. yG E P1- '71 56 140 " S4NITAR\a� pp s. r UPOLE k'r MEYER & SONS, INC. GRAPHIC SCALE I P.O. BOX 981 20 0 10 20 40 80 EAST SANDWICH, MA. 02537 PH: (508)360-3311 71 FAX: (774)413-9468 ( IN FEET ) meyerandsonsinc©gmail.com 1 inch = 20 ft. SHEET 1 OF 2 J 1787 a NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GENERAL NOTES: TOF SEPTIC TANK GRADE SHALL NOT BE < EL:177.50 FOR A DISTANCE INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX 15' AROUND THE PERIMETER OF THE S.A.S. I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL EL.=42.0t OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S. BOARD OF HEALTH AND THE DESIGN ENGINEER. INSTALL LOCKING COVERS IF AT FINISH GRADE INSTALL A RISER OVER DONE CHAMBER (MIIN) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SET TO 6" OF GRADE AND SET TO 3" OF F.G. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE fF.G. EL.=41.2t F.G. EL.=41.1 t F.G. EL: 40.80t LOCAL RULES AND REGULATIONS. F.G. EL: 40.O(MAX.) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR am 0990z"MAW, a TODESIGNNSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE MIN COVER/ y I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING r6L36" MAX COVER L = 20' L = 10'(MAX) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ® S=1% (MIN.) =40.38t ® S=1% (MIN.} 0 S=1% (MIN.) ENGINEER BEFORE CONSTRUCTION CONTINUES. 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" STONE OR FILTER FABRIC' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. DOUBLE WASHED STONE < 10" 6 / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF INV.=39.33 10 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 48"LIQUID HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. IfVEL INV.=39'08 ®®®. O ®®®® PROPOSED a®®®®a®®®®® 7. DWELLING IS SERVICED BY MUNICIPAL WATER. GAS BAFFLE INV.=37.5 ®®®�®®®®®®® B.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED ` INV.=37.7 DB 5 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE EXISTING 1.000 GALLON SEPTIC TANK 3.2 ' 3 X 8.5' 3.25' LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. EXIST. SEWER OUTLET EFFECTIVE LENGTH = 32.0' 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION F12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY INV. ELEV.= 36.5 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY f 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING BREAKOUT 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPEC. ) NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.= 37.50 EL. 37.50 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 36.50; ®B FOR THE USE OF A GARBAGE GRINDER. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ®a 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING GRADE ON A MECHANICALLY COMPACTED SIX aaaaaa®a INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM EL.= 34.50 aaaaaaa 310 CMR 15.221(2) 4' 5 FT. 4' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.30 FT. EFFECTIVE WIDTH = 13' DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 29.20 _ (500 GALLON LEACH CHAMBER) GAS BAFFLE AS REQUIRED N.T.S. DESIGN CRITERIA SOIL LOGS P#:14924 NUMBER OF BEDROOMS: EXISTING 4 BEDROOOM SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) DATE: JANUARY 11, 2016 SOIL EVALUATOR: DARREN M. MEYER, IRS, CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DAVE STANTON, BARNSTABLE HEALTH �01\\ �F MAS`S9 DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOW: 440 G.P.D. �`� �y GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Depth Elev. $ DARREN M. � TP-2 Depth y SEPTIC TANK: 440 gpd x 200% - 880 gpd USE EXIST. 1,000G SEPTIC TANK 40.20 A 0" 40.50 0" LOAMY SAND A 1DYR 3/2 LOAMY SNVO LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. 39.53 8" 39.83 10YR 3/2 8" USE THREE (3 500 GALLON PRECAST LEACH CHAMBERS 36.95 B LOAMY 6/6 SAND 39" B LOAMY SAND Ncl AR 10YR s/s 37.25 W/ 3.25' STONE ON ENDS AND 4' ON, SIDES: 32' L x 13' W x 2' D PERC TEST C1 C 1 39"MEDIUM MEDIUM ® 35.25 SANG g SAND BOTTOM AREA: 32 x 13 = 416 SF 2.5Y 6/4 2.5Y 6/4 SIDE AREA: (32 + 13) X 2 X 2 = 180 SF TOTAL SQUARE FEET PROVIDED = 596 vs. 594.59 REQ'D PROPOSED SEPTIC SYSTEM UPGRADE PLAN -- 2" -- ---- - DESIGN FLOW PROVIDED: 0.74(596 S.F.) - 441 G.P.D. v3. 440 G.P.D. req d 29.20 13 29.50 132" 43 GREENBRIER LANE, HYANNIS, MA PERC RATE <2 MIN/IN. ('Cl' HORIZON) NO GROUNDWATER OBSERVED Prepared for: Skala System Design and Topography Plan by: SCALE DRAWN DATE MEYER&SONS,INC. N.T.S. DMM 01/13/16 • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX961 to conduct soil evaluations and that the above analysis has been performed by me consistent with the E4STSANDWICH,MA02537 REV DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. 5083612922 DMM 2 Of 2 j