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HomeMy WebLinkAbout0165 GREENWOOD AVENUE - Health 165 Greenwood Avenue Hyannis P A = 288 069 r G i Commonwealth of Massachusetts _. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ( on the computer, use only the tab 1. Inspector. key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Code 508 364 0894 1328 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. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority aFJ�"'K �• ��_' IDS March 5, 2011 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 I 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.. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sew a a Di s sar S slamI9 Page 1 of 17 f,9 Po y - I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface'Sewage Disposal System Form-Not for Voluntary Assessments 165 Greenwood Avenue ; Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Citylrown 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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): 15ins•09W Tale 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 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or breal:out or high static water level in the distribution box due to broken or obstructed pipe(s)or due t)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•09108 Title 5 official Inspection Forth:Subsurface Sewage Oisposal System•Page 3 of 17 i Commonwealth of Massachusetts 4, Title 5 Official Inspection Form 'Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1.65 Greenwood Avenue _ Property.Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner ,Owner's Name information i e Hyann.'is MA 02601 March 5, 2011 required for very _ 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 100feet 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: I You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ FX1 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool E a Liquid depth in cesspool is less than 6" below invert or available volume is less than /2 day flow l5ins-09108 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 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue 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 16,000 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. 15ins•09108 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 `Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L: Doll., Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5 2011 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 X❑ ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑X Were any of the system components pumped out in the previous two weeks? EJ ❑ Has the system received normal flows in the previous two week period? ❑ 0 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) M ❑ Was the facility or dwelling inspected for signs of sewage back up? U. ❑ Was the site inspected for signs of break out? © ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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. ❑ Z 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): 5 Number of bedrooms (actual): 4-5 DES.LGN flow based on.310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd (Sins•09168 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is H required for every annis MA 02601 March 5„2011 � page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? ❑ Yes ❑ No Seasonal use? El Yes 0 No Water meter readings, if available last 2 ears usage d 153 gpd 9 ( y g (gpd)): Detail: 2009-2010 Sump pump? ❑ Yes No Last date of occupancy: current Date Commerciallindustrial 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- 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,Pege 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. City/Town 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: owner 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-09= 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 µ — 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis annis MA 02601 March 5, 2011 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age 4+ years. Design lan dated April 11, 2006. Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer (locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron X 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): Depth below grade: 3 feet Material of construction: ❑X 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: 11 ft x 6 ft x 6 ft(1500 gal); Sludge depth 4 in t5ins 09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page:9:of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not.for Voluntary Assessments 165 Greenwood Avenue P�.gperty Address 165:Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is Hyannis MA 02601 March 5, 2011 required for every y _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cone.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 1 in Distance from tap of scum to top of outlet tee or baffle 9 In Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years. Tank appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 15ins•09/08 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trtast; Linda L, Doll, Trustee Owner Owner's Name information is required for every Hyannis MA. 02601 March 5, 2011 - page. CitylTown 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 El 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.): r Attach-copy of current pumping contract(required).is copy attached? ❑ Yes. ❑_ No i t5insr 0V08 Title 5 Official Inspection Form:Subsurface Sewage:Dispospl Sysfom•Page t t of t7 Massachusetts Commonwealth. of Title 5 Official Inspection F�rrr, Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments 165 Greenwood Avenue Property Address 16.5 Greenwood Avenue Realty Trust, Linda L. Doll,Trustee Owner Owner's Name information is H annis MA 02601 March 5, 2011 required for every Y. 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 at outlet inverts 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 appears structurally sound with no evidence of leakage in or out. Few solids.in sump. 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; ns•'09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 t5 P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not:for Voluntary Assessments 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat:) Type: ❑ leaching pits number: ❑ leaching chambers number: 0 leaching galleries number: .1 ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down in leaching gallery. 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•09108 Title.5 Official Inspection Form:Subsurface Sewage.Disposal Symbm.•Page,113of_17 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - No'for Voluntary Assessments r = — 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner. Owner's Name requited for informat,'fgr every Y H annis MA 02601 March 5, 2011. _ page, Citylrown State Zip Code Date of Inspection D. System Information (coat_) 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.'): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts f�� -=,ra Tifle 5 Officia0 �nspecf on Foam - lv:, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments sir 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee _ Owner Owner's Name information is required for every Hya nnis Hy� is MA 02601 March 5; 2011 _ _ page. CitylTown Stale 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: X hand-sketch in the area below ❑ drawing attached separately l , 1 r 3 ❑ � o M (Sins•:0WOa Tit:p'5 Official Ins,ecticn Fcrnr Subsurface Sewage Disposal Sy"siem v Pboe,15'of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust; Linda L. Doll, Trustee Owner Owner's Name. information is required for every Hyannis. MA. _02601 March 5, 2011 page: Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Site:Exam: ❑ Check Slope Surface water ❑ Check cellar El Shallow wells Estimated depth to high ground water: 12 ft 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: 2006pate 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: l You must describe how you established the high ground water elevation: Septic design plan shows bottom of leaching gallery to be over 5 feet above the adjusted seasonal high groundwater table. Before filing this. Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 165 Greenwood Avenue Property Address 165 Greenwood Avenue Realty Trust, Linda L. Doll, Trustee Owner Owner's Name information is required for every Hyannis MA 02601 March 5, 2011 page. Cityrrown 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 M t5ins•09108 Title 6 01ficiat Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 16� �P-EE' WOOD SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL �63 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 1500 LEACHING FACILITY:(type) C21',Y (size) NO.OF BEDROOMS" OWNER L-t 1,4 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: F 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 G(0 TeCM 6l99 3 JAI ZOi I) C7 G N N UOT(�Wk V'1 N TOWN OF BARNSTABLE Lowe LOE I;F',ON /,�0 SEWAGE W,LiAGE ASSESSOR'S MAP & LpOT20-4-1�/�? INSTALLER'S NAME&PHONE NO. T� �' U ' Vow SEPTIC TANK CAPACITY �O® LEACHING FACILITY: (type) G t— ®D i (size)/0 h ,NO. OF BEDROOMS BUJILDER.OR OWNER 4 el PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l W f ' 5 } L' •- I 1 ( � r r zi 5 " SIN 14 TOWN OF BARNSTABLE LOCATION 6re���fG� � ^*���' SEWAGE # VII CAGE k Vq h O a S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) �►Irgi'l (size) ��T, A pp size NO.OF BEDROOMS Qr BUILDER OR OWNER ]'of n+°Ce �06Z LOr PERMTTDATE: 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 EC® b TeCh i Kit ec+I yo) LOCATIONS A B C ,.. I 29 fr 28 Fr • OVERFLOW - 2 24 f T 48 f.1 .x OVERFLOW CESSPOOL 3 29 f 1 15 f Y ` O CESSPOOL O,PRIMARY CE SPOOL O - 8 C EXISTING DWELLING 165 J 'GREENWOOD AVENUE NOT TO SCALE TOWN OF BARNSTABLE -LOCATION S -G►It*- Dot �V SEWAGE # VII,JAGE �a n n S ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r LEACHING FACILrrY: (type) (size) ,N, O.OF BEDROOMS BUILDER OR OWNER PtkM1TDATE: 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 LOCATIONS A B C 1 29 Fr 28 Fi OVERFLOW 2 24 Ft 48 Ft OVERFLOW CESSPOOL 3 29 Ft 15 Ft O O2CESSPOOL PRIMARY O CESSPOOL - I I B C f A IL EXISTING DWELLING # 165 J - 3I GREENWOOD AVENUE NOT TO SCALE No. CAbo eO Fee f J" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ftphcattou for ;Di.5pozar 6p5tem Con!5truction Permit Application for a Permit to Construct( . )Repair Upgrad ( )Abandon( ) Complete System O Individual Components Location Address or Lot No. H.5 G2?EMN AVM, Owner's Name,Address and Tel.No. L 1-1Y4N�oS - Assessor'sMap/Parcel Lori Gq M4117 2 Installer's Name,Address,and Tel.No. .pa'S "CP.-1 100C.AAd .Designer's Name,Address and Tel.No. 0 _, -T S® Lie e e 3G 0,3 q Type of Building: � Dwelling No.of Bedrooms Lot Size 132,25Ysq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S&B gallons per day. Calculated daily flow S 6 9 gallons. Plan Date t%✓DV 'ZQ 00!s Number of sheets Revision Date Title Size of Septic Tank ISM Type of S.A.S. . �/ d 9l C-94A4 Description I Soil 'rP 1 -A C) _-1 j1 S� � ."711 �!m�l I.� � :'�C��� M e, s A to f) Nature of Repairs or Alterations(Answer when applicable) j P r-aAMi 9.��L& w rm io a ras 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 provision Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is e y Bo2sd of Health. Signed Date Application Approved b 1 Date /9 Ap lication Disapproved or the followi g reasons Wit & 1erue q�u Nee Corr9 o,Vr an v. Need r l rt- >3 Permit No. Date Issued 4 --------———————————---—————— —————————————————— b /n Perks t �- - fi; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVIS­4 leeION -TO.V01710F BARNSTABLE., MASSACHUSETTS Application for Miz o'441 *proem Construction Permit a Application for a Permit to Construct( )Repai )�Upgra e( )Abandon( ) it Complete System ❑Individual Components Location Address or Lot No. Avro Owner's Name,Address and Tel.No. L 1,w 0 A DOLL r w YQ t--) s 2�8 Assessor's Map/Parcel `OT 9 M�^� Installer's Name,Address,and Tel.No. P99S 1 Clrl-'G 'E)[GAVAT Designer's Name,Address and Tel.No.eC 0 -.. j�G t, V. P.0 aco,4 R.S9 r_6 nZVT0*-%46 �-A w y$ 'f2,p.,vts GI Q_C X SY-aNOw,+✓�1 (Sob) yZ8- 936rd 10-a - 3(0 y- D8 9y Type of Building: Dwelling No. of Bedrooms Lot Size 131551 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers,( ) Cafeteria( ) Other Fixtures Design Flow J`L 8 gallons per day. Calculated daily flow S(,8 gallons. Plan Date NOV 2$ ZAOf Number of sheets 'Z Revision Date Title F Size of Septic Tank /Sd"O �-"Type of S.A.S. y S OO A/ C.WXi1tMBt5S Description of Soil: ( A O '7 N 5 l., 6 `7 it -3(.11 LS C 3(o -5-7 M c S A x)D M 5-7 13 L' {SAS Nature of Repairs or Alterations(Answer when applicable) V P 6P. C% C,GSJ+*)06I-S� 111A 1j Ymsr. Date last inspected: r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio s of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i4tie ,"yfAt B, d of Health. Signed �A�T "EAC tDV Ya'Y't Date - S ` 0� Application Approved by ' Date Application Disapproved for the following reasons Ll (� tl& NCr' (�'lotuc orC'G, JUopc% (urrV(�far Ur C"i r tops r�up. �Jc�Pcd VHr'v.�rc i S'4s >3' e�p. r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS.._.,. y BARNSTABLE, MASSACHUSETTS ! (Certificate of Comp ance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by P As T'ortz E><C,A V Ps'i(t5N at 1 to S GQ-aC- ,wi9 d-D Ay-6 4A •y lA NN 1'S has been construct d i�y a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No.19O U(s�V/dated y ��Y/ Installer Py%5"FC"tZ GXC-Ay1-M-1`T." Designer Cosa "TEGA-� Ej..ivl Rc Nt$'` �2-- The issuance of this p 'it h not be construed as a guarantee that the systmwte Qs designed.Date a � Inspector , t No. 6q ----------------- Fee � O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5ar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at I G,S GwevNyio'C5Q Milo A--I.J1v'1 5 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: Construct 1st completed within three years of the date a this pe t. Date:_.- l/ Approved by ' Town of Barnstable Regulatory Services Thomas F. Geiler, Director a 9 $ Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: t: ao� Designer: Ll( v'd A I ( F, ceWkr Installer: Address: 43 W qg le Cirrc Ito Address: b9Wal� �r On was issued a permit to install a 1 (date) (installer) septic system at (05 60.'l°k woad k )ko based on a design drawn by (address) (_00A*q&OW Y dated t i z`• (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. eat �sy'stem) ateral elocation of the SAS or any vertical relocation of any component of the septi but in accor ance wit tate & Local Regulations. Plan revision or certified as-built by designer to follow. _tt1 OF gs�c moo? DAVID yG� (Installer's Signature) COUGHANOWR N No. 1093 GISTS i S SRNurrARk (Designer'sSignature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Town of Barnstable P# Department of Regulatory Services I _ Public Health Division Date )o b • .xnxsrneie. = gadMAKR- 1659. `6� 200 Main Street,Hyannis MA 02601 4 � p Date Scheduled N i k 2005 Time '0 iT m Fee Pd. '®d Soil Suitability Assessment for Sewage Disposal y: oxui� �d� IDOia41d �eSw14i'Ui° , Performed B �• �IM1Ut.✓r 1�� Witnessed By: LOCATION & GENERAL INFORMATION Lceation Address Owner's Name L NOA 001,t- �lciCj �'��yL'W' TT11 1 tYa k h/S Address, 3 Rooi—e 130 ©�f-dale, Assessors Map/Parcel: En ineers Nam Q %vi D COL*H 4Now P- �S NEW CONSTRUCTION REPAIR V Telephone# 5019 3C4 QSq1 Land Use WerS 1 deof1 Q l l qty IA Slopes m_ Q __ Surface Stones Distances from: Open Water Body] 100f ft Possible Wet Are L6 - Area t ft Drinking Water Well L00+ ft Drainage Way (0 ft Property Line `v ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Z I 135-0�fr� i r j 49�1 r° 45.02Tf / Parent material(geologic) V-6 aeaal 00twe5 Depth to Bedrock 40 ite' Depth to Groundwater. Standing Water in Hole: Y4 Weeping from Plt Face ©� Estimated Seasonal High Groundwater 747 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 05 yhab( i ndiC.qte Depth Observed standing in obs.hole: ____ _in. Depth to sail mottles: in• Depth to weeping from side of obs.hole: in, Groundwater Adjustor—.R tt. Index Well# ( %W-19Reading Date:Q— d Index Well level_.A.� AdJ,factor' .•C Adj,(Iroundwater 1,eYcl 7 �OGtGg PERCOLATION TEST Date y! ,6 E —AM Time Observation + `Z Time at 911 —i ".— N Hole# / Depth of Perc 6.-, i h 5�' 66�ivl) Time at 6" ,V,�� N` ;3 6 Start Pre-soak Time @ ff 10',61 Time(9"-6") .. End Pre-soak l o g(� i d' I (�ell S fi ha a C( 1 N) Rate MinAnch 2 SVIp t 11'I P t Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division-,• : Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\.SEPTIC\PERCFORM.DOC i NO GROUNDWATER TEST PIT I PARENT MATERIAL: E ROOGLACIALDOUTWASH ELEVATION - 25.55 PERC AT 63 in : 2 MIN/INCH IN C SOILS I . FN EPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER - CHES) HORIZON TEXTURE (MUNSELL) MOTTLING f25.55 R. 0-7 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE ' 4 7-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE j 22.55 36-57 CI-- MEDIUM TO 10 YR 4/4 NONE LOOSE COARSE SAND 57-132 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE 14.55 NO i TEST PIT 2 PARENT MADTERIAL: E ROGLACIALDOUTWASH ELEVATION - 25.30 PERC AT 56 in : 2 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE, (MUNSELL) MOTTLING 25.30 0-6 Ap SANDY'LOAM 10 YR 2/2 NONE FRIABLE 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 1 22.30 36-68 CI MEDIUM TO 10 YR 4/6 NONE LOOSE COARSE SAND 0 14.8 68-126 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE 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 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsiste I t Flood Insurance Rate May: Above 500 year flood boundary No` Yes _ Within 500 year boundary No Yeses Within 100 year flood boundary No Yes Death 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? Ye�� - If not,what is the depth of naturally occurring pervious material? . Certification I certify that on 11 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signaturej<Z• ��++'� I^� Date Q:\SEPTIC\PERCFORM.DOC • f ECOJECH Environmental ,RCEh vvww.eco-tech.us IV THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 165 Greenwood Avenue Hyannis Owner's Name: Barry and Janice Baker ,{y Owner's Address: 2810 North Dixie Highway i- New Smyrna Beach,FL 32168 Date of Inspection: December 9,2004 Name of Inspector: (Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental Mailing Address: 43 Triangle Circle Sandwich,MA 02563 Telephone Number: (508)364-0894 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: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature ZO� �• �S Date: 2< 12� �d�- 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 NOTES AND COMMENTS Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CM R 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no,or not determined(Y,N,or ND). in the_for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not),is structurally unsound,exhibits substantial infiltration or exfiltration,or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level 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 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 four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed I ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fall 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and. the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3)OTHER 3 i Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 D)System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore, the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E)Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes" to any question in Section E the system is considered a significant threat,or answered "yes" in section D above the large system has failed.The owner or operator of any large system considered a significant threat under section E or failed under section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 i Page 5 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? Y Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A) Y Was the facilityor dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? including Y _ Were all system components,exeludixg the SAS. located on site? N Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees material of construction,dimensions depth of liquid, de th of sludge and depth of > 4 P P g P scum.? Y _ Was the facility owner(and occupants, if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y _ Existing information. For example,Plan at the Board of Health. Y _ Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CUR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept. Number of current residents 1 Does the residence have a garbage grinder(yes or no): no. Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection requiredl Laundry system inspected (yes or no): n/a Seasonal use(yes or no): no Water meter readings, if available(last two year's usage(gpd): 330 gpd Sump Pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqft/etc.): Grease trap present: (yes or no)_ Industrial waste holding tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no). Water meter readings,if available: Last date of occupancy/use:_ OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS Source of information: System not pumped in recent past(Owner) 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 X Single cesspool X Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe) APPROXIMATE AGE of all components,date installed(if known)and source of information: Age: 16+years—overflow cesspool added 6/27/88 Board of Health files) Were sewage odors detected when arriving at the site: (yes or no) no 6 f Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 ft Material of construction: X cast iron _40 PVC other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage,etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK:none (locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (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: none (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal _fiberglass_polyethylene other(explain) Dimensions: Capacity: gallons Design flow: _gallons/day Alarm present(yes or no):_ Alarm level:_ Alarm in working order(yes or no):_ Date of last pumping: Comments:(condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: none (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 is equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) PUMP CHAMBER: none (locate on site plan) Pumps in working order: (yes or no) Alarms in working order: (yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located, explain why: Type: _leaching pits,number _leaching chambers,number _leaching galleries, number _leaching trenches, number, length _leaching fields,number,dimensions X overflow cesspool, number 2 —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Soils above overflow cesspools appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation, or other evidence of hydraulic failure was observed. Cesspool#2 was dry and cesspool#3 had 26 inches between tom_ of effluent and inlet invert CESSPOOLS: 1 Primary (cesspool must be pumped at time of inspection)(locate on site plan) Number and configuration: 3 total— 1 primary and two overflow described above Depth-top of liquid to inlet invert: 3 inches Depth of solids layer: 4 in Depth of scum layer: 2 in Dimensions of cesspool: 5 ft x 5 ft approximately Materials of construction: concrete 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.): Soils above primary cesspool appeared unsaturated. No evidence of surface ponding,breakout,lush vegetation or other evidence of hydraulic failure was observed. PRIVY: none (locate on site plan) Materials of construction: Dimensions:_ Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100'(Locate where public water supply enters the building) LOCATIONS A B C 1 29 ft 28 ft OVERFLOW 2 24 f t 48 Ft OVERFLOW OCESSPOOL 3 29 f t 15 f t O CESSPOOL O PRIMARY CESSPOOL O B C A EXISTING DWELLING # 165 J Z J W W H G 3 I GREENWOOD AVENUE NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 165 Greenwood Avenue Hyannis Owner: Barry and Janice Baker Date of Inspection: April 10, 2004 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 15+ feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators, installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Barnstable GIS department records indicate that property is over 15 feet above groundwater table. 11 a r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form RECIIIVED GSM Inspection results must be submitted on this form or on the official itle s eoti r ated 6/15/2000. Inspection forms may not be altered in any way. Y ��' m A. Certification TOWN OF BARNSTABLE HEALTH DEPT. ' Important: When filling out 1. Property Information: forms on the computer,use 165 Greenwood Avenue- Hyannis only the tab key Property Address to move your Barry and Janice Baker cursor-do not use the return Owner's Name key. 2810 North Dixie Highway Owner's Address Q New Smyrna Beach FL 32168 City/Town State Zip Code Date of Inspection: May 13, 2005 Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental 1 Company Name r_a 43 Triangle Circle Company Address Sandwich MA a 02563 `- City/Town State �� Zip Codg— CO 508 364 0894 CrIv :7'1 fz Telephone Number Certification Statement: ut m I certify that I have personally inspected the sewage disposal system at this addre s 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 ❑ Fails ❑ Needs Further Evaluation bythe Local Approving Authority q,..sQ, �• � J�s May 16, 2005 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system 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. t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 I� � Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments M Subsurface Sewage Disposal System Form A. Certification (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5-2050.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG M Subsurface Sewage Disposal System Form A. Certification (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: 1:5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's'Name Date of Inspection 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 '/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 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. 0 ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,.provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 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. t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form } Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM A. Certification (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection 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. t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form B. Checklist 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection 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 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 System Absorption S p y m (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(3)(b)] t5-2050.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a— no plan Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 184 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other (describe): I t5-2050.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 16+ years. Overflow cesspool added 6/27/88 (Board of Health Files Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): NONE 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 ❑ Yes ❑ No certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis Ma 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended every two years. Tank and tees appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) 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.): 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2050.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System- Page 12 of 16 l Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG M Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: Z ❑ 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.): Soils above overflow cesspools appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Overflow cesspool#2 was dry and overflow cesspool #3 contained 1 foot of effluent t5-2050.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 3 total — 1 primary, 2 overflow Depth —top of liquid to inlet invert 3 inches Depth of solids layer 4 inches Depth of scum layer 2 inches Dimensions of cesspool 5'x 5' approximately Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils above primary cesspool appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. 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.): t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection 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. LOCATIONS A B C 1 29 ft 28 ft OVERFLOW 2 24 ft 48 Ft OVERFLOW CESSPOOL 3 29 ft 155 f t O CESSPOOL O PR MARY CESSPOOL 6 C A EXISTING DWELLING # 165 J Z J K W 3 I . GREENWOOD AVENUE NOT TO SCALE t5-2050.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 165 Greenwood Avenue Property Address Hyannis MA 02632 City/Town State Zip Code Barry and Janice Baker May 13, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 15+ 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 15 feet above groundwater table. t5-2050.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 TOWN tOF,cJ3ARNSTABLE Ur; ATION 16 S G ree�v-N ave,SEWAGE # VILLAGE A"-/O�Y\y, !�!®(`-)S ASSESSOR'S MAP & LOT 4, -so►� 5 INSTALLER'S NAME & PHONE NO-QS', ��d 4,Ake,C '?7 S`M335 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (s► � Sa��91�- NO. OF BEDROOMS -S PRIVATE WELL OR(PbBLIC WATEj�p t&�_ BUILDER OR OWNER'�Q,i��.t' �. ` 1 �1 'C V a P_ DATE PERMIT ISSUED: h �- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� 5� �� � %�� � c� 0 � i �%�„� I � ���� ��-s� �v e c✓ • � ._ , -----�_ No.. .:.� FEE_$..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..-T-own.................OF.............B.ar.nst.ab.l-e--------....------.-•--------------------- Allp iration for Dhip a al Works Towitrnrtion ranat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: a�axt�.s-----•............. .....•-----------•---•---••------...---------------•--....-----------•-•-•-•--•--•-••--•---------- Location-Address or Lot No. Jally 11,1�11 ----------------------------------------------------- ..........--..................................................................................... Owner Address WP.M?c4i11 ........................................................ ---•---••-•-•---•..........................--•---......-•-----•-----•----------......---......--.•-- Installer Address Type of Building Size Lot............................Sq. feet U Dwellings No. of Bedrooms......... .................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------•--••------•--------•••-----•-------------------------•-•----------•--•-••-------•----•---••--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__---_--______ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1_---------_.....minutes per inch Depth of Test Pit.................... Depth to ground water-.--__.-._-_____---_---. G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................__. Depth to ground water.._.--_--_-____--_-----. 0 Description of Soil-------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- x sand & gravel V -•------•-•------•----------••---•--------•--•...................•-•• • ---------------......-------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable.______________________________________________________________________________________......... ---------------------------------------------------------------------------------------------------•-1-10 0 0---_q a l l o n -leach pit. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTL LE A p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by�board f healt � � Signed__ �{�/ g(�j � �`� = 6-.-27 -58.... Date Application Approved By............ ............ . Date Application Disapproved for the following reasons:-----•--•--•-•-------------••--------•------•-•-----•----••--••-------•-•--------------••-•--•------------.---- .................•--•----...-----•--------•--------------•••--•--•-•---••-----•---••-•--•--.....--------•-••----•--------------••---••••-•---...------•••--•--------•-----•-••------•---...-•--••------. Date Permit No.-------- ------------------- Issued--------------------------- Date I No.._.A_..3 2!? Fss.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH >. OF. B-11. App iratiun for Binpunal Works Tomitrurtion runat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........LfrS---L ti .lea ..:I:Ty t�aLi .................. ......•.............._....._......_.........................................._._.................. Location-Address or Lot No. ..._.....:1.6� ��1...3w��J.i nia..----•--•-------•-------•.......................... ..........--...................................................................................... •� p Owner Address .....................................................^ Installer Address Type of Building Size Lot............................Sq. feet DwellingXX No. of Bedrooms.........3________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------• -•- -_• - -------------------------------------------•-------•-----------•-------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit_................... Depth to ground water........................ P4 .....................--•----•-•-•-------•-•-••------•-••...........•--.._................----•--•---••------•------••--•--••••--•---------•••••-••---•--•--- ODescription of Soil........................................................................................................................................................................ W sand & cctra`rel U •••-•-•-••...................••--•--.........._..--••--......._...........---•--..._.__...- ..._......_.._...---------•------------•------------•------------.....-••----•---•-•---••-•--••••-•- W UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ----------------------------•----•------------------•-•--••---._..._._...------------................. .-3.�Q�......� c�I - _vaGl1 �i.t-°-----------•-•............... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I T i. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thd board of health Signed.I 1 ry ??.r_. -/:-..... .*..t°/L....'............... , ......... .......... bate Application Approved By.............. ................................... .............I',' Date Application Disapproved for the following reasons------------------------•----•---......------------------------------------------•-•...--•--•••---•••........_._ -•------•-•----•-----•--•-•----•---•--•...............•-•----...--•...........--••--...••-•••-•----•-•-•-•--•--•-•-----••---•-•---•-•---•-•-•---•-•-•••=----•----------•-•----•-----•••------•--------•- �i Date Permit No.........b c5 .� .. �................. Issued_......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............4.'PK!,................OF.........P3 .... ............................................ (IntifirFate of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Q 1) -----------------------•-------•----•------...-------•---•-----------..........------------•••. ----------- 5 _ at........".._ _• r roanue ot. Ave HyannisInstaller .._..-•-•-••--•-----•---- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.__.��.:______.._D�--��--........ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ... .7..... .DATE........................�P • ....._. ......0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Tow.n..................OF.........Ba.r.n.s.t.ab.l.e............................................ FEE... OO Disposal Work, Tonu#ra ion rruti# Permission is hereby granted............ _.I?_.Macomber ......................••. ---•-•---------.......-..-••-......---•.................... to Construct ( ) or Repair (KX)t an Individual, Sewage Disposal System at Nol§§.Greenvood AVe R H;yannl ....._-•........ --...................__.... Street r as shown on the application for Disposal Works Construction Permit No .__ Dated.......................................... •-•..................•- Gr°�7 r 8�............................... Board of Health DATE-------•............................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS FL O N PROFILE ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS -VENT � PIPE `TOP OF FOUNDATION RAISE COVERS TO WITHIN / EL - 26.84 +- 6 in OF FINAL GRADE m ONE INSPECTION RISER FOR LEACHING GALLERY 25.75 /D-BOX 4. 2" LAYER OF 1/8" P H-20 e' 1/2" STONE 3" DRO FLOW LIN 21.75 18" 1 - 14' H-20 LEXISTING 48" GAS�� PRECAST 3/4"-1 1/4" BAFFLE DRYWELL STONE 6 in '`"? BOTTOM OF 21.50 STON SOIL ABSORPTION D BASE 21.15 LEACHING SYSTEM 21.75 6 in STONE BASE_ 21.32 GALLERY5.00 Ft + 21.00 15�� GALLON (END VIEW) ig.00 15 FL SEPTIC TANK 1 1 Ft of 6.5 f t 12.5 Ft USE H-20 UNIT bl 15.5 F'- ADJUSTED y 7.7 SEASONAL HIGH z o a n rn rn�o z � � � I\j GROUNDWATER Rl�y mm d �0�� -,l�o� m I x C) 3mOX Z�O� � -� oama: -0 Z3 Z� ���� � `� ���� �a F_ OS Z� m0 C � x �Oz -�z <co�, Znl� -I rN --Izao 00 O� (nrnz0 OyC Rl � CD0� �O zm m z >_urn (j)7� 3 0 --N r�� �� z6"ICI __ --� r o� F_ - C Zm O O .jc: �c� 0-1 1O�F\J m r� 3 -ice y�y �, I -� CDz. �71� �O�Z Z►Tl0 1 N�--� -I j UNj crn1z� LD (� �Z O�ORI O � - O� ed �1 z Z`I rn 1M1 zt NDIldDf Jn 1 0�a rn d z y y o N' N°IlIC]O • rnl�l 1 Fq 7) 0A1rn' T 11 S� � I_1 1 QD CA < 1 I z m � m � � -4} mz �' O rn� 1 X I n \ _ 1 m m �NIISIX� Q1� F ❑ � 1 1 o O m �. dM F_ z tP C O Z 1 t a�1 1 z c'q0� -Z �NI� O � gz +� Z0 � ' rn � � �`I. o��C o � O � z � O �u O N m A` N1�01 O O r CDI �� Cm O O a a W 1 ry � Q D `I 0.01 1 M a31nc�ll` 1 rno R11�OO m F- O rn �-1 Sd`U I1VONnQ� � 1 cn m z �N NO 1 z• � �mw� O �� �� oz Od-IS ° rnz D I Corn-( -Zi z y tiFT] . M� -o ,Fq I —1 z d i 8d'IS ICI o7 n ONnO� 1 o Z I I �Ild ��d I 1 F_ O m °Ilnlnj z z 3� m 1N CD Zz oom=m rn _E5>� -I W LTIcy)rn N 13 t /� �r=> N �7 O 1 1 , fV� r -� ?J =mrnz fV y I M H >�� �' z -� rn cn Ul c� z Z m ITl N �o z F- Erl :F: ;U 0 OD m��m O fTl n 00 < 0o orn nx rn 0 o z E ry G) F rn < X CC COM�jON (!1 N m o `r' cn C c -I _ �'��o c vz x < Z ?n ' I z Sc���F� Z rn> a '—' rn z ,� rn �,a o � z a '�'3 O o z C17 > m o 'v � y -{ O o>_� _ O O C17 Fo`'' a�� X C � rn a ti m r m� n Z � ---I , Z Z Z I O 2� ro >o om� = 3 > m ITl -001 U'z _ 3 rn z F- r _ F n o m z Z \ Z Z l O > / _7IVSNIVW mmr N � �OZ � � �' fv O � � C m cn C�JI 3 • D O rn rn z D o m= Z O > N3A QOOMNSS6O m 3n V 17 DATE OF TEST: NOVEMBER 14. 2005 SOIL TEST L 0 G SOIL EVALUATOR: DAVID D. COUGHANOWR, "RS DESIGN - CALCULATIONS WITNE-SSED, BY: DDNALD DESMARAIS. HEALTH DEPT. , PERC # 11145 1DE'SIGN FLOW: 5 BEDROOMS X 110 GPD = 550 GPD NO ARENOTUMAATERIIA :NDWATER EPROGLACIRALD OUTWASH SEPTIC TANK: 550 GPD X 2 DAYS = 1100 GALLONS TEST PIT I P ELEVATION = 25.55- +- PERC AT 63 in 2 MIN/INCH IN C SDILS INSTALL H-20 15ZO GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE A H-20 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 52 FL x 10 Ft- x 2 FL LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 25.55 Abot = ( 52 x 10 ) = 52Z sf 0-7 Ap SANDY LOAM 10 YR 3/2 NONE FRIABLE Asdw = ( 52 + 52 + 10 + 10 ) x 2 = 24B sf Atot = 766 sF 7-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE Vt 0.'F4 x 76B = 568.32 GPD 22.55 36-57 C1 MEDIUM TO 10 YR 4/4 NONE LOOSE USE A 52 FL x 10 f t x 2 Ft- GALLERY. Vt = 568.32 GPD > 550 GPD RCUIRED COARSE SAND RESERVE AREA: A 57 FL x 8.5 FL x 2 Ft- LEACHING GALLERY CAN LEACH 57-132 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE 14.55 - �- Abot = ( 57 x 8.5 ) = 484.5 sf' Asdw = ( 57 + 57 + B.5 + B.5 ) x 2 = 262 sf TEST PIT � POAREN TUDWATER MATERIAL:FPROGLACA LD OUTWASH Atot = 746.5 sf ELEVATION = 25.30 +- PERC AT 56 in 2 MIN/INCH IN C SOILS Vt 0.�4 x �46.5 = 552.41 GPD USE A 57 f't x 8.5 f t x 2 FL GALLERY. Vt = 552.41 GPD > 550 GPD REQUIRED DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 25.30 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING LEACHING GALLERY 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE C O N S T R U C T I O N DETAIL 22.30 500 GALLON DRYWELL - USE H-20 UNITS STONE 36-6B Cl MEDIUM TO 10 YR 4/6 NONE LOOSE e �'-6'x 4 10"x 2`9' COARSE SAND 2 Ft EFF. DEPTH 52 ft 6B-126 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE 14.80 c co Ln N0 TEE �so-� 3 f B. 4 f 8.5 4 FE 8.5' 4 f 8.5� 3 f t NOT TO 52 f SCAL E 1) GARBAGE GRIND,ER.NOT ALLOWED WITH THIS DESIGN 2) ALL 'LINES 'TO BE' -SC'H 40 PVC AND PITCH AT 1/B INCH PER FOOT MINIMUM- 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. GROUNDWATER ADJUSTMENT 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED, AND FILLED. EXISTING GROUNDWATER LEVEL SEWAGE DISPOSAL SYSTEM PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE BASED ON TOWN OF BARNSTABLE -TO SERVE EXISTING DWELLING 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2`0" BEFORE PITCHING DOWN GIS DEPARTMENT RECORDS. 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES INDICATED GW 5.2 L_I N D A L_ . D D L-L_ AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK INDEX WELL MIW-29 . ZONE B 165 GREENWOOD AVENUE HYANNIS, MA 9) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. READING DATE OCT 2005 READING 2. EEO-TECH ENVIRONMENTAL 10) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ADJUSTMENT .5 STABLE S THAT HAS BEEN MECHANICALLY SIX INCHESOFCRUSHED STONE HASBEEN PL CO COMPACTED PLACED TOMINIMI) O WHICH ADJUSTED GW Z.� ZEUNEVVENSETTLING 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-2231 NOV 28, 2005 1 12:1f] PLAN REFERENCE CONTOURS ���, PLAN BOOK 110 PAGE 29 EXISTING - - - - - - '- 26 N ,p �ocus� '� ASSESSOR'S MAP: 266 MINIMAL GRADING PROPOSED BENCH MARK LOT: 69 0 TOP OF CONC BOUND �� a a THIS PROPERTY IS NOT IN A t ELEVATION = 26.67 pp z WELLHEAD PROTECTION OR BARNSTABLE GIS DATUM �c,J rn A GROUNDWATER PROTECTION LAN z DISTRICT 26 2 M�Rsr m OA __�� • HYANNIS. MA VEwE LOCUS MAP NOT TO SCALE LOT 69 /�RE.9 = 13254 sf +- LEGEND V C 1 1 1500 GA L L ON SEPTIC TANK O O o m USE H-20 LINI T o H-20 D-BOX 13 TEST PIT STING � s EMI OM q gEgR� G s AEI-L_IN O o t 25 FNE)N 1 7 UP_C)2.84+ / i' \ 1 tN OF Af, O O O m m ��� DAVID cyGN j > �,� 28 D \ 27 COUGHANOWIR X 26 No. 1093 i C3 _ 52 Ft X 10 FL X 2 FL ► 10f 49�-F 26 GIST A o LEACHING GALLERY a � NLJE , IT USE H-20 UNITS 26 _ >�S 44 45 A VEE AV P � 4s.� of C) o SEPTIC SYSTEM AS BUILT PLAN � EDGE 4 0 -TO SERVE EXISTING DWELLING L_ INDA L . DDL_ L_ 165 GREENWOOD AVENUE HYANNIS. MA PLAN ECO-TECH ENVIRONMENTAL !SCA L_E: 1 i n = 20 FL 43 TRIANGLE CIRCLE SANDWICH MA 02563 508 364-OE394 w ETE-2 331 JUNE 15,�2006 1/1 THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED IN BLUE AND STAMPED IN RED. twmnWro D lai t i I C z i � •_-Y 9 m q Ind D I i �D IN i i pm C mym .. MA p_ Om _ y � 37.6r 1 riFll . •,P Nxb4 D - 9 r—_•— ---, i flu_% 7-1 3? 1 r-I I - Z 64 I I IR D "it _m a zk t 3V xPP' G) + 9 r mX r-'-- P-T ' 1jai 0 , 24 t 0- P-1• L3 — y m QO N (�O 94 S-f 2S O . 24 --_ 1 ! o ; i I Sm 7C i. W 1- pI i r P Doer. 0 Z 41. is m/-� �z� ----- _ - - --- 't LJ YJ In t7.1, I .i 3RxPB' �i2i - z 0 m D z DT a g K T 2 Cm z Q ��oco G omp --I -� Z pp Iz -_I m Wn l7 4 tnZ svxsa $ Z C V/ 0 D $ v ��m ve 7 y cn n r �$ om� g �O� O 1 :cm �m o4 C r- O D m 3 0 Z co W r ■ p 0 ocrio N 1 Dn zwy V �" D n I_ I I. _ _ I J -_ n_..—._—;. — _ _ ..•a,.s,.-w¢. r . oom _ ,o f Ilnm� - v 0 D 1 M D m ; Z I 0 , m _ b I w'. D 1 m>c pub ,/tl --- — OZ cow r > _ � 9 V 0> �n Zn Z 00 i mO . p MP ?RZ =2 m 1 D �� w u4 yD TD '` t 3lfxes 1 .o T4 74 a r 00 00 GO Q q9 eP.es -- --- -- --- '�. Z1 °��N 1 j 1 cm 3v:ea €' I Z 1 e O t _� Mo Drn �O a c crow3Pi6P D � I o a k O m0 0� a Do r rr Do m 1 $� 3 1 0m m +ti 06 r-r raQ z.,P zaI 0 Sp v,m a D Dm-1y� =00 OZ $ sa 4r 9 " m ;0v no x ZO*0 v — N m0 OZ k CD z og x' § S Dm �z �� g �7 z U z o �� mo C) 8 m D AO F m m < - r m C.):: Z $ ---- _�_ t (n v a�' oo - ----_ —_—_-- --_ -- _----_—__ m rD Z m �� --_— _--- uu�niv�—ernu --- ---- uuLnw�WEnu uatliv�e�ve § Z as q -- ---- 3 z 3 q ,78 P8 178 9 9 V N F (D a i s c) Dm Dm $:r�m8=rson� o bYpt°pmpPmy�bz°z � �pl�w app�$pn b m F y° So._ v D o CAD NEW ADDITION FOR: COTUITSTER BA R DE G' `� " D TANGER MASHPEE, MA. 02649 z; m z �, m NEIL (508) 274-1166 p � 0 o .. i_ 165 GREENWOOD AVE. HYANNIS, MA sra r.a 19S 42 I N � ^ m I W ��z o OQ im eSN. m ! Y' 4 O� nn4 133t m H 1 Y I m $ 1Q8 s'P I 6d' I r I I 1 g 9 I � I y I I I � 1 1 I I 3Q I �0 m G) 71 .. O m D< 1 . 2 M z0 Z m Z I 0 0 C o �b•° Q1 x m c Z _ I o 0 a z a , Z n v r p z rn II -Yo CM -4 G) DMA O n I N El DO N N py N .0 o 1 . >m N A [m O O§ I Oil z Cl) Z �< 1 n 0 i T I 0OO N N N } N N p O I �� m m o o MCC: �r I x �J= � O �o I �---- A$� mm13s w mm0 f I me Pa Sb Z-, x x x o, x x -Q r- T za I I L7= a a , Nam N Q - n �cZi Z p P A N m e Z og I I $.0.. t7lA 7 _ o C I^ m 00 7c 100 ID m I r I z mmn z zm p C C I C 1 I Z I z I I I D,1 I u'a I � zra NMM010 I � ZP 1 iP8 14W 41 v E' I 1 �� ITCm 3d O N I09 m C)z �----- m K m p Om a 0-4 3 I I 11'8 T.3 S� � L7 z D m M 3C%64 m Qm a Rl i m -- I e m m D t O iO j W4, za o \ (SHO DORMM � as as (AW171Wq Noolimnl > 0 w ! u' NEW ADDITION FOR: z TUIT BAY DESIGN � 11 NEIL TANGER 43 BREWS ER ROAD o mz „ MASHPEE, MA. 0264 970O o - (508) 274-1166D . ,