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HomeMy WebLinkAbout0125 GROVE STREET - Health 125 Grove Street - �� A= 310 - 167 r 0 4 o � a ry 1 4 i j y 9 TOWN OF BARNSTABLE LOCATION ��'� !3 44 L 51 . SEWAGE# C;�O/ 3 VILLAGE a�ys ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. .���Yb SEPTIC TANK CAPACITY 0 �\ LEACHING FACILITY:(type) Ctov,\,R,0 (size) a �X 13 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: ro 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 CA No. ®3 / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppficatiou for Disposal *pstrm Construction Permit Application for a Permit to Construct( " Repair Upgrade( ) A 'and ( ) ❑Complete System ❑Individual Components �e Location Address or Lot No. 22 2 �� Owner's Name,Address,and Tel.No. f� jet Assessor's Map/Parcel --Y Q Installer's Name,Address,and Tel.No. � -��y- f-��� Designer's Name,Address,and Tel 0 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(min.required) 350 d gpd Design flow provided 3711 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank, Type of S.A.S. (�t���aEt LLic.� ���i -t Description of Soil �fU Nature of Repairs or Alterations(Answer when applicable) ;/� J d � /Gta �( j�i� A7"i!� CcWoM /4//& (d14km4elS I''s). S�o;i e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to-place the system in operation until a Certificate of Compliance has been issued by this Board of He tgned Date Application Approved by Date Q Application Disapproved by V Date for the following reasons Permit No. Da? Date Issued C) � .... .t'rt.,,,Y• ° .'�\;, M1:. .<y:'^.""^ .':-'•rr...cq,.=�a'..s+.-.,-:...!`+..a�v,..,J �}.1 ,y,�-', •.ri-•'.. . •1. ..f"/*.r..,'is. .�, ...r�� .vi-- - ,ti•.yM r'.` r*• � � t No. Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphtation for Disposal 6pstem Construction Vermit Application for a Permit to Construct( �Repair , UpgraOAbandon( ) ❑Complete System El Individual Components ��` -1�efi Location Address or Lot No. 22 S �'•V _. Owner's Name,Address,and Tel.No. y not �'d7 Assessor's Map/Parcel (a � 60,r165 z Ci/e`� Installer's Name,Address,and Tel.No.��� ��� Designer's Name,Address,and Tel.No:, _ tn 1 3 T_ Fig c r%tip rr J'tiw. W')r S •L /'? Type of Building: /C tWA�ad Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 310 gpd Design flow provided ��� gpd Plan Date Number of sheets Revision Date Title / �- Size of Septic Tank�� 1) /U Type of S.A.S. 6 0 {SCE��ara C lil r 4.ys i el ) j 'i4o t E Description of Soil s�en Nature of Repairs or Alterations(Answer when applicable) /�l tzo 4,e I©,..f _54r . .0 C°{&M /* 4AZ.st LX/.S I 5 fi o.w e Date last inspected: Agreement: ; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea Stigned ,.,----- --A ....�. Date /lJ ✓,� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. I -�-- Date Issued s _ t. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIIFFY,that the On-site Sewage Disposal system Con cted Repaired( ) Upgraded( ) Abandoned( )by i/,3 .ti y 4 d 40 6( aQ j1 --- -at _ 247---{S_-.r p V _has been constructed-in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. ) dated Installer • Designer #bedrooms 3 Approved design flow k _gpd The issuance of this permit shall not be construed as a guarantee that the system wil4ftc4ion/as designe . Date I d:! Inspector -- ---- NO. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal .pstem Construction Permit Permission is hereby granted.to Construct( vy Repair Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must be)completed within three years of the date of this pe�'j . Date �{ / Approved by _ V -� ToY�n,of Barnstable °F`��`"c Regula,toi Y Ser�ttces Rtckiat d_fir.Scab,Interim Dtrecto`r.- snnxs�ae� �' a � Paabltc Hlealth Di isinrr .. `�homag.l�IcKeait;.t)trectoi'. 200;tVlain 5frcr."f„HIyatins,VkA-03Gt)1'. Ufftcc'SOS,&b2 tC�44` Fax:-.;:50 -70,0-6304 Josialler&besianer C crd iiaii4n Fbrttt.. D77 Atei. �3 � ,. Bettie c i'ertnith AOessor's . A .\Farce[= 3 j t�' C` Designer ��aneecfl�Wo,-�(s�.j,nC;_�: Iiista[let.. j7,)3t�Qn.c!, .z3L� �"�?r��-v; �ddr,:ess 12 tJ�S c�,ss ,ep(� l�J;: Add'r".-.css � Ori (�, ��cian�, yyQr t pax`-� wAs is5ued;a perriiit t0,irista(!'a` (�nsta:[t.er)," 5- - '4 ✓t tJ based on a deli n drawn b' + F septic system<2t / t �t y __.. (address) l�etef IA1Gri rye it - ,�Yti� (d41' fier) tv Y t c er-tif thdtrtl i �eplic system.referencet£above:it<is instafketl stibstantiatly ace ncdin '.to Alie de�tgn,�uhzch mau include.minor a�iptovc d chan�e�sµc h a�i�teral rek�cat�an.qf the drstrikruUon bux and7orxseptic tan1. Strip out•("i'f ct,ginze�) was:_nspecte l and Qtc sn�ls crc found fat}sfactaxu, k certi.y that tti(�septic=systet2"leferetcd above`:titan installed with maaQac changes gre ttor.thin t(}'katerai celocat�on or the AS'or ahy veitical relocation ofuriy ornponent of the sephc sj stem}bit en accordanceF itti Stare'&Local ll��nilauons k'1'an revtsion or cettified as bultby.dcsguct to fotkow. Stctpout"(cf acquired)Ha3'cnspected aitd thy:sails cce�fgrtd satisfaetnrya.. k certify that-thel sy,terii refer ecl above�a§'tonstrcicte` ncC-W. th the terms of-the I1 a pr"o ra te) �: a# CML knstal;ie s Signature)'", t�G3$5'!Dp ` rrQ ste ::(Des}grier's SjIgnatitie) (A'(Txx pestgner tamp H'ere),: FUSE'121 t CIt2 -1 O BA 2i`IS I ABLL`PU}3L1C:HE ALTHI DIVTS 6N. CER71F1Gt1 fE ()t',CO131?"LIA'\'CE;I�'iL'L'•iVOT .QE "ISSLEll.'L7�TLL -BO75�C=THIS I�bI2N[ ADD.A'u= •Bt9.IIrT CARD A-RE RECEIVED}0,L-.,T fE'RAR,NS't'A,:F I'UI3LIC" EAETH Div SION Q tScgfict7cst�ner CgrttfipAf on t�irri kt'v 4 t t:3doc r Town of Barnstable r# 11155 Department of Regulatory. Services wxUrAate, ]Public Health Division Date ►) 81 r -7 �A i63q gym : 26l)Main Street,Hyannis MA 02601 l6Date Scheduled /� Time Fee,Pd. Soil Suitability Assessment for Se e Disposal Performed;By: F��-ec- MC_ IN -*-� 5tC-1$yZ Witnessed By: Location Address LOCATION &GENERAL INFORMATION C-trovQ Owner's Name Cgrjos CmnZG.1eZ 9-�y ck VA n is Address. P 2S Cry v S r J�yelvim is, 1Y1A 02C01 Assessor's Map%Parcel i 0/ O (0 7 Engineer's Name,CV)r1 ,2u-►^9 Acy45lei C NEW CONSTRUCTION REPAII Telephone# $'p$— 97-7—5 31' Land Use /Zee cBcnl tom/J�r""resit !-c�n„Slopes(9o) f Z Surface Stones �6 n Distances.from: Open Water Body/L)JA ft Possible Wet Area—,^)JA ft. Drinking Water Well Drainage Way A)AV ft Property Line I —. S ft Other {t SKETCH:(Street name,dimensions of lot,exact'locations of test holes&perc tests,Jocate wetlands in proximity to holes) r.! used ? j ._.... Ly Parent.material'(geologic) Q` iS Depth to Bedrock. Depth to Groundwater. Standing Water in Hole: �e� Weeping from Pit Nce � f✓fi�^e Estimatedasona Sel High.Groundwater >1 3 Z DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed-standing in obs.hole: ___ _: in, Depth to Soil Mottiff, Depth to weeping fromside of obs:hole in; Groundwater Adjustment ft. Index Well.# Reading Date: Index Well level,.,,a,.,,,m,_�, AdJ.PActor,,,.,.u,.,� Adj,Urountlwater bevel_ i PERCOLATION TEST gate 'Cline Observation ,�G►_/ Hole# 1 Time at'V Depth of Perc 3 Z1So Time at 6" 24 S,,I l/v .s� Start Pre-soak Time.@ _ - d ro:✓t ep End:Pre-soak ( 57 rvt%v� Rate Min./Inch. 1' 2 Site Suitability Assessment: Site Passed Site Failed;• Additional Testing Needed(YL,N Original: Public Health Division Observation Hole Data To Be Completed on Back'----------- ***If percolation test.is`to be.conducted within 100' of wetland,you must.first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERUO RM.DOC DEEP,OBSERVATION HOLE LOG Hole# 1-10— . Depth from. Soil Horizon Soil Texture Soil Color' Soil Other Surface(in..) t(USDA) (Mansell) Mottling '(Structure,-Stones;Boulders.. o i ten ravel —i32 G5��-wry 7a�.`f �� 10-20� (DEEP OBSERVATION HOLE LOG Hole: z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) '(Munsell). Mottling (Structure,Stones,Boulders; Consi s ten %Graven -y A, E'/ot y -5 ioytt y�z _2y 13. is elm V 5-141J Io YrZ sjb DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munscli) Mottling (Structure,Stones,Boulders. Cnitec 9'oG vell DEEP OBSERVATION HOLE LOG Hole.# Depth:from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (MA) (Munseil) Mottling (Structure,Stones,Boulders. onsi ten Flood Insurance Rate'IViap Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within l00 year flood boundary No x Yes Depth pf Naturally Occurring Pervious 1Vlaterial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed'for the soil absorption system? `{` "if-not,-what is--the depthof naturally occurring pervious material? Certification i q — I certify that on I i (date)I have passed the soil evaluator examination approved by the. Departmentof Environmental Protection and that the above analysis was performed by me consistent with the required,traini ,expertise and experience described n.310.CMR 15.017.. t. Date l Z 27 �I Signature Q;\SEp TICIPERCrORM.DOL i Town of Barnstable Barnstable Regulatory Services Department i � M '"* M ' Public Health Division D i639• 1� 1 " ilk 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 2572 January 25, 2016 Carlos Gonzalez 125 Grove Street Hyannis, MA 0260 iThe septic system located at 125 Grove Street,Hyannis,MA. was last inspected on 10/29/2015 by Michael Dibuono, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system"Fails". • Single cesspools automatically fails in the Town of Barnstable You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health . i Q:/Letters Septic Inspection failures or Future Evil/125 Grove St Hy Jan 2016 r `a Town of Barnstable + lAHN3fAHLE, • _ q Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,'2007 - Rev. 7/6/15 DEADLINES TO REPAIR-FAMED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within'a Zone 1 to a public welI ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water.quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO 2 YEAR DEADLINE CRITERIA Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) f OTHER Repair deadline: QASEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc I - Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 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. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain reb Company Name 8 Johns path Company Address low S Yarmouth MA 02664 City/Town State Zip Code 508-364-9587 SI 13522 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: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the.Local Approving Authority 10/29/15 ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I - Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a single cesspool ( Unsafe and unsound )as well as a leach pit. Cesspool is no longer leaching and kitchen sink is on another cesspool or dry well. The leaching pit appears to be functioning properly however it will not be at a proper elevation when kitchen line is tied in. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts _ v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 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 wM 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is Hyannis Ma 02601 10/29/15 required for every Y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system contains a single cesspool ( Unsafe and unsound )as well as a leach pit. Cesspool is no longer leaching and kitchen sink is on another cesspool or dry well. The leaching pit appears to be functioning properly however it will not be at a proper elevation when kitchen line is tied in Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 119 Gpd 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code -Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 25 + years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throught the roof. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�M ,••'•y 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Citylrown 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 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Cesspool was pumped recently Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 17 r . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Na Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal p g p System•Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No breakout or ponding Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 0 Depth of solids layer 0 Depth of scum layer 0 Dimensions of cesspool W Materials of construction block Indication of groundwater inflow ❑ Yes ® No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I . Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydraulic failure. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ftfeet 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: Local maps indicate NGE at 15 ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 125 Grove st M Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Y" Commonwealth of (Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments U _ 4 ,, '�� .•' 125 Grove st ••--t Prope _arlos_G_onzaiez Owner Owner's Name ---- --- -- - —-------- ----- wry -- informa requir ed for ev � Lion is require Hyannis Ma 02601_ 10/20/15 - --- -------------------------- ---- -- ..� page. I y l own 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 fillingng formicA. General Inforaiation on ththeconl uter, �j 11 2 3( use only the tab 1. I nso?CTOr: key to rnove your cursor-do not Michael DiBuono use the return ------ --- - ------- ---- ------ ------ ---- ----- --- ---------- — - -- key. Name of inspector r DiBuono Sewer and Drain 9 Company Name `--- -- 8 Johns path -- - C impany Andress r I S Yarmouth MA 02664 !tyTovvn Slate Zip Code 508-364-9587 S113522 Teiephone 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 Titic 5 (310 CMR 15.000). The system: •I Passes (1 Conditionally Passes Fails (—! "deeds Further Evaluation by the i-oca! Approving Authority 10/29/15 ------- --— - ------ - — ----- - !repertors SignatureDate The system inspector shall submit a copy of this inspection report to the Approving Authority (Boord of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 101000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate Fegional 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 ;tot address how the system will perform in the future under the same or different ewtditiois of use. 'isle 5 01 icial lnspecuon Form:Subsurface Sewage liaposal Syslem ,c,,7 i Commonwealth of Massachusetts W� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez _ Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a single cesspool as well as a leach pit. Cesspool is no longer leaching and kitchen sink is on another cesspool or dry well. The leaching pit appears to be functioning properly however it will not be at a proper elevation when kitchen line is tied 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•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /t 125 Grove st Property Address Carlos Gonzalez _ Owner Owner's Name information i e H annis Ma 02601 10/29/15 required for every _y _ _ _ _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health).- broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to'determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water . ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form I^t r• — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `\a 125 Grove st Property Address Carlos Gonzalez _ Owner Owner's Name --- information is required for every Hyannis — Ma 02601 10/29/15 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 ---_—_-- • - title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every ljyannis — Ma _ 02601 10/29/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 125 Grove st Property Address — Carlos Gonzalez Owner Owner's Name information is required for every Hyannis Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3---- Number of bedrooms (actual): 3 — DESIGN flow based.on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ms•3113 1itle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ., 125 Grove st Property Address — Carlos Gonzalez Owner Owner's Name information is H annis _required for every — Ma 02601 10/29/15Y page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a single cesspool as well as a leach pit. Cesspool is no longer leaching and kitchen sink is on another cesspool or dry well. The leaching pit appears to be functioning properly however it will not be at a proper elevation when kitchen line is tied in. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 119 Gpd 9 ( Y 9 (9p )): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): -------- __—_ Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): ------ ---- ---- _- Grease trap present? ❑ Yes' ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ----- ---- —_ _ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts _ f Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \a 125 Grove st Property Address Carlos Gonzalez _ Owner Owner's Name information is required for every Hyannis _ Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: date - Other(describe below): General Information Pumping Records: Source of information: — —Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? --- --------_ _____ Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M aV 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is Hyannis Ma 02601 10/29/15 required for every —Y _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 25 + years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18 -- feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): ----- Distance from private water supply well or suction line: feet — Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throught the roof. Septic Tank (locate on site plan): Depth below grade: feel — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: --- ------- __ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3113 Title 5 Official Inspection Form.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 • 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is y required for every H Ma Hyannis 02601 10/29/15 H _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? — ----- Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan).- Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez __ Owner Owner's Name information is H aunts Ma 02601 10/29/15 required for every _y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Cesspool was pumped recently - Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan),- Depth below grade: ----- ----- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — — — ----- --- Capacity: -- gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: ----- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date ----_-- Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System••Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \ J� 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is annis Ma 02601 required for every F_y 10/29/15_ _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Na Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If.SAS not located, explain why: 15ins•3/13 Title 5 Official Inspection Form: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 125 Grove st Property Address Carlos Gonzalez _ Owner Owner's Name information is Hyannis Ma_ 02601 10/29/15 required for every —y _ _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1— --- ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: — — ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -- - ❑ innovative/alternative system Type/name of technology: -- - ----------- ----- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No-breakout or ponding Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configurationDepth ——top of liquid to inlet invert 0 Depth of solids layer 0 _—__— Depth of scum layer Dimensions of cesspool 8x8 Materials of construction block Indication of groundwater inflow ❑ Yes ® No t5ins•3/13 lltle 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is Hyannis Ma_ 02601 10/29/15 required for every �ann page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydraulic failure. Privy (locate on site plan): Materials of construction: -- - -- ---- Dimensions — --- — -- Depth of solids ---- -- -- ---- — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts __ - �a Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 125 Grove st _ Property Address Carlos Gonzalez Owner Owner's Name information is Hyannis Ma 02601 10/29/15 required for every y _ page. CityrFown 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 I t5ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17 1 LOCATION `25 '7SOue SEWAGE a �b"?r89 VILLAGE ASSESSOR'S MAP&LOT 12 (Q+ INSTALLER'S NAME&PHONE NO. MO.Cbm'VAC 428 'q.028 SEPTIC TANK CAPACITY `}= !�1Q\ emec \ 010 ter- to LEACHING FACILITY: (type) NO,OF BEDROOMS J � BUILDER OR OWNER �.l I Ij�SAmc� PERMITDATE:1,9'o7Q"g� COMPLLANCE DATE: G�vZ 3130 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility k o '3 Ftet Private Water Supply WeU and Leaching Facility (If any wells exist �J on site or within 200 feet of leaching facility) I' Feet Edge of Wedand and L.eanFacit )lity(lf any wetlands exist Iwithin 300 feet of leasciliFeet Furnished byC�'r CVO p �\� a o�'� i � o i i Gc skc-AN r • Commonwealth of Massachusetts • Fi _ � Title 5 Official Inspection Form ;� _ Subsurface Sewage Disposal System Form.- Not for Voluntary 9 p Y Assessments 125 Grove st _ Property Address Carlos Gonzalez _ Owner Owner's Name information is H annis Ma 02601 10/29/15 required for every _y _ _ _ page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Site Exam.- Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ---! ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: Checked with lo cal excavators, Installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation. Local maps indicate NGE at 15 ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5,ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Inspection Form Title 5 official Ins p iml -_1 I;I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments HL 125 Grove st Property Address Carlos Gonzalez Owner Owner's Name information is required for every Hyannis _Ma 02601 10/29/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i. 15ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 17 7'�K habas-e Print Page Page 1 of 4 Print this page • Owner Information - Map/Block/Lot: 310/ 167/- Use Code: 1010 Owner Map/Block/Lot GIS MAPS BARTLETT, DEREK W 310 / 167/ Owner Name as 1240 EAST NINTH STREET Pro er Address of 1/1/15 125 GROVE STREET CLEVELAND, OH. 44199 �a --V1 Co-Owner %SECRETARY OF VETERANS Village: Hyannis Name AFFAIRS OF USA Town Sewer At Address: No GIS Zoning Value: RB • Assessed Values 2015 - Map/Block/Lot: 310 / 167/- Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building $ 91,300 $ 91,300 Year Total Assessed Value: Value Extra $ 38,300 $ 38,300 2014 - $ 198,500 Features: 2013 - $ 198,500 $ 2,100 $ 2,100 2012 - $ 197,300 Outbuildings: 2011 - $ 193,000 Land Value: $ 66,800 $ 66,800 2010 - $ 229,000 2009 - $ 262,200 2008 - $ 291,000 2015 Totals $ 198,500 $ 198,500 2007 - $ 290,100 Residential Exemption Received= $87,192 • Tax Information 2015 - Map/Block/Lot: 310 / 167/- Use Code: 1010 Taxes Hyannis FD Tax $ 450.60 (Residential) Community Preservation $ 31.05 Act Tax Town Tax Residential $ (Residential) 1,035.16 Fiscal Year 2015TAX RATES HERE 1,516.81 I http://www.townofbarnstable.us/Assessing/Printl 5.asp?ap=0&searchparce1=310167 11/2/2015 i COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M + d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ��d Property Address: #125 Grove Street Hyannis,MA Owner's Name: Lillian Strange Owner's Address: 125 Grove Street r Hyannis,MA 02601 Date of Inspection: 06/07/07 Name of Inspector: (please print) Mr.Carmen E. Shay Company Name: Shav Environmental Services,Inc. Mailing Address: 185 Ashumet Road Mashvee,MA 02649 t a Telephone Number: (508)-548-0796 t� 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: XX Passes y' Conditionally Passes Needs Further Evaluation by the Local Approving Auth `' CARMEN tiN. Fails Zi E. SHAY a Inspector's Signature:-. Date: 06/07/07 cFgT�F��oP Fsin+s�� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Cesspool Acting as a Septic Tank with an Overflow Leach Pit. Liquid Level in Leach Pit meets the required inspection criteria for Title V. No Liquid observed in pit. Stain line observed at 3'. 3 Effective Sidewall Available. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. /, Title 5 Inspection Form 6/15/2000 page 1 Lo P pg Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: I Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: f - Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. .,. ., 1 . .,.1,.,,,,.,. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XX _ Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection? XX _Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up ? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site'? XX _ 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? XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX _ Existing information. For example,a plan at the Board of Health. XX _ 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)J Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): NO i Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIA LANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unknown Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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: 1980's-Leach Pit installed per Homeowners&BOH Records Were sewage odors detected when arriving at the site(yes or no): No r 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Stranize Date of Inspection: 06/07/07 BUILDING SEWER(locate on site plan) Depth below grade: 20" Materials of construction: cast iron _XX_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: _(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:, Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): r .,..,. 7 I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type J leaching pits,number: 6' diam by 6' deep Overflow Leach Pit leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Probed stone around SAS with a 6' probe with no evidence of hydraulic failure noted. Inspection inside Cesspool revealed no standing water. 3' stain line observed. CESSPOOLS: 1—ACTING AS SEPTIC TANK (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1_ Depth—top of liquid to inlet invert: No liquid—cesspool was dry from non occupancy. Depth of solids layer: 5.5 Depth of scum layer: No scum Dimensions of cesspool: 6'x 6' Materials of construction: Cement Block Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Stain lin indicated liquid level equal with outlet tee invert and overflows into overflow Properly_ 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.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 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. GROVE STREET Swine Ties: Water;Line A- Cesspool—25.' verflow B- Cesspool—23.5' A—Leach Pit-46' B—Leach Pit—27' B ' CO Exist House A Cesspool Acting As A Septic Tank .„.,. 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #125 Grove Street Hyannis,MA Owner: Lillian Strange Date of Inspection: 06/07/07 SITE EXAM Slope Surface water -'/4 to''/Z mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water 15+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Inspector has performed perc tests in area. Per USGS MAP PLATE 2: Elev.of Ground=42 Feet Elev.Of Groundwater=20 Feet Elev.Of Bottom of Leach Pit 34 Feet Therefore: 34—20= 14 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well MIW-29: 1.7 feet Adjusted Groundwater Separation=34'—21.7= 12.3 feet between bottom of Overflow and adi.groundwater Grade=Elev.42 feet Overflow Cesspool Bottom of Overflow=Elev.34 feet Adj.Groundwater=Elev.21.7 TOWN OF BARNSTABLE LOC:,a+iZOI;. �S '7C81i2 y� SEWAGE # �Z89 V1"i.I,,,�Ci ASSESSOR'S MAP & LOT 31D I I C¢ + INSiALLER'S NAME&c PHONE NO. tn=hmbaC 42,0 gOZ.B SEPTIC TANK CAPACITY �,mo SolOA cessem\ 010 U2r LEACHING FACILITY: (type)) I , 0ko -' (size) NO.OF BEDROOMS 3 BUILDER OR OWNER L.i 11cc-, SAM�- PERMITDATE: COMPLIANCE DATE: G a 3-ga Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �' Feet Private Water Supply Well and Leaching Facility If an wells exist PP Y g tY ( Y on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leac ' Facility(If any wetlands exist Feet within 300 feet of leac ng acility) — Furnished by G U , T X C) PL �1 'gi qg O ` "_ LAI" r 0 LOZABO SEWAGE PERMIT NO• VlVLAGE INST1 LER'Si ' NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� a � £' 70 �. `� � M Sj�� �, . _ ,��, T - ` ci �b THE COMMONWEALTH OF MASSACHUSETTS s 3)a BOAR® OF HEALTH ........ . ...7 .,l....OF.... .1' ``7'G � ................................... ApplirFation for Disposal Works Tonstrurtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: .....�,Q� . .�...� 4ae -----------•.............. anon-Address or Lot No. ......1 � .... r'� a. ... -- aDD ............................................ O ner Address ---------------•-------------- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ....__..... No. of persons....................... Showers p4 yp g ................. p ._.__ ( ) — Cafeteria { ) a' Other fixtures -------- d ---------------••••---...... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.--__-_--------.--. Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground.water.....................__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil------------- .�--- -----.----------------------•---•------- ....._...............••--------.-•-.-•--- U •--•-••----------------•-•---•-••----••---------------------------------------------...........------.............----- VW ---------•-•--------------------------------•------------•--------------•---•----•-•--------------••--•-•--•........................-•------------...---•-------....-----•------------•-••-••--....._. Nature of Repairs or Alterations—Answer when applicable-----------P .................................................................... ...... . ................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT .;:;. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has keen issued by the board of health. Si ned_._:. . ,.: ...� ......... � �. ._ t Date Application Approved By........ .. .............. ....... -------- ate Application Disapproved for the following reasons:-=---•---------•--------------------------------•-------------•--------....-•--•-----------•.----•-------..... ....................•--......----•---•---------------------...--•--------....-•-------.........----------------------------------------------------------------------•---�--------------......__. �� ^ Date Permit No. Issued.- ---•----�..b........I..---------••-•-----•--- Date R No. = •C`-- FEB..j................r .... THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH �..L . }�. ....OF.... .�r:�.!.�::.'.. / r).•j` C�'__..__.... Appliration for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair (;�,) an Individual Sewage Disposal System at: -------- - .................:......._...:::........................................ .......-----........---•----------------------.......------------.................•.........-•-••- f 1 i Location-Address J jj or Lot No. __... .... ..................................................... .................................................................................................. Owner /{� / _ /1 Address ..................................................--................................_:.... ......... • ..................-••--...........----............................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------...................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building No. of persons............................ Showers Pa YP g -•------•.................•• P ( ) — Cafeteria ( ) al Other'fixtures ----------------------------••......-----••••. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity...._._.....gallons Length................ Width................ Diameter..............._ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter............... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...................--------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .............••••-•--•--••-•-•......•-•--•--•••...... ........--•--.........•---•.............-------------••••-•--•-•------..................--------- 0 Description of Soil.............:.. ..a-_-- --- r ! a , f t%i, , I -----------------------------------------------------------------•--------....................................................... x U W U Nature of Repairs or Alterations—Answer when applicable........... ..:.!_! ..._.._._........____._.__..........._................._...........__. y ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed................................................................0..._.•--- r� Date Application Approved By....... . ........................ . �� $ate Application Disapproved for the following reasons:------•------------------------•---------------------------•-------------------••------------•--......•-••-•-- -•--•--•-•-•----•-•-•--•.............•••......-•••-•-----•••----.......0..••-- Date PermitNo....................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... �rr#ifirtt#r ,af f�am�li�anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (. ) by '.. -.................................. --------------------------------------------------------------------------------------•-•...----....-- Installer _ / = at - = =----_---- has been installed in accordance with the provisions of T Tj,F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ �j.�.__..2--8.7._....... dated............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WIL FU�N)CTTION ,S T FACTORY. DATE.........--- ---- -- d-•---_-.......•.-_--------•--•----------------...... Inspector. -----. ------• ..................................... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e..>.......OF.. .. .. / }�:........................................................� ::..:::. :... ... .... No. . FEE. (�G Disposal Works Tnnotrnrtion. until. Permission is hereby granted........ '............... !........_r.i 1_i_h--Y......._...... to Construct ( ) or Repair (,, ) an Individual Sewage Disposal System r lStreet as shown on the application for Disposal Works Construction Perrpit No..............•.....• Dated......................................... ,. ---------------------------------- ......... .__r..B. . oard of,F ealth DATE...... 5 ' .................................... Y FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -1 0=1-- EXISTING CONTOUR N i� 10 PROPOSED CONTOUR LOCUS j x 100.98 EXISTING SPOT GRADE Charles St W—EXISTING WATER SVC. n —e.H.-KL—OVERHEAD,WIRES ° a)N � Birch St TEST PIT v o �0 0� BENCHMARK 3 N 5 LEGEND A CP TOP OF CONC. BOUND Louis St `c a EXISTING CESSPOOL EL.=99.72 (APPROXIMATE) r TO BE LOCATED, PUMPED, PROPOSED SEPTIC TANK 3 FILLED WITH SAND AND ! CBDISK CB S 2T34'S6" DISK ABANDONED. 5, North . 99,72 North St 100.70 x 99 75 138.01 x 99,g1 chain link fence x 99,96 x 100,12 x LOCUS MAP \ '99,8 Pv1 0 10, � NOT TO SCALE \tN\STALL CLEANOUT �� Q \ - Ij GENERAL NOTES: 0 0 ..-10.. 99 9 / Q 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100,38 TP 2�: Q p• o BOARD OF HEALTH AND THE DESIGN ENGINEER. V �'Lo 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 0x DECK 100,53 'wry t ,CQ'N ° OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Z SHR. �`r':^ Q .DI9 ,93 LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 100,25 —310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL 00 4" SEWER 1) A 3' variance, S.A.S. to cellar wall, fora 17' setback. rn lNV.=98.8E 172 'J rn 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR I W x 100,10 1�12.8i'--I W DESTO IIGNPENGIONEERND APPROVAL BY THE BOARD OF HEALTH AND THE x 100,25 GARAGE EXISTING s I �, al Cn C4 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING HOUSE(;-I(' 5) 4" SEWER I 0 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN T.O.F.=101.5E INV.=98.8f ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 100,88 :.:;:. ti I EXISTING CESSPOOL 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF TO BE PUMPED, FILLED THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 1 I WITH SAND & ABANDONED HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x 100,29 100,70 I 01,43 STP 100.57x 1� INSTALL CLEANOUT 7• WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. • �' LOTS 22 &23 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. Q . j "•. j.. 99 5 TO BE PUMPED, FILLED 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS I 12,044 ±SF 0,16 EXISTING LEACH PIT AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PARCEL ID. 310-167 WITH SAND & ABANDONED ® DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY . . :.: L P ; ;;.;_' ,.v • 98.0 sPlit rail fence SHELL: THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 00 >' 1IZ0,0 �1'2e 23'30" E PARKING: 9 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS �00 _ 59,9 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND k 99,93 edge of — REPLACE WITH CLEAN SAND AS SPECIFIED IN. 310 CMR 255(3). 100.02 9 Pavement 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE RI R T BACKFILL. INSPECTED Y DESIGN ENGINEER PRIOR 0 99�97 ` 98,95 EC ED B 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. GROVE STREET 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 0F 4f4ss9� SYSTEM COMPONENTS NOT SHOWN ON THE PLAN � G T. s I SYSTEM N PETER PROPOSED SEPTIC EM UPGRADE PLAN Mc 125 GROVE STREET, HYANNIS, MA CIVIL VIL "' t No. 35109 Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 Si- Engineering b SCALE DRAWN JOB. NO. \ 9� 9 Y� � OWNER OF RECORD CARLOS GONZALEZ Engineering Works, Inc. 1"=20' P.T.M. 299-17 125 GROVE STREET 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. HYANNIS, MA 02601 508 477-5313 12/29 17 P.T.M. 1 Of 2 SEPTIC TANK NOTE: SHALL PREVENT TBERATK OR BELOW, EL.=98.00 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. 17'--{--12�8'--1 INSTALL RISER & COVER PROPOSED S.A.S. 1) SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND / T.O.F=101.54- SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT 1 ; F.G. EL.=100.5t F.G. EL.=100.0f F.G. EL.=100.0E F.G. EL.=100.0t rl.�` ��` i -0 iN MAINTAIN 2% SLOPE OVER S.A.S. .� to L = 52'(MAX.) 3'(max.) t L = 11' 4" SEWER 8, 0 V D L a 5, , lNV.=98.8f 2 Jr, (n I ® S=1% (MIN.) @ S=1% (MIN.) ® S=1% (MIN.) 4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC 2 DOUBLE WASHED S ONE2" EX/STING VI: �12 8' 6" s" aa.. (OR APPROVED FILTER FABRIC) GARAGE HOUSE(#125) 14" aaBeaaa 4" SEWER ' INV.=97.60 48" LIQUID aaaaaaa -3/4" TO 1-1/2" DOUBLE / T O.F=101.5E INV.=98.8t 1 LEVEL ADD PROPOSED 4' 4.8' 4' WASHED STONE ` ` ` ` ` GAS BAFFLE INV.=97.27 _ INV.=97.10 us� INV.=97.35 p BOX EFFECTIVE WIDTH = 12.8' AIM AWk AM dmk 3 OUTLETS INV.= 97.00 PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN CONNECT TO EXISTING SEWER PIPES AT HOUSE, AT OR ABOVE, INV.=98.8 H-10 RATED TOP CONC. ELEV.= 97.8t NOTES: BREAKOUT ELEV.= 97.50 SEPTIC LAYOUT INV. ELEV.= 97.00 MEaaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BMMMMMMaaaa aaaaaaaaaaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM OF S.A.S., ELEV.= 95.00 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 2 x 8.5' = 17.0' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=88.9 - 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE = ®®®®®® ® ®®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. d- w ® Ea 3a E3 a SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT DATE: DECEMBER 27, 2017 (REF#15,556) NUMBER OF BEDROOMS: 3 BEDROOMS (PER AS-BUILT CARD & OWNER) SOIL EVALUATOR: PETER McENTEE PE 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT 4" KNOCKOUT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT 58" 0 DAILY FLOW: 330 GPD 99.9 A 0 100.0 A 011 LOAMY SAND 11 LOAMY SAND DESIGN FLOW: 330 GPD 99.5 10YR 4/2 99.7 10YR 4/2 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design B 5 B 4 LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 10YR 5/6 10YR 5/6 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 977 C PERC 98.0 C 24" CHAMBERS PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 32"/50" N.T.S. D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES M-C SAND M-C SAND° PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 . � 125 GROVE STREET, HYANNIS, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: DiBuono Sewer & Drain 35 Content Lane Cotuit MA 0263 r P 5 � BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. i Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. 88.9 132" 89.0 132' Engineering Works, Inc. N.T.S. P.T.M. 299-17 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD PERC RATE 2 'MIN/IN. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 12/29/17 P.T.M. 2 O 2 i