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HomeMy WebLinkAbout0012 GROVE STREET - Health 8 Bristol.Ave .Hyannis A= 309 097 Q 1 I i �a I� p. TOWN OF BA.RNSTABLE LOCATION SEWAGE # �' VILLAGE 0 �ta lti�'t I ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type= size) NO.OF BEDROOMS BUILDER OR OWNER V PERMUDATE: 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 �- rA�- Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is I� MA 02601 04/08/2021 required for every Hyannis page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information :51gr 15309 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return key. Company Name 52 Rivers End Road Q Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification j I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails �%�/ 04/09/2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary i Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. i 1) 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: This 3 bedroom home has an H-10 1500 gallon septic with ari H-10 D-Box feeding a 54'X 4' leaching trench. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. I Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. I 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. I ❑ Y ❑ N ❑ ND (Explain below): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i r .. 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA. 02601 .04108/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: i 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State 'Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form A-P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33 plus GP Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Town water 9 ( Y 9 (gP ))� Detail: In 2020-95,744 gallons were used and in 2019- 56,848 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No I I Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): i i 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: i Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 13"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 4"feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No I Dimensions: . H-10 1500 gallon Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is Hyannis MA 02601 04/08/2021 required for every H y , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle I 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: One 51'x 4' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every y H annis MA 02601 04/08/2021 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 38 Bristol Ave Property Address Claudio Netto& Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): II' I i i I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts �Uo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I i d o i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.)- 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet 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: i I i ❑ Checked with local excavators, installers-(attach documentation) I ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show four plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 38 Bristol Ave Property Address Claudio Netto & Danubia Demelo Owner Owner's Name information is required for every Hyannis MA 02601 04/08/2021 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 r i Commonwealth of Massachusetts 3D 9— 0/�- Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owner's Name information is required for every Hyannis ✓ Ma 02601 3/16/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important When A. Inspector Information sl# filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return any Name _ key. Company ee 74 Beldan Lane _ Company Address '*�J Centerville Ma 02632 Cityfrown State Zip Code 774-248-4850 smjonestitle5Qa gmail.com, Sl 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector In full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3/16/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5insp.doo•rev 7126=18 Title 5 Ottimal Inspection Form,Subsurface Sewage oisposat System-Page 1 of 18 Commonwealth of Massachusetts _ -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments n 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owners Name _ _------—__--- information is required for every Hyannis Ma 02601 3/16/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passe,':. ® 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: The property located at 38 Bristol Ave Hyannis is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and a signle leach trench 54'x4'. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.MAIM Title 5 Official inspection Forte:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owner's Name za._ information is required for every Hyannis Ma 02601 3/16/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will j pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system Is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: t5insp.Qoc•rev.726=18 Title 5 Official Inspection Porte:Subsurtace Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form - — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E owner Owner's Name information Is required for every Hyannis Ma 02601 3/16/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well•". Method used to determine distance: I i This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: i I i 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ❑ ® clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5lnsp.doc•rev.748=8 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 4 o118 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti :,;�• 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owner's Name Information Is required for every Hyannis Ma 02601 3/16/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: I ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply'or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.do•rev.UAMIS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of is Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. j Property Address NETTO, CLAUDIO A& DEMELO_, DANUBIA E Owner Owner's Name Information Is Hyannis Ma 02601 3/16/2020 required for every page. City/rown State Zip Code Date of inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all Inspections: Yes No i ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows In the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available.note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions; depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on- ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp,doc-rev 7f2 O18 TNIe 5 official Inspection Form Subsurface Sewage DNxwl System•Page 6 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form — — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yr; 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name -- - - information is Hyannis Ma 02601 3/16/2020 required for every y page. Cltyrrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: a Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to:Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date %Ump doe•rev 726=18 Title 6 Official inspection Forth:Subsurface Sewage Disposal System•Page 7 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form k — — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name Information Is Hyannis Ma 02601 3/16/2020 required for every page. City/Town state Zlp Code Date of inspection D. System Information (cont.) 2. 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 I � Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: bate Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped detervnined? ® — Reason for pumping: t5insp.doc•rev.7126=18 Titte 5 official inspection Form:subsurface sewage Disposal system-Page a of to i Commonwealth of Massachusetts -= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name information is Hyannis Ma 02601 3/16/2020 required for every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I Approximate age of all components, date installed (if known)and source of information: system installed 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet I Comments(on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5hV.doc•rev 72&2DI8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 .� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owners Name information is Hyannis Me 02601 3/16/2020 required for every C frown State Zip Code Date of Inspection page. ty D. System Information (cost.) 6. Septic Tank(locate on site plan): .5 Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ® polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3 ---— 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doe-rev.7f26r2018 Tf11e 5 Official Inspection form:Subsurface Sewage Disposal System-Pape 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -� 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name information is required for every Hyannis Ma 02601 3/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle - ---- — Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons i Design Flow: gallons per day tfiinsp.doc•rev.7I2 MIS Thle 5 Of ulal hspeafon Form:S~ace Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form — — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. g 38 Bristol Ave. Property Address NETTO, CLA_UDIO A_ & DEMELO, DANUBIA E Owner Owner's Name information is Hyannis Ma 02601 3/16/2020 required for every y -_- page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) I Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5nsp.doc•rev.7126018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts - - Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A&DEMELO, DANUBIA E Owner Owner's Name Information is required for every Hyannis Ma 02601 3/16/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): � I •If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 54'x4' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t6trtsp.00c•rev.712&I2018 Title 5 Official Inspection Forth Suhsurfam Sewage Disposal system-Page 13 of 18 Commonwealth of Massachusetts -= Title 5 64fficial Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 1V 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owners Name information is Hyannis Ma 02601 3/16/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of past hydraulic overloading, no lush vegetation, no damp soil 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): MIMP.doc•rev.71xmi a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts y=_ Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments S :fir J 38 Bristol Ave._ Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name information is required for every Y.__.H annis. Ma 02601 3/16/2020 _ _ _ page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions — Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Lt5bup.0oc•rev.7/2VMIB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 i Commonwealth of Massachusetts --_ _ Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name Information is Hyannis Ma 02601 3/16/2020 required for every Cfty/Town State Zip Code Date of Inspection page. D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I I I �Z ZS 'e �3 2$ �33 z' t6mspAm•rev.7120/2018 Me 5 official Inspection Pone:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owner's Name information is required for every Hyannis Ma 02601 3/16/2020 page, Cityfrown State Zip Code Date of Inspection D. System Information (font.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. _ t5lnsp.Qoc-rev,7lswe Tdk 5 Of ial Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts =_ Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. v Property Address NETTO, CLAUDIO A& DEMELO, DANUBIA E Owner Owners Name information is Ma 02601 3/16/2020 required for every Hyannis page City/Town State Zip Code Date of Inspection: E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8 jight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.tloe•rev.7r26rM18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. �w DATE: v2 Fill in please: . APPLICANT'S YOUR NAME/S: " BUSINESS YOUR HOME ADDRESS: t! ��- 6 �. �.. 5, 3�I9' �o TELEPHONE # Home Telephone Number 399!- 3D $(o E I N OR : —! if 8 l7 `r E-MA I L: n ' l a NAME-OF CORPORATION: \Ca T J NAME OF-NEW BUSINESS .(�-f vie' {{JM� C TYPE OF BUSINESS IS THIS A HOME OCCUPATION? V e YES NO' Z6 ADDRESS OF BUSINESS' ' .2 / MAP/PARCEL NUMBER (Assessing) . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSIO ER'S OFF E MUST COMPLY WITH HOME OCCUPATION This individu I e in ed of n p r t r qui e e is that ertain to this type of business. RULES AND REGULATIONS. FAILURE TO Au horiz n to / COMPLY MAY RESULT IN FINES. M ENTS / 2. BOARD OF LTH This individual has bee i ormed of the a it req ents that pertain to this type of business. uthorize-d Sign s j 1 g MU;� I�+allifPLY•1NItFfAl1�� COMMENTS: uA7Aen/1�JQ iMAVITIM �e�ea�n•r - w 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: ,/c; J TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM � NAME OF BUSINESS: =:r�.rN�� i BUSINESS LOCATION: y • INVENTORY MAILING ADDRESS: 14y A nn`�S 11 1q • 0 Ufa Q I TOTAL AMOUNT. TELEPHONE NUMBER: CONTACT PERSON: .� EMERGENCY CONTACT TELEPHO E NUMBER: --Qy S� G •- d r-wa MSDS ON SITE? TYPE OF BUSINESS: L( e-"n1 nT� INFORMATION / RECOMMENDATIONS: is Fire District: 4V/a is f Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product- Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's I V Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) .❑ NEW O'USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) — - Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes e -3 Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash , Z WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Si6naturd Staff's:In:ii Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 38 Bristol Ave. UloIV . W Property Address t� BROWN, ALVAN & NESBETH, TAMARIA Owner information is Owner s Name required for every Hyannis 7 MA. 02601 1/5/17 M; page. City/Town State Zip Code Date of Inspection W m 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 A. General Information filling out forms I� � a on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the retum key. Name of Inspector Robert Paolini Septic Service V=V Company Name 17 Playground Lane Company Address Yarmouthport MA. 02675 City/Town State Zip Code 508 362-3555 S 14454 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 15.340 of Title 5(310 CMR 15.000).The system: ❑x Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evalvation by the Local Approving Authority 1/5/17 Inspec oes 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. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1�of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Properly Address BROWN,ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑x 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: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owners Name information is required for every Hyannis MA. 02601 1/5/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN, ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Cl 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 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 38 Bristol Ave. Property Address BROWN,ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 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. ❑ ❑O 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.] ❑ ❑x The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑x The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. CityfTown 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? I ❑x ❑ Has the system received normal flows in the previous two week period? ❑ ❑x Have large volumes of water been introduced to the system recently or as part of this inspection? ❑x ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑x ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ❑x Existing information. For example, a plan at the Board of Health. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑x No Laundry system inspected? n Yes ❑ No Seasonal use? ❑x Yes ❑ No Water meter readings, if available last 2 ears usage NA ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ❑x No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Scott Frank j Was system pumped as part of the inspection? ❑x Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ❑x Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN,ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 1' feet i Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 1' feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gl. Sludge depth: 2" t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 45" 9" Scum thickness Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 3" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound.Tank should be pumped. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 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 w 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN, ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is level. Box has one outlet lateral. No evidence of solids carryover.No evidence of leakage.Replaced cover on box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN, ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: 54'x4' ❑ leaching galleries number: ❑x 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Stone was clean and dry. I Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Zj >" 38 Bristol Ave. Property Address BROWN,ALVAN & NESBETH, TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) 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 I Depth of solids i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN,ALVAN &NESBETH, TAMARIA Owner Owner's Name Information is required for every Hyannis MA. 02601 1/5/17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately �. . O tsins.lino >fe s Inspection Form:Subsurface Sewage Disposal System-Pap 15 oI 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Bristol Ave. Property Address BROWN ALVAN & NESBETH TAMARIA Owner Owner's Name information is required for every Hyannis MA. 02601 1/5/17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑x Check Slope Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leachinf 17' 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: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 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 38 Bristol Ave. Property Address BROWN, ALVAN & NESBETH, TAMARIA Owner Owner's Name information is Y required for every Hyannis MA. 02601 1/5/17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked ❑O Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 `y • e 1 0 TOI iV OE BARNSTABLE 2011 JUL 25 AID 8: 54 DIVISION Ci " a �l • �1 �l k G �1 �l N � � • } v N Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the computer,use 38 Bristol Avenue la only the tab key Property Address to move your Today Real Estate sal n cursor-do not t use the return Owner's Name key. 1533 Falmouth Road Owner's Address Centerville MA 02632 Cityrrown State Zip Code Date of Inspection: 01/12/08 Date 2. Inspector: MR. ROBERT A. DRAKE Name of Inspector KCJ ENGINEERING Company Name 66 GREENVILLE DRIVE Company Address FORESTDALE MA 02644 City/Town State Zip Code 508-477-5048 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ I �-�N OF M4ss9 per' ROB TA. ctiG Eleeds Further Evaluation by the Local Approving Authority DRAKE f CIVIL y No.41642 Q Cl) Inspector's Signature Date 9pF G/STE 0 EN�' The system inspector shall submit a copy of this inspection report to the Appr V AL o (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. 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 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: Septic Tank and D-Box appear to be structurally sound and working properly, tees are inplace, no ponding around the leaching field. 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: 38 Bristol Avenue-T51NSP1.DOC.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 Subsurface Sewage Disposal System Form A. Certification (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 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 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cunt.): 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: 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State ZipCode Today Real Estate 01/12/08 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to dogged 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 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. i 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) Bristol Avenue Property Address Hyannis MA 02601 Cityrrown state Zip Code Today Real Estate 01/12/08 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. i 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. I I 38 Bristol Avenue-T51NSP1.DOC.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 Subsurface Sewage Disposal System Form B. Checklist 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 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, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7of16 Commonwealth of Massachusetts ------------------ Title 5 Official Inspection Form _ Not for Voluntary Assessments o,e Subsurface Sewage Disposal System Form C. System Information 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 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(gpd)): 256 GPD 9 ( Y 9 Sump pump? ❑ Yes ® No Last date of occupancy: A couple of months ago Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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): 38 Bristol Avenue-T51NSP1.DOC.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 M C. System Information (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Citylrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection General Information Pumping Records: i Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/Agallons 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: House built in 1960. According to Town records, entire septic system was upgraded in 2006. Were sewage odors detected when arriving at the site? ❑ Yes ® No 38 Bristol Avenue-T51NSP1.DOC.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 Subsurface Sewage Disposal System Form C. System Information (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2.00' +/- feet Material of construction: ❑ cast iron ® 40 PVC ® other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer pipe appears to be in good condition. No signs of leakage. Septic Tank(locate on site plan): Depth below grade: 2.0' +/- Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Tank inlet cover 9" below ground surface. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1,500 GALLON Sludge depth: APPROX. 0"+/- Distance from top of sludge to bottom of outlet tee or baffle APPROX.34+/- Scum thickness APPROX. 1"+/- Distance from top of scum to top of outlet tee or baffle APPROX. 8"+/- Distance from bottom of scum to bottom of outlet tee or baffle APPROX. 13"+/- How were dimensions determined? MEASURED IN FIELD 38 Bristol Avenue-T51NSP1.DOC.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 (cunt.) 38 Bristol Avenue Property Address Hyannis MA 02601 City/Town State Zip Code Today Real Estate '01/12/08 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.): Tank appears to be structurally sound, tees are in place, water level in tank is 4.0'deep at the level of the invert of outlet pipe. Grease Trap(locate on site plan): j Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Dace 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: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 38 Bristol Avenue-T51NSP1.DOC.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 Subsurface Sewage Disposal System Form C. System Information (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection Tight or Holding Tank(cunt.) Dimensions: N/A 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 At invert of outlet pipe. Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box is level, water at invert of outlet pipe, no signs of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 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: 4'x 54' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: i ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit appears to be working properly, no signs of ponding and vegetation is normal. 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 i !� Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today real Estate 01/12/08 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 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. Q I 3 ,a .3 Fla�i R 3 v � � - ISJ QI Z1 � � S-u ► ZI 38 Bristol Avenue-T51NSP1.DOC.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 M C. System Information (cunt.) 38 Bristol Avenue Property Address Hyannis MA 02601 Cityrrown State Zip Code Today Real Estate 01/12/08 Owner's Name Date of Inspection Site Exam: Slope Surface water I i Check cellar Shallow wells Estimated depth to ground water: i Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Barnstable GIS Groundwater Maps indicate high groundwater elevation is at approx. =23'+/-,t GIS Contour Maps indicate that the ground elevation is approximately at elevation 42.0' approx. 19'+/-above the groundwater table.Therefore, 10'of separation exists. 38 Bristol Avenue-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 THE Town of Barnstable OF Tp� Regulatory Services saxr,srnaie Thomas F. Geiler,Director v$ 16 `0g A,FD 9. Public Health .Division Thomas McKean, Director 200 Main Street,.Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. "J, No. Z06 r` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VY PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Digpogar bpgtem Congtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( Abandon( ) O Complete System DEQtdividual Components Location Address or Lot No S OL-b4 t P_, Owner's Name,Address and Tel.No. Y v- v P T6AJ Assessor's Map/Parcel Installer's N e, ddre s,and Tel.No. Designer's Name,Address and Tel.No. 0 6� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 y gallons per day. Calculated daily flow -3 31, `l •gallons. Plan Date — —ako Number of slXets Revision Date Title V 0-reKJ Y61V Size of Sep c Tank Type of .A.S. S� ITT✓�clY�� Description of Soil Nature of Repairs or Alterations(Answer when applicable) ` \ � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance haseeu-issa a Signe ® Date S1-0 Application Approved by I Date Application Disapproved for the following rea n Permit No. Date Issued �► "ia�+«sui ► 'sir ��;,�,,�,,�-... ---�:e�-� � � � .. 40fNo. / - Fee THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Zig;poear *pgtem Con0truction Permit 6Application for a Permit to Construct(I. )Repair( )Upgrade Oweandon( ) O Complete System CKdividual Components Location Address or Lot No. 3 gI(1/SOLi�t�, Owner's Name,Address and Tel.No. Assessor's Map/Paz �( cel 66,w U dAJ �� - 0 7 Installer's N Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms . Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow , 3 7 y gallons per day. Calculated daily flow 3.3�� `� gallons. Plan Date - nto Number of sheets Revision Date Title Size of Se ti Tank —mot l..Z.wk-,cc .— T e of S. .S. , �_ 1r— 1_ C p _z z yp �T; s�� I �� aqL Description of Soil t Nature of Repairs or Alterations(Answer when applicable) ✓ Q� f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee Signed 7 © / Date O' Application Approved by Date Application Disapproved or the following reaso Permit No. bU Date Issued ———————— —————————— -- ---- --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance i THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded Abandoned( )by < , L at 3 a, has a constructed iq acc rdance with the provist s of Title 5 and the for Disposal Syste Construction Permit No. ated { Installer AAr.-r�S Designer ' The issuance of this pe t s all not be construed as a guarantee that the system wi f 'c t n s designed. Date ��� �a Inspector No. — ��Wf7THE Fee — COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mig;po!6a[ *pztem Construction Permit Permission is hereby granted to Construct Repair( )Upgrade( andonX ) System located at _ and as described in the above Application for Disposal System-Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be comPeted within three years of the date of this rm I Dater Approved by A , _ 1 07/07/2016 20:27 FAX fa 002/002 Town of Barnstable .°� Regulatory Services s Thomas F. Geiler,Director t�tuverests +� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862.4644 pax: 508-790-6304 Installer& Designer Certification Form Date: 4-11-06 Designer: Shay Environmental Services,Inc. Installer: Robert Septic Services. Address: _P.O_ Box 627 East Falmouth Address: 5 Trenton Street MA 02536 -„_ Yarmouth, M,A, On 4-06-06 Robert SpRtiq Servi a was issued a permit to install a (date) (installer) septic system at 38 Bristol Avenue,Hyannis,MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 4/0 /06 (designer) XX 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 r distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. I�LAIA o CAPMENInstallers Signature) ` E. SHAY N No. 1181 PA (Designer's Signature) (Affix. Desig ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE F COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS: BOLT CARP ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q;Health/Scptic/Designer Certification Form ' {Yr�' :1rv'ie;�}•t':�.ii`/'.f1ti?�t'' .r- -, [•C7C'!'i) L+..G 'lj •i:':F. i! i:� �_tS.r: .t.�� iS�v iS:.!ra.'�.i.r �. trj:.t�a s�`_. Txi.�,t�•.i.i' 6��a,ii��3•jv: ��.�.'S,l�;'.a1_.'?�,t.;;. ........-1 3iK[�S�t..�...� }r�i3 �'rs.�;j - .� ...�•�','f �'�SeG'�tiJ�f.f`'S'!�y�-x�'jtitliE'.lt.� •n r�•'•I j•'/�'11_rr �• � � 1,T 'l`1V ,`.Y i r _ _fir!*-.�4�}3�c..:..::��'•� ,�,Ftr�_t.. .�._.. ;�',�� �_ ,,•.;,,: ..r p,T• .- .r,.r,:.. r ti r t�+t• to TCZ• o fir` of !!%- :T 1117t; .�•x Sf:Sti 4": ;:i C:0LrU-8f .; ;i i�; �['±lid Tri:r7; i�4'+{!i(iSi.'�S� Ftij7'3 '..6P,IG!G.'•1 t'1. r>tf;r(}"'t i`i+T7 j !!7 ;l:ij t'yst+FfJjit�i,' of (jx- .o y`; CIL ' ' Coe.!.1�' "1I �frc. ?Gf1,FC :�.?j�o:U !>� fJzTa:.::* Js:<?Y,f";�•::� fl;2 Ftlsr i Iloi?1 iv fl0?. Q-c OFF-�T,"!)TF:JCtT� ::^:: fi�[s'�tf]T.�C-.1''YG i4�F�•'.' rl.: 0•C2•tiil" 1111"C .13:11 1tlt"If+C?': :i:1luir, Yi)�1rr:bi r . t"s en, �L. to xz;golt o i,'.; �1 , 3 i-�. 1 t.j1.Fi ) 1lliy' lilt. Zo1):Jt� 2:. ( «[T I,r•(rr?.�11t •:kt3L4, #,.4 6 )L`+±:,jf7�.! i G ' Sy,. ��i cri n ).r�i (J ti •[ ..+ ! ttfiti _1i., :3 •1 /� !�. rrp. •;IC1r...,rJ [,ii.YM t;)l �..fs�-+,^3s3 !(r�1 ;?yi? I'~:'ti;li:Fs r;.;it, s'it 'y , L`l;S�Jtli t0 fiJ?j tt( ' 1 �i!';l (...r.<j -- - -•-�--_•�.....____.. ..r._,..14`li'�11f1ii•'.p3� ��('.J...._.i.___... 'J rQ rife %!' j+.J" TE ! ;�!r.: r) t. ,�i;L1=r1 `t�tlli•; : 3i:1 .iui .�bi.1v 6'� =I.. , t�l;•S 'Is^^. :YjjGi. Si 'fii.T,f;I;;�D�:'st ►:2 710, [ •t 33 7]�� f'1��' ' i•Ji!.kp�..a.: S±f� [i1�'.'..'ln�r'.:V�i tTA:alyL;rz lfrr t- � �IS,,*J .i:?•'i Y,�ii�i � i t,,;Ye� rrKi f��i jD••Si� i7. ! f;; ...tco.,re^._� ,t' 7 (;'rJrj� � • I'�;ri;gt' 3(�.(ti::l!!i., I 9/16/03 i Notice: 'This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, CPEM.r­-1. hereby certify that the engineered plan signed by me dated Oh concerning the property located at .5 meets all of the. following criteria: • This failed system is connected to a residential dwelling only..:There are.no,commercial or business uses associated with the.dwelling. • The.soil is.classified as.CLASS I and the percolation rate-is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. • There is noincrease in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation using GIS information). A0,06 B) G.W. Elevation 15 +adjustment for high G.W. 2.6 DIFFERENCE BETWEEN A and B 2 Z. Z p . SIGNirD cc L_ DATE: NOTICE Based upon the above information; a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. +�111,E C qAseptic\percexemp.dcc . .. L v rr'ii %Ji� aY'wi.ar - . LOCATION rrS�C?j �- SEWAGE # • VILLAGE • i J ASSESSOR'S MAP & LOT 32E-1a[.1- INSTALLER'S NAME&PHONE-NO. SEPTIC TANK CAPACITY -5 v j LEACHING FACILITY: (type)'�� ^'�� (size). NO. OF BEDROOMS i ,r. ll BUILDER OR OWNER �1Ke S V t7'V 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 j 1 within 300 feet of leaching facility) Feet Furnished by �F/ t 1 all - fL D b �•`.J 4 # :J i ALL OUTLET PIPES FROM THE e r ter r ! E \. tba rlll+5tf *NOTE.- ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. DMMM� F� FT. tYSALL BE lE ? �3Q• 10' min. from VENT PIPE O Least 24 inches taM) r. �{' 3 , �F� Maul,lyy (( r_ o �-- Schedule 4t1 PVC w/Charcoal Odor nter 3-r OUTLET r LReen t NEW Foundation I house to septic tank 0-roxe KNOCKOUTS r .4J TOF ELEV = 100.00 (Assumed) Septic tank covers must be _ s s' ' n` y,r'W'j within 6 in. of finished grade f 12" NLET N ' Grade over Septic Tank - 99.50 Grade over D-Box - 99.50 ��`- 1 OUTLET Mary An,,Lp `i va %ga�4 let, Grade Elev 99.50 r t s %`> CR IN A\ Cho,,, S 0.02 3 HOLE M-10 Top Of $yst ELEV 96.25 t3 4" - SM. 40 T 1,75• ' Hvannk E"tt anp y 9' Oawr •a El.mentary1•( R®Nlan 10 NEW S'•0.10 or Greater Box S- 0.010' per foot j S-.005 \``' �- PLAN SECTION CROSS-SECTION scha°ll�.+'Caaday s" EXIST.PIPE ri 1,500 GAL OR GREATERr-r a P�Roreted P-Y.c. -IIV-1/Y We I Stone FROM FOUNDAT EN rn SEPTIC TANK 10 a Invert Elev-96.73 "gist e } 1 POLYETHYLENE rc g "+ 5• O /4'-1X'Nteahee Stan. 4 qr�.e 0, - CONCRErE Ftal _e 1 H-10 4' Bottom of Leach Foclit Elev.- 94.73 tn4 t ` 3 HOLE H-10 DISTRIBUTION BOX �.ad /r O - j Note: M Mach Owe to be capped at wde e/1"M papa 'S'PROVIDED NOT TO SCALE it SYSTEM 1 1 1 0 IWtbNatriterpnro� ^� '''� SYSTEM PROFILE aampaated atone o o Bottom of Test Hole 1 Bev.-88.50 Not to scale � n � •� LEACH TRENCH GENERAL NOTES (1 TOTAL) LEACH TRENCHES CROSS-SECTION (2 TOTAL) 1. Contractor is responsible for Digsafe notification NOTE ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 4-0 wide and protection of all underground utilities and pipes. 2. The septic tank and distri ution box shall be set level on 6" of 3/4 -1 1/2" stone. r 3. Backfill should be clean sand or gravel with no "'1id St"" stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance s/e'-1'�+�. with Title V of the Massachusetts state code, the approved plan PERCOLATION TEST <pwAm-W P �.ew and Local Regulations. NOT TO SCALE 6. If, during installation the contractor encounters any soil conditions or site conditions that are different Date of Percolation Test: APRIL 1, 2006 from those shown on the soil log or in our design Test Performed By. CARMEN E. SHAY, R.S., C.S.E. installation must halt & immediate notification be Results Witnessed By. WAIVER (Per Barnstable B.O.H.) made to Carmen E. Shay - Environmental Services, Inc. EXCAVATOR: Shay Env. Svcs. Percolation Rate: Less Than 2 MPI 0 40" 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. ---------------------------------------------------- ---gg 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Test Hole Test Hole �/-- ---------------------------------------------------- ---97 No. 1 No. 2 98------------------100.00-------------------------------- ---98 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. DEPTH SOILS ELEV. DEPTH SOILS ELEV. PA 10. All solid piping, tees & fittings shall be 4" diameter 0 99.50 0 9950 TEST HOLE f1 TEST HOLE #2 Failed Schedule 40 NSF PVC pipes with water tight joints. Sandy Loom sandy Loam SHED ELEV.= 99.50 ELEV.= 99.5 Cesspool 11. Municipal Water is Connected to ALL OF The Residence and Abutting _ �6. Properties Within 150 Feet. 10 YR 3/2 10 YR 3/2 0'-9" A. &75 0"-9" Ae 96.75 4' THE PROPERTY LINES ARE APPROXIMATE AND 4. D-Box COMPILED FROM THE SURVEY PLAN GENERATED BY sandy sandy PROJECT BENCH MARK �•t L Loam TOP OF FOUNDATION �Q° 1 ' ALLEN BEALE, CIVIL of HYANNIS, MA ENTITLED 10 nt 5/6 10 YR s/e ---, NEW 1500 GAL. SUB. PLAN OF LAND IN HYANNIS, MA" LCC 14034-A SHEET 2 ELEV. = 100.00 (Assumed) K7 O 01DATED g'_ 40• Ba 96.17 9._ a. Be 9617 L--- SEPTIC TANK AND S NOT DATED INTENDED 1954 A SURVEY PLOT PLAN Medium/ Medium/coarse PATIO SCREENED DECK IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sand 2.5 Y, 2S�+ PORCH f0 5' THE SEPTIC SYSTEM INSTALLATION. 40"- 132 G 40- 132 C, EXISTING CESSPOOL TO BE PUMPED OUT AND FILLED IN PLACE OR REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION 0 EXISTING #38 p NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE C GARAGE EXISTING FROM THE EXISTING CESSPOOL TO BE DISPOSED 3 E DRO01! _ _ .._... -- _._ _.�_ .__ _, --__. __..._.____.__. --.- _--..__. ._..u_,-CF,A.- PER BOARD-OF-HEALTH SPECIFICATIONS. HOUSE NO WETLANDS ARE PRESENT WITHIN 200. OF THE PROPERTY ASSESSORS MAP 309 PARCEL 017 s9 -- ---- --------- Perc #1 --&-------------------- -- --99 LEGEND Depth to Perc: 42" to 60" �--- EXIST. --------- Perc Rate= 2 MPI Groundwater Not Observed ( DRIVEWAY I LOT #16 104X1 DENOTES PROPOSED No Observed ESHWT 9.000 Square Feet +/- SPOT GRADE ADJUSTED H2O Elev. = None 98------- -------- --�--u ------------------------------- ---98 100.00' x 104.46 DENOTES EXISTING PL SPOT GRADE 97------4------------ ---------------------------------------97 PL PROPERTY LINE 96P PROPOSED CONTOUR B R I►Sr T O li -A VEN Z_TL' -- - -- -97 EXISTING CONTOUR TYPICAL 1500 GALLON SEPTIC TANK (40 FOOT RIGHT of WAY) ® DEEP TEST HOLE & _ PERCOLATION TEST LOCATION NOT TO SCALE .--. 6 FOOT STOCKADE FENCE 3-2r IMAM. ACOESS MANHOLES (H-1 0 LOADING) SCREENED -f�.:• =�-�• ,- - . - PORCH DECK � � n P SOT P LAN % `=% i NET /Dining Kitchen Bath Bedroom Bath OF PROPOSED SEPTIC SYSTEM UPGRADE rr THE ACCESS COVERS FOR THE SEPTIC TANK, t DISTRIBUTION BOX A LEACHING COMPONENT EXISTING ND SHALL BE RAISED To WITHIN 6" OF GARAGE PREPARED FOR FINISHED GRADE. ~ STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITS GAS BAFFLES OR EQUALS Living Room Bedroom Bedroom M R. JAM ES UPTON PLAN VIEW ON ALL OUTLET TEE ENDS AT /-3-24•REI (ABLE COVM #38 B R I STO L AV E N U E _ ••, min. clearance 3 BR HOUSE FLOOR SCHEMATIC HYANNIS, MA R/LET r mYnT Y min.Het to ouUst 4• tT Ra[►j, T _e-� _ OUTLET Design Calculations 10•mh Li�itrel 14' r':�' PREPARED BY: 5-7' § :•5'-7' Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title e s: s'-D-min. Garbage Grinder. No </ �4 ,S'H Y a �� UgAd Leaching Capacity Proposed: 330 Gol./boy Minimum (Min. Per Title V) "' °``S rr E. q Septic Tank : 2 x 330 Gal./Day = 660 INSTALL NEW 1,500 GAL. POLYETHYLENE Septic Tank, 0 20 40 y F ENVIRONMENTAL SERVICES, INC. ., � .��-:�:. I�� '-.•.•,,L�, -. -..,.•_-_- ,r •,_ a --- .:.. i SOIL ABSORPTION AREA: Using percolation rate of C2 min./inch ,o•-o• 5 -6" Proposed Leaching Trench Dimensions: 1 TRENCH -4' Wide by 54' Long by 2' Depth P•0• BOX 627 CROSS SECTION END-SECTION Bottom Area: 0.74 gal/sq. ft. x 216 sq. ft. 159.84 gallons Fc1"3 EAST FALMOUTH, MA 02536 = Sidewall Area: 0.74 gal./sq. ft. x 232 sq. ft. = 171.68 gallons " S N1TAP, TEL/FAX : 508-539-7966 MAY BE SUBSTITUTED FOR 1500 GALLON POLYETHYLENE TANK - GEORGE OBRIEN CO. Providing: = 331.52 gallons SCALE: 1 =20 SCALE: 1"=20' DRAWN BY: CES DATE: APRIL 3, 2006 L Use: 1 TRENCH - 54 by 4 W x 2,D PROJECT#SD890 FILENAME: SD890PP.DWG SHEET 1 OF 1