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HomeMy WebLinkAbout0015 GUNWALE ROAD - Health 15 Gunwale.-Road,,'.-',A'.' \ Hyannis P A = 268 062 r !/ v� 7 r Commonwealth of Massachusetts ° O(0_ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road v Property Address - r Laurent Araujo Owner Owner's NamJ� information is H annis ►/ MA 02601 02/15/2021 required for every y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 514r t6l&3 j on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road ,Q Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 02/16/2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at.the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System 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: This 3 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding a 13'x 25' x 2' leaching trench. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) .Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 1 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for aH inspections: it II 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 ® ❑ y ece ed normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33 plus GP Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gPd))� Detail: From March 2019 thur 2020-214,676 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp_doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every y H annis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 01/02/2008 new system Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 15" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 • r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 6" 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: H-10 1500 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: One 13'x25'x2x ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 5 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 f Assessing As-Built Cards https://townofbamstable.us/Departments/Assessing/Property_Valu... TOWN OF BARNSTABLE LOCATION Cr �vvJff/.J ofQ, SEWAGE#-To"'F'chJ VILLAGE ASSESSOR'S MAP&PARCEL-:2 6d 0621- INSTALLERS NAME&PHONE NO.lJ-;A'!, L 4-46"4�- SEPTIC TANK CAPACITY /1�oa 4z. LEACHING FACILITY: 1 XaT T Xd NO.OF BEDROOMS OWNER .!?�LLPtF�li PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i 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) ,J Feet FURNISHED BY- jti..r �E8G16`Gf 7 1= .dais 4 CAb r 9� P? o �- � fp ;e� ,rlE S� 1 of 2/16/2021,7:24 AM Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar Shallow wells Estimated depth to high ground water: 10 plus feetfeet 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: I augered a hole at a lower elevation and shot it with a transit. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Laurent Araujo Owner Owner's Name information is required for every Hyannis MA 02601 02/15/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 NOW, THEREFORE, GPV 2 f-,4 ( does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. /S 6w w 'e may have constructed (address) upon the lota house containing no more than bedrooms. G�2 ( agrees that this shall be permanent deed (owner's ame) restriction affecting located on MA, and being shown on the plan recorded in Plan Book 3)0$ , Paged . Or on Land Court Plan For title of see the following deed: Book 31 OSB , Page [S ( Or Land. Court Certificate of Title Number . E ecuted as a Baled instrument day of E' igrna tur Owner's signat re �' COMMONWEALTH OF MASSACHUSETTS 9 s 20S Then ers�n II ea ed th�= �e �; Ch known to me to be the person who execu ed the foregoing instrument and acknowledged the same to be free act a d deed, before me, Notary Public `4. '�- My commission expires: ( ie)REID ¢ Notary Public COMMONWEALTH OF MASSACHUSE'TS deedr '. My commission Expires . January 23.2020 1 SAMPLE To be used as a Guideline NOTICE: The Town of Barnstable recommends that the applicant seek legal advice to prepare a properly worded deed restriction document. DEED RESTRICTION WHEREAS, LA'�� A'ul/-1 V 0 of (owner's name �S 9vi�IwJI�� MA (address) is the owner of l�Gv/�C�//�ZE located (addre ) of MA (hereinafter referred to as an ein shown on a plan entitled "Subdivision of Land in MA, Property of . et al, duly recorded in Barnstable County Registry of Deeds in Plan Book 3� � tt , Page Or on Land Court Plan Number WHEREAS, ( M as the owner.of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum . Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and authorizing the issuance of a building permit for the construction:of.a single family home on this property, is requiring that the agreement for tine restriction on the number of bedrooms in any house constructed on the lot be.Pi~t o z .record with the Barnstable County'"Registry of Deeds by recording this document, 4,j c Commonwealth of Massachusetts Title 5 Official Inspection Form Op Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug! 3.- �s 15 Gunwale Road rQ Property Address Duane Noreau :3> Owner Owners Name information is 171 required for every Hyannis,/ MA 02601 12-21-17 /C,Vt' page. CityrTown State Zip Code D pection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. General Informationan the ,ttttt,itili,i,/ use only the tabr 1 Inspector: ``.`��� �t�� l�OF PdgsS�n key to move your ; cursor-do not James D.Sears sue; JAMES kee the return Name of Inspector Y Ca wide Enterprises Q Company Name .� 7 t F.,.� 153 Commercial Street Company Address if Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15,340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-10-1 B actor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. RRRRThiS 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. t5ine.doe•rev.6/16 T tie 5 Official Inspection form:Subsurface Sewage Disposal system•Page 1 of 17 vs 6 6 abed iced dH 50 b l 8 60Z 01, Uer f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments v 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 page. Cdyrrown state Zip Code Date of Inspection B. Certification (coat) Inspection Summary: Check A,B,C,D or E 1 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 is a 1500 Gal.Tank D Box and and two chambers. 113) 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.cloc•rev.6116 Title 5 Official Inspection Form:Subumlace Sewage Disposal System•Page 2 of 17 OZ a5ed xeJ dH 90'b I. 9 60Z 01• Uef Commonwealth of Massachusetts . - Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumpslalarms 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.doc rev.6A 6 Title 5 offidel Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 l,Z a5ed xed dH 90:t,6 2 602 0 6 uef Commonwealth of Massachusetts gphl�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 page. CityrTown 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 ondin of effluent � ® 9 P 9 to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in is less than 6" below invert or available volume is less than %day flow ,L FPrN I NG t5ins.cloc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ZZ a5ed xed dH L0471, 81.0Z 06 Uef Jan 10 2018 14:57 HP Fax page 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is Hyannis MA 02601 12-21-17 required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cons.) 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- 10,000g pd. ❑ ® The system fgil . 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.doc•rev.We Title 5 OftlGal Inspection Form;Subsurface Sewage Disposal System•Page 5 of 17 Jan 10 2018 14:57 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth- Not for Voluntary Assessments 1, 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is Hyannis MA 02601 12-21-17 required for every page, CityJTown State ZJp Cade 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 NIA) ® ❑ 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 t5lns.doc•rev.506 Title 5 Of iclal Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts 0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name isrequired for every Hyannis MA 02601 12-21-17 page. City/Town State Zip Code Date of Inspwion D. System Information Description: 1500 Gal Tank D Box and two chambers. Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15,203); Gallons per day(gpd) Basis of design flow(seatslpersonslsq.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: tSlns.doc-rev.6116 Title S Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 SZ a5ed xed did 90471. 81.0Z 06 Uef i Commonwealth of Massachusetts Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .ti 15 Gunwale Road Property Address Duane Noreau Owner owner's Name information is required for every Hyannis MA 02601 12-21-17 - page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins.tloo•rev.6116 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page a of 17 92 a5ed xed dH 80:17 6 ME 0 6 Uer Commonwealth of Massachusetts I� Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '0" 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name Information is required for every Hyannis MA 02601 12-21-17 page. Cltyrrown State Zip Code Date of Ins pection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2008 Permit # 2008- 001. 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.): Pi ein is 4" PVC SCH-40. Septic Tank(locate on site plan): Depth below grade: 8"feet Material of construction: ® concrete ❑ metal ❑fiberglass g ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: ill t5hs.doc•rev.6r16 Title 5 Official Inspection Form:SUD841raCe Sewage Disposal Syetem•Page 9 or 17 LE a5ed xed dH 80:ti6 860Z 06 Uer f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at 811. In and outlet Tee,s. No sign of leakage or over loading. Note: Tank should be pumped Grease Trap(locate on site plan): Depth below grade: 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 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 8z a5ed xed dH 80:b 6 8 ME 0 6 Uer I Commonwealth of Massachusetts � Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 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.): 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 That switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins.tloc•rev.6/16 Title 5 OfFicial Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 6E abed xed dH 60:V 6 91,02 06 Uef Commonwealth of Massachusetts Title 5 official Inspection Form < Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is required for every Hyannis annis MA 02601 12-21-17 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-2' Below Grade w/cover at 8". Box is clean and solid w/no sign of over loading or solid carry over. 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: l5ins.doc-rev,6118 Title s ofriclal inspeaion Form:Subsurface Sewage oisposai Sysiem-Page 12 of 17 0£ a5ed xed dH 60:b 6 2 602 0I• uer I:\ Commonwealth of Massachusetts G 9Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F l`.�' 15 Gunwale Road Property Address Duane Moreau Owner Owner's Name information is required for every Hyannis MA 02601 12-21-17 page, City/Town State Zip Code Date of Inspection D. System Information (cont,) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number.- El innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal.dry well chamber's w/4'stone. Chamber's at 32" below grade w/cover at 1'. Chamber's are clean - like new walls,Wet bottom. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins.doc•rev.6116 Title 5 Official Inapaetion Form:Subsurface Sewage Disposal system•Page 13 of 17 6£ a5ed xeJ dH 60:b 6 91,02 01, Uer Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information equiredio re Hyannis MA 02601 12-21-17 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5lns.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page U of 17 Z£ a5ed xe� dH 06'b6 81.0Z 01, uef Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owners Name Information is required for every Hyannis MA 02601 12-21-17 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 U ��► • `/G azo , 3 R4 3� .� �3� 09-3 - pt- '/8 t5ins.doe•rev.6!16 T He 5 official Inspection Form:Subsurface Sewage Olsposal System•Page 15 or 17 ££ a5ed xe� dH UV I, ME 01, Uer Commonwealth of Massachusetts vr Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information is H required for every Hyannis MA 02601 12-21-17 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells . NJ Estimated depth to Figh ground water: 1T+ 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: 11-2007 Date ❑ Observed site(abutting propertylobservation 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: T.H. on design plan 11-2007 11'+ no G.W.. Bottom of chamber's at 5' below grade. Bottom of chamber's at 6'+above G,W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 b£ abed Y2J dH 0 V I. 8 60Z 0 L Uef commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Gunwale Road Property Address Duane Noreau Owner Owner's Name information Is required for every Hyannis MA 02601 12-21-17 page. Clty/7own 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 We t5irwdoc-rev.6/16 Tile 5 Orfidat Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 5£ abed xeJ dH 06476 8602 06 Uel- TOWN OF BARNSTABLE � l LOCATION �� =�''�✓/-'1d��' SEWAGE# � ;,.,VILLAGE��/T Ar�A'A ASSESSOR'S MAP&PARCEL --2 4:rF" � INSTALLERS NAME&PHONE NO. C"iW2 SEPTIC TANK CAPACITY IOd j 4f. LEACHING FACILITY:(type) (size) NO.OF BEDROOMS - . OWNER PERMIT DATE: ",0 CP COMPLIANCE DATE: 000�-m 40 4 r 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 Vh TOWN OF BARNSTABLE / r LOCATION / !!�' 6&vlaMLSEWAGE # VILLAGEaww)s ASSESSOR'S MAP & LOTC'X INSTALLER'S NAME&PHONE NO. 4a SEPTIC TANK CAPACITY Ce tS� J LEACHING FACILITY: (type) C2 SSAa�I (size) NO.OF BEDROOMS BUILDER OR OWNER �T P�ICi e PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) Feet Furnished blt ST/� d^ 1 SU Wj W V No. V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for 33igpo5al *pgtem Cott.5truction Permit n for a Permit to Construct Repair Upgrade Abandon ?room lete System ❑Individual Components Application o (� p O Pg O O P Y P Location Address or Lot No. ���� j r �� �y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel—r6l J�� �` 4AX el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building or-e-'r, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 'jG gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Be0d of Health. 'a Signed i Date d �— G Application Approved by Date j o2 Application Disapproved by: Date for the following reasons Permit No. 41'0 0 Ca Date Issued —p -•,•..•. „ .;�..,•.^•.,-.. .,.,.h .,,• -.a, , •.."`l•",r,fi^r"."`v 7 wmw.•-•-�r'+d;'�.�.,�,.,.y,-••�y'��..,�t_..+ry .7 ,r.r.�1lY"�.,. � _ ., y - No. Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYicatiou for ;Bioponl *pg;tem Con0truction Permit Application for a Permit to Construct(j/f Repair( Upgrade( Abandon( ?.Complete System ❑Individual Components n Location Address or Lot No.���y�/v�/jQ ,/Sry Owner's Name,Address,and Tel.No. f `^ Assessor's Map/Parcel 6- b ' Installer's Name,Address,and,.Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms `"�3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building •�P'Gcf', No.of Persons Showers( ) Cafeteria( ) ' 1 ` Other Fixtures i1 Design Flow(min.required) gPd Design flow Provided �O gPd Plan Date Number of sheets Revision Date Title t; Size of Septic Tank Type of S.A.S. w: Description of Soil Yid Nature of Repairs or Alterations(Answer when applicable) I Date last inspected: I �t 'Agreement: i The undersigned agrees to ensure the construction and'maintenance of the afore described on-site sewage disposal system in j 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 JBAAof Health. Sgned % ) Date ` - a Application Approved by .' Date / oZ Application Disapproved by: Date for the following reasons i Permit No. 9-0 0 Oa Date Issued it— 'p— `0 -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance f '/ THIS IS TO CERTIFY,that the On,?site Sewage Disposal System Constructed (A) Repaired ( ) Upgraded ( ) Abandoned( )by at I �G 41'`W.I'Le 0P4V• e TKX has been constructed i accordance r/ with the provisions of Title 5 and the for Disposal System Construction Permit No. a.-DO 6 00� dated I � 2 C' \( i Installer ���'� LEQc liic' Designer,e_,V,ii,e�> ,�/.e�.e'�/'0/"P �', ✓' #bedrooms Approved design flow gpd The issuance of this pe s 11 not b construed as a guarantee that the system i unction a es�'gn t/ Date Inspector i / —————^——Q————————————————— ——— i No. o` O O � I — Fee a V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Dig;po5ar *pg;tem Construction Permit Permission is hereby granted to Construct ( � Repair ( ) Upgrade ( ) Abandon ( ) System located at J T and as described in the above Application for Disposal System Construction Permit.The applic rrecognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this�rmix.., Date —' a _Q O Approved by ) V Town of Barnstable b e P# Department of Regulatory Services .,,"Mem t Public Health Division Datellql MASS 200 Main� Street,Hyannis MA 02601 Ep t r"o Date Scheduled doll, rwej Fee Pd. Soil Suitability Assess Witnessed By.� 'F � 1 `-t ent for Sewage Disposal )`--/ , Performed B(. V 4D � �4WA7 LA , 1y2� �1 LOCATION& GENERAL INFORMATION Location Address / ,L� Owner's Name Address Assessor's Map/Parcel:.2 r �d� Engineer's Name NEW CONSTRUCTIO N CC �1�R�EJPPAIR Telephone# f 3 7� 7�rb'3 �773 Land Use W ID -'i i Slopes(%) Surface Stones .Distances from: Open Water Body ft Possible Wet Area Drinking Water Weller ft: Drainage Way ft Property Line ? ft Other ft e c;-. SKETCH:(Street name,dimen of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � I i i Parent material(geologic) �U7W 1%5q Depth to Bedrock / > /�+� Depth to Groundwater. Standing Water in Hole: 'T Weeping fiom Pit RnCe Estimated Seasonal High Groundwater 1-2 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole:. __— id. Depth to soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. ---- Index Well# Reading Date: Index Well level , Adj.factor— Adj.Groundwater Level,,,e PERCOLATION TEST Date Time.� Observation Hole# Time at 9" Depth of Perc o/ Time at 6" Start Pre-soak Time @ 2 'time(9"-6") End Pre-soak j Rate MinJtnch -� Atm. P Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil [her Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv.%Gravel) & j DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten %Gravel) i I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) C9 +� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Munsell) Mottling ( [ ,Stones,Boulders. Cons ten Flood Insurance Rate May: Above 500 year flood boundary No_ Yes . Within 500 year boundary No Y Within 100 year flood boundary No r Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification w �/ I certify that on � (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was perfo by a consistent with . the required training,expe a rience described in 310 CMR 15.017. q Signature Date Q:\.S.EP11OPERCFORM.DOC Jan 07 08 07: 15a 508-833-2177 p. 1 Town of Barnstable Regulatory Semees Thomas F.Geiler,Director Public Health Division - . a T honlas/McKean,Director 200 Main Street,Hyannis,Mi 02601 Offtce:.508-862_-4644 T= 508-79C,6304 Installer&Deskner Certification Perm Date: 6LA YDesiguer-. J Vi c` Installer:. Address: . Address: L� i (as issued a permit io install a (date) (installer) septic system at t �D'�T), ltIAV4+I I%ased on a design drawn by (address) dated ' 7 (designer) ",]_.certify that-the septic system referenced: above was installed substantially according"to " de design:which may include minoz approved changes such as Tat ra' zelcacation of the dtstnbufion box'and/or septic tam _ I certify that the septic system referenced above was installed with changes,(i e. greater 6= 10' lateral relocation of the SAS or any ve�cal~re"ativn.of any componmt of fihe.septz system)but in accordance with State&Local_RegOlations. Plan revision o certified asbifflt by desig*to fellow_' 0 If o I ilID �. (installers Side) gs'.I�f�}��S[°.•ON 4... iYQlvvty RT7 (!D er s Signature) CAT ( ens�Ea Herd) OF. CUNLPLl�A1VIrE 1--AQ ---3E ISSUED.' i0 `'- RM' - l�l TCARD ARE RE CEA%D B AAM&T ABLE PUBLIC_U THANK YO1t7. Q:Hea1tmeptirll7esigner CerficaEivp Fora t f 4 c v s Z er � � o u y r 'J `` 41 4 J � t me j t Iw n j C - t G COT T. r csJ >- { p = rp Jam. .,..� ... ��,ti�-•- �.` � � _ yam' `� � } ti � n v r 1/0 _6'.210: Reparation of Plans ana Soecifications, fr a,Y' The plans and specifications for every on-site system shall be prepared.as follows: (1) -Every system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system designed to discharge more than 2,000 gallons per day pursuant to 310 CMR 15.203. Any other agent of the owner.may prepare-plans for the repair of a system.designed to discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203 provided they are reviewed by a Massachusetts Registered Sanitarian and approved by the approving au ority; (2) Every plan submitted for approval must be dated and bear the stamp and signature of the designer, (3) Every plan for a now system or plan for the upgrade or expansion of an existing system which requires a variance to a property line setback distance,must.also reference a plan which bears the stamp and signature of a Massachusetts. Licensed Land Surveyor in accordance with M.O.L. e: 112, § 81D; (4) Every plan for a.8 ystem shall be of suitable scale(one inch=40 feet or fewer for plot . Yand one inch = 0 feet or fewer for details of system coin onents) and shall include PVn of. the legal boundaries of the facility to be served; (b),�tthhe holder and location of any easements appurtenant to or which could impact the .stem; (c) a location of the all dwelling(s)or building(s)existing and proposed on the facility a identification of those to be served by the system; ��d) the-lacation of existing or proposed impervious areas, including driveways and rking as; adon and dimensions of the system (including reserve area); (f) .system design.calculations,including design daily sewage flow,septic tank capacity . eq ' 'd and -rovided); soil absorption system capacity (required and provided); and ether s ern is designed for garbage grinder, (g) arrow and existing and proposed contours; (h) ocati eland log of deep*observation bole tests including the date of test, existing ade vations marked on each test, and the names of the representative of the ap ving authority and soil evaluator, cation and results of percolation tests including the date of test and the names of th representative of the approving authority and soil evaluator, name and certification number of the Soil Evaluator of record; (k) location of every water supply,public and private, 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case;of tubular public water supply wells, and 3. within 150 feet of the.proposed system location in the case of private water supply wells; location of any surface waters of the Commonwealth, rivers, bordering vegetated wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone, surface water supplies,tributaries to surface water supplies,certified vernal pools,private water supplies or suction lines, gravel packed or tubular public water supply wells, / surf,'ce drains, leaching catch basins, or dry wells; and the location of any nitrogen N se ' ve area identified in 310 CMR 15.215 within which portions of the proposed rein ar'-located. m) cation of water lines and other subsurface utilities on the facility; observed and adjusted ground-water elevation in the vicinity of the system; o. a complete profile of the system; a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought f" conjunction with the plan; (q) . the location and elevation of one benchmark within 50 to 75 feet of the facility which is not subject to dislocation or loss during construction on the facility; ` when dosing is proposed,complete design and specification of the dosing system proposed including but not limited to dosing chamber capacity (required and provided), ump cames and specifications,number of dosing cycles and depth per cycle; { he 'R culating Sand Filter or equivalent alternative technology is required or J" yr d, omplete plan and specification for the system,including a hydraulic profile; a cus plan,to show the location of the facility including the nearest existing street, (u the street number and lot number,if any, of the facility; and the materials of construction.and the specifications of the system. ' i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION iVED DEC 0 4 2002 TOWN OF BAR JSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 Gumvwale Road Hyannis, MA 02601 Owner's Name: Robert Neagle Owner's Address: Date of Inspection: November 26, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:268 Osterville,MA 02655-0049 Parcel:062 Telephone Number: (508) 862-9400 Lot: 10 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: December 1, 2002 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Gumvhale Road Hyannis, MA Owner: Robert NeaQle Date of Inspection: November 26, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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: 2 s Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: IS Gumvhale Road Hyannis, MA Owner: Robert Neazle Date of Inspection: November 26, 2002 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Gurrwhale Road Hyannis, AM Owner: Robert Neap—le Date of Inspection: November 26, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ 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 M described in 310 CR 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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered `yes to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neakle Date of Inspection: November 26, 2002 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 ? n/a 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neagle Date of Inspection: November 26, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a 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): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd 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: Pumped approximately 1 year ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system 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: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 i Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neagle Date of Inspection: November 26, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) (Cesspool acting as a septic tank) Depth below grade: 12" Material of construction: _concrete _metal _fiberglass _polyethylene ✓ other(explain) Cesspool block If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: S'Wx 7'Tx 9'bottom to grade Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle: -- Scum thickness: 0" 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: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The cesspool had approximately 4'of water on the bottom. An outlet tee was present. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 ` Page 8 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neade Date of Inspection: November 26, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 1% ' Page 9 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neagle Date of Inspection: November 26, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ✓ overflow cesspool,number: 1 -S'W x S'T x 7'6"bottom to grade 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.): The overflow cesspool was dry. The scum line was approximately 1'6"up from the bottom There were no signs offailure. The cover was approximately 6"below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of"l 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neakle Date of Inspection: November 26, 2002 Map:268 Parcel. 062 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 10 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. A 3 a- A S 33 aa� y 10 Page 11 of 11 4 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Gunwhale Road Hyannis, MA Owner: Robert Neagle Date of Inspection: November 26, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20 +/- 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: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the cesspool to grade was approximately 9' Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 20'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 Bk 31058 P0151 Y5163 01-31--2018 & 41 =5414p MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 01-31-201E @ 01:54am Ct2*: 938 Doti: 5163 Fee: $17015.74 Cons: $297000.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 01-31-2013 a 01:54am CtIY: 938 Doc-: 5163 QUITCLAIM DEED Fee: $908.32 Cons: $2977000.00 a 4 1,Duane T.Noreau of Barnstable County,Massachusetts for consideration paid of Two Hundred Ninety-Seven Thousand and 00/100($297,000.00)Dollars Grants to Laurent Araujo, individually,now of 15 Gunwale Road,Barnstable County,Hyannis,Massachusetts. 12 With Quitclaim Covenants 2 T The land,together with the buildings thereon, situated in Barnstable(West Hyannisport), Barnstable County,Massachusetts,more particularly bounded and described as follows: NORTHERLY By.Gunwale Road,as shown on a hereinafter mentioned plan, 97.50 feet; jEASTERLY By Lot#11 and a portion of land of Robert A. Watt as shown on said plan, 102.40 feet; SOUTHERLY By a portion of land of Frank L. Horgan et ux,as shown on said plan,96.00 feet;and WESTERLY By Lot#32 as shown on said plan, 106.23 feet. i Being shown as Lot#10 on a plan of land entitled,"Rudder Village,a Subdivision in West Hyannisport,MA,Property of Rudder Realty Trust",dated January 3, 1967,and recorded at Barnstable County Registry of Deeds in Plan Book 212,Page 61. The premises are conveyed together with a right of way over the ways shown on said plan in common with all others entitled thereto for all purposes for which the ways are commonly used in the Town of Barnstable. Being the same premises conveyed by deed recorded on 2/19/2003 with the Barnstable Registry of Deeds at Book 16410,Page 167. Bk 31058 Pg152 #5163 Grantor hereby releases all rights and claims of homestead in the,above-described premises, granted hereby,including,but not limited to,any and all rights and claims of homestead created automatically pursuant to M.G.L. c. 188, §4 and certify that there are no other person or persons.. entitled to any homestead rights. Witness my hand and seal this 3 day of ( ,2018 Duane T.Noreau COMMONWEALTH OF MASSACHUSETTS ss. a�uu authority, On this 3 day of ,2018 before me,the undersigned au h y, personally appeared Duane T.Noreau, proved to me through evidence of identity,to wit: 1)n64 ,to be the signer(s) of the attached document,and who swore or affirmed to me,under the penalties of perjury,that the contents of said document are truthful and accurate,to the best of his knowledge and belief and who acknowledged the foregoing instrument to be his free act and deed,before me, STACY SARNO Notary Public COMMONWEALTH OF MASSACHUSETTS Notary Public MV Commission Expires. December 28. 2018 ) j My Commission Expires: 1 a ��`` Bk 31058 Pg153 #5163 I,Edilene Aparecida Simoes,the spouse of Duane T.Noreau hereby voluntarily release all rights of Homestead, if any, as set forth in M.G.L. Chapter 188 and state that there are no other person or persons entitled to any homestead rights. Witness my hand and seal this day of ' (1tQ 2018 Edilene Aparecida Simoes COMMONWEALTH OF MASSACHUSETTS ss. On this 9 day of f}uu 4 ,201before me,the undersigned authority, personally appeared Edilene Apare 'da Simoes,proved to me through evidence of identity,to wit: (Vic,, I i C wpe- ,to be the signer(s)of the attached document,and who swore or affirmed to me,under the penalties of perjury,that the contents of said document are truthful and accurate,to the best of her knowledge and belief and who acknowledged the foregoing instrument to be her free act and deed,before me, Notary Public VACY$ARNO Notary Public ) ? ]/ Eta0MMONWEAIIN of mAnAcNINiii My Commission Expires: 6 / My Commission Expirex' December 26. 2o1E i 1. l BARNSTABLE COUNTY REGISTRY OF DEEDS 13ARNSTABL E REGISTRY OF:DEEDS A TRUE COPY,ATTEST John F. Meade, Register JOHN F.MEADE,REGISTER 62'-O't o 0 5 ` (EXIST. BUILDING) A p:w: aNmoQ,'�Z Ti --__- EXIST. DECK '.$REV. NO. : ,DATE I I I `i I �k- EXIST. EX15T. EXIST. I D05T. I F D(15T. '��,I ;EXIST. C CLOSET i EXISr --- �� `IBATH ��: is z_ f it EXIST. EXIST. \ �' ! EXIST. KITCHEN i ss. (J� BEDROOM BEDROOM a i �a �zLo r� ��+ II WLLJ �' e cay� i S? NEW PSL i z z I POST 3.257 l +ii o s 0 9 _ NEW _--_ o! I - 2) 9 1/4" LVL BEAM I -� (ABOVE) ; `o �-_ � EXIST. 4 m �rJ EXIsr. -_ ._ GARAGE i R Ff .-- ��� ---- .___ i t- EXIST. PC SLAB i L ti ST NEW PSL-I J 3.250.25 I I ._.LAUNDR`f 4-4- POST I ! �--`--'--- - AREA ( i ..._ 1 .-_ . Ex. SLAB - 3 i EXIST. ; ! 1 NEW 4- �- EXIST. LIVING RM. il, DINING RM. tl] BEDROOM (VAULT cwc.) I� I (NEW VAULT CLING.) I �°-- NEW 32"x32" > j (MATCH EXISTING)2 ' r I -�--t-� i I`� SHWR. I A3f - NEW _ —.:- �5 BATH EXIST. �- EXIST. I EX15T, EX15T. EX15T. —— 2D AND 03 i 0 20310 _ — EXIST. ^ ? i — �D 2'-6" 3' 7" 2'-4" 20'-0" (EXIST. BUILDING) [� 7ENERAL NOTES: / SIDING SEE ELEVATION (� E �� FIRST FLOOR PLAN I CONTRACTOR IS TO VERIFY EXISTING CONDITIONS AND DIMENSIONS "TYVEK" HOUSEVh2AP IN THE FIELD PRIOR TO THE START OF WORK CONTRACTOR TO REMOVE EXISTING WALLS, DOOR$ AND WINDOWS ETC. AS LEGEND 1/2" CDX PLYWOOD i I REQUIRED FOR NEW CONSTRUCTION. -li r � EXISTING WALL CONSTRUCTION TO REMAIN ALL NEW CONSTRUCTION TO MATCH EXISTING CONSTRUCTION 2.4 0 16" O.C. s' - ) NEW WALL CONSTRUCTION !� O00 00 - IN MATERIAL, DETAIL, AND FINISH. z — [' L --' EXISTING WALL CONSTRUCTION TO BE REMOVED R-20 SPRAY/FOAM INSUL " - ROUGH OPENING HEAD HEIGHT OF WINDOWS AT FIRST FLOOR TO BE 6' 00 -10" ABOVE SUBFLOOR (MATCH EXIST. FIELD VERIFY) SMOKE DETECTOR O I OC ALL WORK SHALL CONFORM TO THE MASSACHUSETTS CARBON MONOXIDE DETECTOR O fi MIL. POLY VAPOR BARRIER �) N © CV STATE BUILDING CODE AND ALL OTHER APPLICABLE " HEAT DETECTORS Q • 1/2" G.W.B. ` LOCAL CODES II I i SCALE : � fi+I ANY DISCREPANCIES, ERRORS AND/OR OMISSIONS IN THE NOTES, i '1 DIMENSIONS, AND/OR DRAWINGS CONTAINED ON THESE DOCUMENTS 1/4 - 1-0' - SHALL BE BROUGHT TO THE ATTENTION OF THE DESIGNER PRIOR TO NOTE: ; * COMMENCEMENT OF CONSTRUCTION. PROCEEDING O9TH CONSTRUCTION ALL WINDOWS ARE TO BE I DWG..NO.: , p CONSTITUTES ACCEPTANCE OF THESE DOCUMENTS AND ANY DISCREPANCIES, ANDERSON TW 400 SERIES ERRORS AND/OR OMISSIONS BECOME THE RESPONSIBILITY OF THE • .BUILDING CONTRACTOR. FIELD VERIFY W/ OWNER AND ' AND. SALES REF'. ��' SCALE ALL DETAIL -) CONTRACTOR IS TO DOUBLE ALL JACK &KING STUDS - AND PROVIDE SOLID BLOCKING *HORIZONTAL PLYWOOD SEAMS � -1/2" = 1'-O" r F I _ 24,_0°t I � I i I I 1 ' I j i "ff � ( 1 i I i i I i ! j I i FTI \ i I % I O ( -- O -�- I 1 C 1 z n Z � W I -O I i I O ---- O ' I EXIST. EXIST. 1 — - �i O7z i ! 1 ow I i I I =� zrn O � mL <Q F—riJ� t (•, _ _ J N O Fq,I SOX u' c ;l " ( rn ruG G I � I rn�I lI i N __� �__—___J ( u" �O � 169 l -I i I EXIST. EXIST. 1 23'-0'f NCiE: PROJ. NO.: EXISTING CONDITIONS FOR: DESIGNED/DRAANN BY: - TY.E PLANS stio`.n7a AU r THE SOLE PROPEKTY OF 'p I 218-221 8 R & R DESIGN THE 6UILDEK AND R,EPKGDUCEC GAIJ P1O1- L`J 6E CGPIED, C— r AND.+OK ALTEK D'd 7TH JUT DATE: LAURENT ARAUJO 5 COACHIVIANS LANE o lHcE<PKESS,iKITTe,a 2/18/2018 SAGAMORE BCH. ,MA. CGF,SEITGP-H�_L.I, 15 GUNWALE RD. HYANNIS, MA. EXIST. ROOF CONST. / 3+� TYPICAL LVL/GLULAM BOLTING/NAILING ° 0o w RAFTER 16" O.C. 2 x 6 ROOF RAFTERS ® 16" o.c. ® o z r z - 1/2" COX PLYWOOD ROOF SHEATHING A3 J MULTI 1 3/4" BEAMS / p - ASPHALT ROOF SHINGLES \ / w O K O P w Q a v - 15LB. FELT PAPER I` 0 3~ - NEW 6" SPRAY-FOAM INSULATION 2x8 TIES ® 16" o.c. (R=42) 11 � g C) °- z x w • - (OR EQUAL) - 2 PIECES ID-4" 2 ROWS OF 160 NAILS O 12"O.C. 0, * u a w z - EXIST." RIDGE BOARD H2.5 ® EA. RAFTER z L� / I y'� o =pzi7al18 �A3, EXIST. - 2• 0 REV. NO. • ��-` NEW ATTIC -_ io o TOP PLATE DATE : / t 2x4 WALL T.O. PLATE 2' EXIST. Bm. — (TO REMAIN) _: S . J __ ;. . 3/4" BIRD. ON ,- NEW 3 PIECES -4" 2 ROWS OF 1/2-DIAM BOLTS O 12.O.C. 1 x 3 STRAPPING 016' o.c. 1. 2) 9 1/4' LVL BEAM NEW WALL CONST. i (MATCH Ex.) j - 2 x 4 STUDS 016" o.c. +0 SIMPSON STRONG-TIE H2.5 - 1/2" PLYWOOD SHEATHING NEW ?I - _...- 2' SCALE: N.T.S. - 3 1/2" FOAM/SPRAY INSUL. (R-20) DINING RM. ' EXIST. r - 1/2" GYP. BD. (NEW VAULT CLNG.) } KITCHEN ` - W.C. SHINGLE SIDING (MATCH EXISTING) { "r - 'TYVEK' FIRST FLOOR NEW SUB-FLOOR i S EXIST, SUB-FLOOR BEAM & STRAP Z _ T SUB-FLOOR - -, (TO MATCH Ex) Q (TO REMAIN) - , U 1 -a EXIST. JOISTS —— EXIST. P.?TJOISTS —.----- LSTA EA. RAFTER Q rz� z (� END V W o EXIST. DISTANCE Q w O CRAWL SPACE � ^ EXIST. L-_J ° , Z Q CGNC. FOOTINGS EXIST. CMU FOUNDATION WAILS J! L RIDGE BEAM w C/.���•...-----.../_��� NOTE: I Lo -L RIDGE STRAPS ARE NOT REQUIRED WHEN COLLAR TIES OF NOMINAL 1x6 OR 2x4 LUMBER ARE LOCATED IN THE NEWSECTION UPPER THIRD OF THE ATTIC SPACE AND ATTACHED TO RAFTERS USING 5)10d NAILS EACH END A 3�i�-` �1= ^- 3 IDGE BAND STRAP SCALE: N.T.S. V 1 z EXIST. ASPHALT ROOF SHINGLE O O I1 IS IS EXIS ! EXIS + O EXIST. ASPHALT ROOF SHINGLE .. .. --- _. ffl - ---- -- - - -------- ; , I _. f -- - I EXI T ;i ST , EX15T 03 i I I 031 I I _._ EXIST. _ _ { . — — N -_ - 4-i Q N SCALE : NEW SIDING MATCH EX15T,) _� - 1/4"= F-Y. "CltTO THE WFATHER ' DWG. NO.: r'�\' NEW FRONT ELEVATION ASSESSORS MAP : TEST H__GLE LOGS PARCEL : -- �~ SO I L EVALUATOR : t ��( FLOOD ZONE: al ��i�(•«��..�...� _..— _-� WITNESS : 1 t7�tt`'�-�l_- 'Aloav VI, 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: �27-1 1 � �G�T C. DATE: �O t 31 Regulations. "f2rJ. �` C .__ _ .,__.. _'����_._... .,�`L.�.....�~; �� Health Re lations. GL)' PERCOLAT ON Rid E:` wll%l. 1 2) The installer shall verify the location of utilities, sewer inverts and septic components prior to installation and setting base elevations: - ----- 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first TH 1 TH-2 two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other l ;� x tO� 6 � purpose other than the proposed system installation. 5) Parking shall not be All septic components must meet Title V specifications. I� , 6) ' b constructed over H10 septic components. LOCAT I ON MAP � ,;, � r 7) The property is bounded by property corners and property lines. EI 8) The property owner shall review design considerations to approve of total �, hJ !�', � � ro � � pp , ✓ design flow and number of bedrooms to be considered for design_ Receipt of payment for the plan and installation based on the plan shall be deemed pIfa roval of the design flow P g by the owner. y , '27 1 .0 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed - sand per Title V specs: I ZDZ�j 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if SEPT C SYSTEM DES i G N applicable. 1 l) If a garbage grinder exists it is to be removed and is the responsibility of the n 9 PLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line. \ '13)The installer shall verify the location, quantity and elevation of the sewer BEDROOMS AT 1 1 0 GAL/DAY/BEDROOM -3 GAL/DAY lines exiting the dwelling prior to the installation. \ , Z& .. ,__ _ SEPTIC, TANK GAL/DAY x 2 DAYS GAL USE �5(?) GALLON SEPT I C TANK o , SOIL t;tSORPT ON-'SYSTEM._ _ .-,..__..._--__.._ ..._.... _.._ U;T Y�. 00 !�C�} i/fir t 1. _e.-.,...�.� ,. ' 1 f I7'3.a^''S0 �t SIDE AREA: '� + 2. y /fir ' "� s ram,{ { E10TTOM AREA: _;70,(\j %� ( � rtytx f Cam' b. SEPT : C SYSTEM SECT 1 ON p� J1 ____UT_ _.__�.��v�`'t �_ _, -----------.__... �-�- f c: + . u►1 r GAL 31,3 ^D3 SEPTIC TANK v7�� x , , SITE AND SEWAGE PLAN LOCAT I ON : I G�� V`� 1- .- O�,I� XA—i 1!5 NAB} PREPARED FOR : �. + IS WAS SCALE: 1 o °x a . W DAV I D B . MASON DATE: IZ Z007 DBC ENVIRONMEN AL DESIGNS W DATE HEALTH AGENT EAST SANDWICH .' MA W - ( 508) 833 2177 Z