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HomeMy WebLinkAbout0067 HAMDEN CIRCLE - Health 67 Hamden Circle Hyannis A = 291-309 y .ti _ TOWN OF BARNSTABLE LOCATION `q 1' �A C e- SEWAGE# ,�O/7 a 06 V-'LLAGE l 3 ASSESSOR'S MAP&PARCEL , INSTALLER'S N ME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY. (type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: -7 I G / 1 - A 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 +, � � � � � � a �, W � �, rr1 X � _ � � � .�, � � ' I R ,. Commonwealth of Massachusetts. 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Volu 11 ntary Assessments r. r 67 Hamden Circle Property Address Stephen & Sarah Nicholson t ' Owner Owner's Name, — information is required for every, Hyannis Ma 02601 8/18/2020 page. City/Town State Zip Code Date of Inspection Inspection results must,be submitted on this farm. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A:, ins eeto.r Information filling out forms p � ILI on thecomputer,' use only the tab Sean M. Jones key to move your Name of Inspectorcur use the - et not S.M.Jones Title V Septic Inspection use the return;. _ R R. key. Company Name Ito 74 Beldan Lane . Company Address Centerville Ma 02632 City/Town State Zip,Code 774-248-4850 smjonestitle5@gmail.com; 8I4522: sean@Smj6nestit105'.com license Number B. Certification 1 certify that: I am a DER approved system inspector in full compliance with Section 15.340 of Title (310 CMR15:000); I have personally inspected the sewage dtsposal system attheiproperty address. listed above; the information,reported below is true, accurate and complete as of the time of my inspection; and,the.inspection was per based;on my trainin and experience In the proper function and maintenance of on-site sewage disposal systems. After;conducting this inspection I>have that the system:_ _. determined, 1. ® Passes 2:. ❑ Conditionally Passes'.' 3:, ❑ Needs Further Evaluation by the Local Approving Authority 4: ❑ Fails 8M 8/2020 ::Inspector's Signature:. . Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board: of Health or DEP)within 30 days of completing this inspection.'If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to he appropriate regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer, if applicab e, and the approving authority. Please note:This report only.describes conditions at th'e time_of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the ifuture underthe same or different conditions of user 1501sp:doc rev..7l26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system a Page 1 of 18 Commonwealth of Massachusetts Title 5 4fficia,l Insp% ti®n Form �• Subsurface Sewage Disposal System Form Not for Voluntary Assessments u 67 Hamden Circle Property Address Stephen &Sarah Nicholson Owner Owner's Name information is Hyannis required foreveryMa 02601 8/18/2020 page, Clty/Town State Zip Code Data 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 cnteria_described in 310 CMR 15:303 grin 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below: Comments: The property located at is served,by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 9 Cultec Contactor C4 units'.. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. - 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* oe the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration orexfiltration 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,2p years old is available. ❑ Y ❑ N' ❑ ND(Explain below): t5insp.doc•rev:7/26l2018 Title 5 Official Inspection Form:Subsurface'Sewage,Disposal System•Page 2 of 18. Commonwealth of:Massachusetts p Title 5 Official Inspection Firm ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f <� 67 Hamden Circle Property Address Stephen &Sarah Nicholson Owner Owner's Name information is required for every Hyannis" Ma 02601 8/18/2020 page: City/Town State Zip Code Date of Inspection C. Inspection Summary (eont.), 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 disfnbutiori box. System will Pass.inspection if(with approval of Board of'Health): [] broken,;pipe(s)are replaced ❑ Y ❑ N ❑ ND;(Explain below): %obs. is removed EJ Y ❑ N ❑ ND.(Explain below): El distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ The system required:pumping more than 4 times a year due to broken or obstructed pipe(s).The , system will pass'inspecfion if(with approval of the Board of Health) broken pipes)are replaced ❑ Y ❑ N 01 ND'(Explain below): ❑ 'obstruction is removed ❑ Y [] N ❑ NO(Explain below): 3) Further Evaluation is Required by the;Board of:Health:_ ❑ Conditions exist which require further evaluation by he 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 15303(1)(b)"that the system is hot unctioning"in a manner which.will protect public health, safety and the environment t5insp.doc•rev.7r1612018 Title 5 Official Inspection Form:Subsatace Sewage Disposal System?Page 3 of 18 Commonwealth of Massachusetts Title 5 Offici2tl tns.pection form Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments 67 Hamden Circle Property.Address Stephen & Sarah Nicholson Owner Owner's Name;- information is Hyannis,required for every y Ma 02601 8/18t2U0 page. QWTown State Zip Code Date:of Inspection C. Inspection Summary (coat.) Cesspool or privy is within 50 feet of a surface water El 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 ma manner thatprotects 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, El The system.has a septic tank and,SAS;and:the SAS is.less than 10G.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 coliforen 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 ins ections: p 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 a rev.J/28t2018. Title 5 Official Inspect on Form:Subsurface Sewage Disposal System•Page 4.of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hamden Circle Property Address Stephen&Sarah Nicholson Owner Owner's Name- information is required for every Hyannis Ma 02601 8/18/2020 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 inv ❑ 0 ert due to an;overloaded or cfoggetl SAS or,cesspool 0 ® Liquid depth;in Cesspool'is less than 6" below invert or:available volume is less than Yh day flow 0 Required pumping.more than 4 times in the last year NOT due to clogged or obstructed pipe(s).:Number of times.purnped: El 1Z Any portion of the SAS, cesspool or privy is below high ground waterelevation. ® 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: E: 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,nrtrogen,and nitrate it is a ual.to or less than 5 ppm, provided that no otherfailure 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.: Q, IMThe system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 1 b.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be` necessary tocorrect the failure. 5) Large Systems To,be considered a large,system the system must serve a facility with,.a design flow of 101000 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 Ell, the system is within 400 feet of a surface:drinking water supply 0 ❑ the system is within'.200 feet of a tributary to a surface drinking water upply_ El the system is located in a nitrogen sensitivearea(Interim Wellhead:Protection Area=IWPA)or a mapped Zone Il of a public water supply well t5insp.doc•rev.7126/2Dt8 Tdte 5,official Inspection Form:Subsurface Sewage Disposal Systemi!.Page 5 of to Commonwealth of Massachusetts p . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments, 67 Hamden Circle Property Address Stephen &Sarah Nicholson Owner Owner's Name information is required for every Hyannis _ Ma 02601 8/18/2020 page. Cltyrrown 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 C. 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 C.4,shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office ci the Department. 6. You must indicate"yes?or"no-'for each of the following for a/!inspections:, Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health El ® Were any of the system components pumped out in the previous two weeks? Z El Has the system received normal flows in the previous two week period? E 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) - E ❑ 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, ncovered; 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 S64.Absorption System`(SAS)on the site has been determined based on: N_ ❑ 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)] Mnsp.doc•rev.72612618 Title 5 Official Inspection Form`.Subsurface Sewage Disposalsystern Page 6 of 16 Commonwealth of Massachusetts re Title 5-Official. Inspecti®n Forrn Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.; 67 Hamden Circle Property.Address Stephen &Sarah Nicholson Owner Owner's Name information is required for every Hyannis Ma 02601 _ 8/18/2020 page. Gltylrown State Zip Code Date of Inspection D. System Information : 1: Residential.Flow Conditions: Number of bedrooms desi n : 3 3 ( 9 ) Number of bedrooms(actual): DESIGN flow based on 310 CMR;15203 (for example: 110 gpd x#of bedrooms):' 357 gpd' provided Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes H No. Does residence have a water treatment unit? El Yes EDNo if yes,,discharges to: 1s laundry,on a separate sewage system?,(Include laundry system inspection information in this report:) El Yes ® No Laundry system inspected? ❑ •Yes ® No .Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage.(gpd)): Detail:' Sump pump? ❑ Yes ® . No Last date of occupancy: current Date t5msp.dob•rev 7l262018 Title 5 official Inspection Form Subsurface Sewage Disposal System;+;Paga 7 or16. Commonwealth of Massachusetts Title 5 Off` cial Inspection o=orm Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments 67 Hamden Circle - Poperty Andress Stephen & Sarah Nicholson Owner Owners Name information is required for every Hyannis K 02601 8/18/2020 page. City/Town State Zip Code . Date of Inspection D, System information (cunt.) 2., Commerciallindustrial Flow Conditions: Type.of Establishment: Design flow(based on 310,CMR 15.204 Gallons per day(gpd) Basis of design flow.(seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Watertreatment unit present? _ El Yes ❑ No If yes, discharges to: Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged,to the Title 5 system? El Yes '[❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: - tank pumped after inspection Was system Pumped as part of the inspecfion? ® Yes El No If yes;volume pumped; 1000 gallons How was quantity size of tank q , ty pumped. — Reason for pumping: routine maintenance t5insp.doc-rev.7/26/2018. Val 5 Official Inspection Form Subsurface Sewage Disposal system:•.:page:B:pf.18 Ak Commonwealth of Massachusetts j R Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hamden Circle Property Address Stephen& Sarah Nicholson Owner Owner's Name - information is required for every Hyannis Ma 02601 8/18/2020 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 Ell Overflow,cesspool ` Privy El 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: ;system repaired - Were:sewage odors detected when arriving at the"site? El Yes 2, No 5. Building Sewer{locate on:site plan}: Depth below grade; 1.5.' feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): - Distance from mnvate water>supply well or.suction line: feet Comments(on condition of joints, venting, evidence of Leakage; etc.): Joints in good condition, no leakage, vented"through roof. t5msp.i4c-rev.7126Yd018 Title 5 Wiicial Inspection Form.Subsuiface S y age 9"of i e swage Disposal S stem•P r F Commonwealth of Massachusetts Title g Official Inspection Form ' Subsurface Sewage Disposal System Form=No for Voluntary Assessments M 67 Hamden Circle Property Address Stephen&Sarah Nicholson Owner Owners Name information is . Hyannis required for every Y - Ma 026.01 8/18/2020 page., - Cltylrown State Zip Code Date of Inspection D. System Information (cunt.} 6. Septic Tank{locate on site Dian); Depth below.grade; 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass [].polyethylene poi efih Y Y El 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: 1000 gallons Sludge depth:. 6" Distance from top of sludge to bottom of outlet tee or baffle 3 Scum thickness 2,. Distance from top of scum to top of'outlet tee,or baffle Distance from bottom of scum to bottom of outlet tee or baffle loll. How were dimensions determined? Opened,covers and took measurements Comments(on pumping recornmendation5 mtet and outlet tee orbaffle condition, sfructural integrity, liquid levels as related too Met invert, evidence of leakage, etc;): Tank was pumped for inspection and should be done again every 2 years for.proper;maintenance: water level was even with outlet;tank was>not Peaking and was;structurally sound. t5msp,dac•rev.7l26/2018. Pie 5 Official inspecfion Form,subsurface.Sewage Disposal system-.Page 10 of is Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 67 Hamden Circle Property Address Stephen&Sarah Nicholson Owner Owner's Name - -- information is required for every Hyannis Ma . 02601 8/18/2020 page. CityRown State Zip Code. Date of Inspection D. System Information (cant.) 7. Grease Trap(locate on site plan) Depth below grade: feet Material of construction: ❑concrete ❑ metal - ❑fiberglass g 0 polyethylerne 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,, liquid (evelsras related,to outlet invert, evidence of leakage, "etc.): r 8. 'Tight or Bolding Tank(tank must be pumped at time of inspection)(iocate on site plan): Depth below grade: . Material of construction: ❑ concrete 0 metal ❑fiberglass polyethylene. El-other(explain): Dimensions: Cap acy: gallons Design,Flow: gallons per day t5insp_doc-rev.7126/2018, 'idle 5 Official Inspection Form:Subsurface sewage Disposal System.•.Page of 1t3 Commonwealth of Massachusetts Title 5 Official : Inspection Form Subsurface Sewage Disposal System t=orm=Not for Voluntary Assessments 67 Hamden Circle Property Address Stephen&Sarah Nicholson Owner: Owners Name information is H annlS - required for every y Ma 02601 8/18/2,020 page: Clty rowrt State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: 0 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 Sox(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:): Distribution box was video inspected and found level arid in good condition with no rot. Water level was even with outlet invert with no signs of past'backup: t5insp.doc•rev.7lZ6I2018. T tie 5 0ffcial lnspectionform:Subsurface Sewage Disposal System•;Page 12.of18 Commonwealth of Massachusetts ,� Tithe 5 Official Inspect%®n Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hamden Circle Property Address Stephen &Sarah Nicholson Owner Owner's Name information is required for every Hyannis Ma 02601 8/18/2020: 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:, El 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 - 9 Cultec Contactor C4; El leaching galleries number El leaching trenches number, length; 9 number, dimensions: leachin fields overflow cesspool number. ❑ innovative/afternative system i Type/name of technology: t5insp.doc rev.7Y28Y1018' 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 67Hamden Circle Property Address Stephen &Sarah Nicholson Owner owner's Name information is H anniS required for every y Ma 02601 _ 8/18/2020 page.' Cityrown 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.): s.a.s.consists of 9 Cultec Contactor C4 units in a 24'x12'x6"field. Soil and stone within leachina. facility was probed and found dry with no sings of past saturation. 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 t Comments(note condition of soil;,signs of hydraulic failure, level of panding,.condition of vegetation; l ` f t5insp.doc rev.7/2612Q18 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 -Notfor Voluntary Assessments 67 Hamden Circle Property Address — Stephen &Sarah Nicholson Owner -- Owner's Name information is - required for every Hyannis Ma 02601 8/18/2020 page. CitylTown State Zip Code _ Date of Inspection D. System 10orrnation (coat.) 13. Privy(locate on site;plan) Materials of construction; Dimensions. Depth of solids Comments (note condition of soil,signs ofi hydraulic failure, level of ponding;condition of vegetation, _t5insp 0c•rev 7l2612t11 t3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System:Page 15 of 18 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal Sy steth Form-Not for Voluntary;Assessments' 67 Hamden Circle Property Address Stephen&Sarah Nicholson Owner Owner's Name information is Hyannis required for every. y Ma 02601 $/1$f2020: page•'' City/Town State Ztp Code Date of Inspection Ll; System Inforr»ation (cont.) 14: Sketch Of Sewage Disposal System: Proyder a viewr 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 r1. 4 V� fine .-.-^' v •ra/�! G.rraiQ Mr�.doc•rev_71261MI8 rrrle s orrrc al i rrspecliori Form:Subsurface Sewage Disposal System j Page 16 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 67 Hamden Circle Property Address — Stephen &Sarah Nicholson Owner Owner's Name information.is required for every Hyannis Ma. 02601 8/18/2020 page. Gity/Town State Zip Code Date of inspection D. System 'Information (Cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check.cellar El Shallow Wells Estimated depth to.high,ground water: 11' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from:system design plans on record !f checked, date.of design plan reviewed: 9/27/200Z Date El Observed site.(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-=explain: ❑ Checked with1ocal excavators, installers'-(attactr<documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground waterrelevation: Design plan dated 9/27/2007 indicates that groundwater was encountered at 131"and system is designed to have 5'seperation between bottom of s.a:s.and adjusted'>high water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev..7l28/2p18 -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 \u` 67 Hamden Circle : Property Address Stephen:& Sarah Nicholson Owner Owner's Name -- information is H annls required for every y Ma 02601 8/18l2020 page, City/Town State Zip Code Date of inspection E Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete.all fields.in this section.. ® B. Certification:Signed& Dated and 1, 2, 3,:or 4 checked ® C: Inspection_Summary: .1,'2, 3, or 5 completed as appropriate 4(Failure Criteria)and B(Checklist).;completed Q.,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•re¢'.Z/262018 7iti.e 5 Official Inspeation.Foim.Subsurface Sewage Disposal System:.:Page 16 bf 1a No. C ^� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fiPfication for Misposai bpstent Construction 3permit Application for a Permit to Construct( ) Repair(✓) Upgrade( ) Abandon( ) ❑Complete System 21ndividual Components Location Address or Lot No. to-? �,,M C�(n G• 4}y�� wCnetr,''s Name,Address,and Tel.No. Assessor's Map/Parcel ' � Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. rN\dv'� o ti o ato Type of.Building: ` Dwelling No.of Bedrooms /v A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 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) �p� r/t C�tn L ty t_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been.issued by this Board of Health. Signed Date A Application Approved by a — Date Application Disapproved by Date for the following reasons Permit No. � ® Date Issued ---------------------------------------------------------------------------------------------------------------------------------- -- T - -.�..��-_.. .r �. . r-%'•r��.j^!-r1,r""%�'-g.ii.�j�v�i. r4''°"�z:-�"',-..�IhI+�•'r�:.':.".:�RAr....W� n...Mw...-'� .. •*..31•T+.:'.�S"r ••fz�4'fk. ,"�I�lf�... �+^ `a''. - y No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(,-') Upgrade(' ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ko_J\rk AM -f,^ C-,r 4A yc nn►Vwner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and \N% O(J f Designer's Name,Address,and Tel.No. 'A,,'A,,f c,n,\,S rn c, Oa(30 t 5EUc6 a Gt,tl Type of Building: Dwelling No.of Bedrooms J" Lot Size sq.ft. Garbage Grinder( ) Other - Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures a �..�- Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date l Title ' Size of Septic Tank Type of S.A.S. Description of Soil t.# .Nature of Repairs or Alterations(Answer when applicable) 2 Q c.cc_ t A c� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by � --Y - Date Application Disapproved by Date for the following reasons a Permit No. ;`o I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( l Upgraded( ) Abandoned( )by U (V\ l'C.tn - at C,M t_S. has been constructed in co dance with the provisions of Title 5 and the for Disposal System Construction Permit No. Pqf, Agated Installer C C S� M C'�l��L Designer #bedrooms /V )4— Approved design flow N gpd The issuance of this permitshall not be construed as a guarantee that the system will fiinctioon as esigned. Date J Inspector - ---------- - ----- - ---- - -- -- -- - - - - - - - - --------------_�' - - - No. 0`'6 .��O Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( \) Repair Upgrade( ) Abandon( ) System located at �p `h�M u C\r �� C N and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date r Approved by , , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 67 pawtdew CI✓' Property Address Pe 4v- (,le Id 0 V? Cw ner Cw ner's Name /4j,2,,ol5* finformation is /"�/T Qa b 0/ . (f ol/ required for every i page. City/rown State Zip Code Date of Inspe tlon j Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see.com plots ness checklist at the end of the form. i "rp°rtant:When A. General Information filling out forms (� ion the computer, �1 use only the tab 1. Inspector: key to move your cursor-do not C.✓ham ° ��ill� use the return Name of inspector key. �'�/�l 0 Company Name Company Address GS / � n�. City/Town t� �� State Zip Code, 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 6(310 MR 1b.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspec is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of Inspection and under the conditions of use at that time. This Inspection does not,address how the system will perform In the future under the same or different conditions of use. One-W 3 711e 5 010cial Ins peotlan F orm Subeirfaee Sewage Dlepoeel System•Page 1 of 17 i f i 4 <ts' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage/Disposal System Form -Not for Voluntary Assessments ✓I C� I" Property Address Ow ner Ow ner's Name Information isA4 required for every ✓ill page. City/Town State Zip Code Date of I pact' n B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) S ystem : an Information ywhich Indicates that any of the failure cnteria 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. Check the box for"yes", "no"or"not determined"(Y, N, ND) for the following statements. Pf"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 Healt h. "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): i Wins•3113 TIVe5ofOdsl Ins pectlanForm Subsuface Sewage DispoW Sulam-Page 20f 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage�JDlsposal Sy m Form -Not for Voluntary Assessments c►r-)�8 yr C,. I r Property Address Oar nor ON nor' s Name information Is Qd O/ required for every page. Cilyfrown r>1 State Zip Code Date of IrApectO B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or breakout 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 mannerwhich 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 tft,3M 3 Tile 5 0rAGal ins pec tlon F am Subsulace Sewage Dispose!System•Page 3 or 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1W (;7 Property Address e o ON ner ON ner's Name /� information Is required for every 0 �f / 1,1T page. City/rown a4 State Zip Code Date of �spe bn 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 Al Inspections: Yes No ❑ a--," Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ g]" Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ B tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool CO] Liquid depth in cesspool is less than 6" below invert or available volume is less than%day flow One 3N8 Title6of0clalInapecaonForm subsulace Sewage Disposal syftm-FaBe40117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o � ��►�.�� Cry Property Address We ok7 ON nor ON ner's Name / required Information Is a 0 p r �a 0 l required for every page. City/Town State Zip Code Date of n ectio B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ L7 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. ❑ [9 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 6 ppm, provided that no other failure criteria are triggered. A copy of the analysis Ind 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 fib I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303, therefore the system falls.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must Indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ Q 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. One.y13 Tile 60fAcIal Inspection Form Subsuface Sewage Dlspossl System.Page Sot17 Commonwealth of Massachusetts Title 5 Official Inspection Form 6 subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 A;;0-7 e ✓1 �� � Property Address e o Ow ner ON nor's Name equired foat fo Is every r / 9RA f 0d6 p aI / requir page. Qy/Tow n State Zip Code Date of Vswtbn C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Imo"/❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ►L� Were any of the system components pumped out in the previous two weeks? fd" ❑ 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? IrJ/ Were as built plans of the system obtained and examined?(if they were not available note as WA) ❑ 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? ITT LJ 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: 3 Number of bedrooms (design): Number of bedrooms (actual): �330 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Wine Y13 Tile 50Hldal Ins pecIon Form Subu rfam Sewage Dlapoeel Sow-Page 6of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal S75i Form -Not for Voluntary Assessments � � �� Cyr Property Address Cw ner Cw ner's Name Information is required for every State ZO Code Date of Inspection page. City/Town D. System In 7,7 ation Description: �Go l —'/�v Ir� l N x, F�?) Wow /T Pc ✓'t Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection 0 Yes L7 No Information in this report.) Laundry system inspected? ❑ Yes 2"'No Seasonal use? ❑ Yes �No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: pate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Tltle 5 system? ❑ Yes ❑ No Water meter readings, if available: One,3113 Title S OfAdsi Ins pectim Form Subauriaoe Sewage Dispose!System•Pape 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary,Assessments Roperty Address In orn�ation is Ow ner's Name 4 op L o Cl o f requled for every R441l /% T page. City/Town State Zip Code Date o Inspo�tion D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: 8wl j/ Source of information: —T Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type 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) ❑ InnovativelAltemative 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 UA system by system operator under contract ❑ 'Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Ons,3M 3 Title 5 olaGel trm pecoon F am Submiece Sewage olepaeel System•Pape S of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form T p Subsurface Sewage Disp osal System F rm -Not for Voluntary Assessments c4e0 C/✓ Property Address Cw nor ON ner's Name /y�� information is P(l / ' 001-60/ d l �f required for every page. Cityyfrown State Zip Code Date of In ct D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: a ©o7 6o# Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 40 PVC ❑ other(explain): tleo Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): </ 472 Depth below grade: feet Material construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: year; Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No S Dimensions: Sludge depth: One,3I1 3 Title 50111elel Ire pectlan F orm Sutswlaoe Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Nott for Voluntary Assessments /7/�&7 Property Address 61e Ido VI ON nor Om ner's Name information is G Oa 401 / page. CityRown �edtorevery f f State Zip Code Date of Inspection page. D. System Information (cont.) Septic Tank(cont.) J2Y Distance from top of sludge to bottom of outlet tee or baffle / Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle o 4 /Ikag How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): a r► cz P'2 (crease 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 t5irm-3113 Tile 501 Add Ir a pectlon F orm Subavlaoe sewage DispoW System Pape 10 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments Property Address / 1.e / Wr 0� Ow nerrm Owner's Name Information is required for every State Zip Code Date I spection page. cityrrol D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Ons•yt 3 Title 5 01AdA u Inspw0an Form Subs lace Sewape 0lopoo S",,n•Pape 11 d IT 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 01 v�7 NPr/! OVA Property Address ON nor ON ner's Name / od 6 0 I Cf Inf ormauon is ����f /r" rr 98iredforevery Qtylfown State ZoCode� Date of epecton D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): ,^ Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage Into or out of box, etc.): I 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: Tito 50Hldal ire pectanForm subsuiece sewage0lepassl system-Page 12 d 17 Wine•3M 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form �.-Not for Voluntary assessments JTGw►G�e`I Property Address �✓e 19 info ner Qv ner's Name 4 0r�`c)� oZ/ information is N 4�1 .�� page.edforevery /Town State Zip Code Date f sped n page. Cy D. System I formation (coat.) Type: la .y ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altematiw system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): (_5 ©i C14e a V? ,o ! oS o7,—,- -7< X tee.. 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 Mrs•3/13 TileSgeCIA InepeclanForar SUM090e SewepeDlapaeal SVOW Faye 13d 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Syste Form -Not for Voluntary Assessments C2 Property Address (Ale Ido vl Ow nor Ow ner's Name information IsL/required for every Rt�✓�1l ./ , 0 07! Av page. Cityfrown CIL State Zip Code Date of hisWVon D. System Information (corn.) 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.): tSns•3113 TOSOfsdd InspecsonForm Subsulieoe S"eolsposel Symm•Pepe 14 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fof -Not for Voluntary Assessments G✓'7 C'?1 Property Address Lle Mop Owner Owner's Name �f Information is / a.1 n�f Ae 10o26U/ .2-! L required for every - --- page. Cityfrown State Zip Code Date of Ins ction D. System Information (cont.) r Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two manent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where lc water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately CIA 14 SA C/ Lf FpN7 Y Fey ' k 33 We-3113 Me5Of1dal InspecsanFam Subsurface SewageDlspossl System-Page 16d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address ON nor ON ner's Neme infomiationis R� /t oc (6o/ C2/ / required for every —' page. Zi mown State Zip Code Date of spec n D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells l Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: Cl Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑— / Observed site(abutting propertylobservation hole within 150 feet of SAS) C9' Checked wl �'°�al Board of Health-explain: � G Nf i I Csl /�°%S ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: U 9 ti C14 t,5'6/ � �� /f'-V /o yHeI, c- OCa�ic' , S//4 S l s Ou.vr d Before filing this Inspection Report, please see Report Completeness Checklist on next page. Win,W13 r10e50read InspecaonForm subarlece Sewapeo1ep0Sd SAW Pepe 15 a 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON ner ON noes Name / Information Is /—� Al 4D-z o A* required forevery - page, city/Town State Zip Code Date of nspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed :�Syk*etch m Information—Estimated depth to high groundwater of Sewage Disposal System either drawn on page 15 or attached in separate file Mrs,3n3 Tide 5ofaciai Inspec6onF=SubWwe SevmgeDiepo@W syelem•Page 17d 17 =Commonwealth of.Massachusetts -- Title 5 Official Inspecaion Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et als Owner owner's Name information is required for every Hyannis MA 02601 December 2, 2010 page. Cityfrown State Zip-Code Date of inspection Inspection results must be submitted on this form. Inspection forms may not be altered in,any way, Please see completeness checklist at the end.of the form. Important:utut forms When A. General Information filling o forms on the computer, use only the tab. 1. Inspector' key to,move your cursor-do not David D. Coughanowr use the return Name ofinspector key. � Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich 'MA 02563. City/Town State Zip Code 508;364 0894 -1328 Telephone Number: License Number B. Certification: I certify that] 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 rapp roved`system inspector pursuantto Section 15.340 of Title 5(310 CMR 1`5000)..The system: ® Passes 0; Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority December 2, 2010 Inspectoes.Signature Date The system inspector shall submita copy of this inspection report,to.the Approving;Authority (Board of Health or DEP) within 30 days of completing this inspection..Ifthe:system is a shared system or has:a design flow of 10,000 gpd or greater, the inspector and the system;owner shall submit the report to,the appropriate regional office of the`DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This reportonly.describes conditions at the time of inspection and under the conditions.<Uuse at thattime.This inspection does not address how the system will perform in the future:under -the'same or different:conditions of use. I � 15ins-OV08 Title 5 Official Inspection Form:Subsurface Sewage Disposal stem-Pago 1 of 17 Commonwealth of Massachusefts _ Ti'fi&1e 5 4fificial Inspection Form Subsurface•'Sewage DisposalSystem,Form -Not for Voluntary Assessrneiits O'Hamden Circle Property Address Joanne F. Wge etals Owner owners:Name information is required for'every Hyannis MA 02601' D`ecember'2,2010 page., Citylrown State. Zip.Code` Date of Inspection B. Certification (con..) Inspection Summary: Check A,B,C,D or E/always complete all of Section D ;A) System Passes: 'I have notfound any information which indicates that any of the"failure criteria described in"310 CUR 15.303 or in 310.CMR 15.1304 exist. Any failure criteria nofevaluated`are indicated below: Comments:' Inspector'.s;Note==> A;septic system is deemed to pass#his Real Estate Transfer Inspection if it does not trigger any,of-the failure criteria listed below. The septic system has been evaluated according,to;the conditions observed on the day it was inspected. No estimate or guarantee.of system longevity'.is made or implied by a passing determination. Removal of garbage grinder is recommended.. B) System Conditionally Passes: ❑ One ormore,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. Checkthe'box for"yes";``b.6'or,"not determined"(Y, N, ND.) for the following statements. if"not determined" please explain:. Theseptic tank,is metal and over 20:.years old*'or the septic tank(whether metal,or not),is structurally unsound, ekhibits:substantial infiltration or eAltration or tank-failure is imminent. System will pass. inspection'f the ex stmg;`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. El Y ❑ ,N. '❑ ND (Explain below): 15ins•09108 Title 5 Official Inspection FonnaSubsur(aceSewage Disposal System•Pap2.of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System:Form -Not for Voluntary Assessments 67 Hamden Circle PropertyAddress Joanne F. Barge-et als Owner Owners Name information is required for every Hyannis MA 02601 December2, 2010 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes [] 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-): ❑ brokeh.pipe(s)are replaced ❑ Y ❑ N; Q _ND(Explain below)' ❑ obstruction is removed ❑ Y ❑ N ❑, ND (Explain below): Q distribution..box is leveled,orre.placed ❑ Y ❑ N ❑ ND (Explain be l'ow): ❑. 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)` El broken pipe(s) are replaced ❑ Y ❑ .N ❑ ND(Explain.below)- ❑ obstruction`is removed ❑ Y ❑ N ❑ ND (Explain below)`. C) Further Evaluation is Required:by4he Board of Health': Conditionsexist 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 wil I V:pass..unlessi Board of Health determines.in accordance with 316 CMR 1'S.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 Q Cesspool or privy is within 50Jeet of a bordering vegetated wetland or a salt marsh t5!ns;-091D8 Title 5:Ofticial Inspection Form:Subsurface Sewage Disposal System.-Page 3 of 17 77 C�:ommonwealth of`Massachusetts �.; Title- 5- Official Inspection Form Sub surfaceSSewage.bisposal System Fo;rm-Noffor Voluntary Assessments 4� 67 Hamden C.irCle Property.Address Joanne F. Barge et als Owner Owner's Name information is required for every Hyannis MA 02601 December 2, 2010 page' Cityrrown State Zip Code Date of inspection B. Certification (cont) 3. .System will'fail unless the Board of'Health(and Public.Water Supplier, if any) deterrnines 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 10(feetof a Surface-water-supply or tributar -to"a surface water supply, 0 'The rsystem.has a septic tank"arid'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 5G feet:of`"a private water supply.well. ❑ The system has"a septic tank and SAS and the SAS"is less,than 100 feet but 50 feet or more from a private water supply,well**; Method used to determine distance:: ** This system passes if the well water--analysis,"performed at a,DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than r5 ppm, provided that no other failure criteria are triggered, A copy of the analysis must be .attached to this,form. `3..,.Other. D) "Systerii 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 faeilityor,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'ar cesspool Static liquid level in.the distribution bbkr 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 El M than '%2"day flow t5ins•69166 Titlo 5 Official lnspeclion Form:Subsudace.Sewago Disposal System•Page 4 of 17 ' 1 ',I CorhM,nw.e'alth of-Massachusetts Tittle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not forVoluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et als Owner Owner's Name information is required for every Hyannis MA 02601 December 2, 2.010 page. Cityrrown State Zip Code. Date of Inspection' B. Certification (cont.) Yes No ❑ Required pumping more:than 4 times in the lastyear NOTdue to clogged or obstructed;pipe(s). Number of times pumped: Any portion of the:SAS,.cesspool or privy is. below high ground water elevation. El 0 Any`portion of cesspool or privy is within 100 feet=:of a surface water supply or tributary to a surface water supply. ❑ Any portion ofa cesspool or privy is within a Zone 1.ofa public well: ❑; 0. 'Any portion of,a cesspool or privy is within 50 feet Of a private water Supply well. ❑ 0 Any portion of.a cesspool or"privy is less than 100 feet but greaterfhan 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.] El The'.system is a.cesspool serving a facility with a design flow of 2000gpd= 10,000gpd.. Q The system fails. l 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 10,00.0-gpd to.15,000 gpd. For large systems, you must indicate either"yes"or"no"t0 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: rotection ❑ ❑,. Area-IWPA)s ora'mapped Zone:ll of,a public water supply well If yo,u 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 underSection 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. 15ins­09108 Title 5 Offidal Inspeclion.Form:Subsurface Sewage Disposal System Page 5 of 17 Corrirn'onwealth of'Massachusefts _ T-ItIe .5 Official Inspection Form Subsurface Sewage Disposal System Form .,Not for Voluntary Assessments .67.Hamden-Circle Property Address Joanne F. Barge et als Owner Owner's Name information is required for every Hyannis MA 02601 December 2, 2010 page: aty(Town State. Zip Code Date of Inspection C. Chgckfist. Check.if the following have been.done.YoVrhust indicate"yes or"'no" as.to each of the following:` Yes `No Pumping information was provided by the owner, occupant, or Board of Health El 0 Were any of the system:components pumped;out in the previous two weeks? ❑ R Has the system received'normal flows in the previous two week period? ❑ z Have large volumes of water been introduced to the system recently or as part of this inspection? 0 Were as built plans of the system obtained and examined? (If they were not ❑ available note as N/A) ❑X ❑ Was the facility or dwelling inspected for signs of sewage back up? Z ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? M, ❑ 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-cfsludge and depth of scum? ❑ Was the facility owner(and ioccupants'if different from owner) provided with information on the proper maintenance of subsurface'.sewage disposal systems? The size and location ohhe 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)] I, D-. System 'Information Residential Flow Conditions: Number of,bedrooms (design:):; 3 Number of bedrooms(actual): 3 DESIGN flow based on 31.0 CMR 15.203 (for.example-. 110 gpd;x#of bedrooms): 330 gpd t5ins 09106, Title 5 Official Inspection,Form:Subsurface Sewage Disposal;System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et als Owner Owner's Name information is required for every Hyannis MA 02601 December 2, 2010 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 82 gpd 9 � ( Y 9 (gpd)): Detail: 2009, 2010 Sump pump? ❑ Yes ® No Last date of occupancy: undetermined Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ►Sins 09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal g po System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection on Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et als Owner Owners Name information is required for every Hyannis MA 02601 December 2, 2010 page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the.DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Ofrccial Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth:of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal'System Form -Not for Voluntary Assessrrients �w 67 Hamden Circle Property Address Joanne F..Barge et a'IS: Owner Owner's Name information is required for every Hyannis MA 02601 December 2, 2GTO page. Cltyfrown State, Zip Code Date of Inspection D. System Information (,cont.-) Approximate age of all components, date installed(if known)and source of information: Age 3+ years. Certificate of Compliance issued 11/2/2007 (Board of Health files). Were sewage odors detected when arriving at the site? ❑ Yes.. 9 No Building Sewer(Locate;on site p,lan): Depth below grade: 2 feet Material of construction: ❑ cast iron Q 40.PVC: Z other(explain): Distance frorrl private water supply well or suction.line; feet Comments(on condition of joints;:venting;evidence of leakage, etc:): Sewer line:appears structurally.sound with no evidence of leakage or backup into dwelling, Septic.Tank (locate 6n:site plan): 1 ' Depth below grade: feet' Material of_Cr 0 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' 8.5ftx6ftx5ft(1000.gal) Sludge.dePtFa 6:in: t5ins'+:0910B. Tifle 5 Offi 61 Inspedion Fornii Su6wiface Sewage Disposal System-:Page 9:0'f 17 -w . Commonwealth ,Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 67 Hamden.Circle Property Address. Joanne'F.`Barge ef_ais Owner Owner's Name information is required for every Hyann.'is MA, 02,601 December 2, 2010 page. CityFrown State Zip Code Date of Inspection D..System Information (cont), Septic,Tank (cont.) Distance from top of sludge 'to,bottom,of outlet tee or baffle. 2$in Scum s thicknes 1 in Distance from top of scum to top of outlet tee or baffle 9 in Distance=from bottom of scum to bottom-of-outlettee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations,'inlet and outlet tee or baffle.condition,structural integrity, liquid levels as,related to outlet invert;.evidence of leakage; etc-): Pumping is_not required at this time but maintenance pumping issecommended within and every-two years.Tank appears structuraIlysound and functioning as intended. Nq evidence,of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction; El concrete metal ❑fiberglass ❑'polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom oUscum to bottom;of outlet-,tee.,or baffle Date of last pumping: Date t5 ns+09lDB' Tilla SOKcial Inspection Form-Subsurface Sewage'Disposal:System-Page 40 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Hamden Circle Property.Address Joanne F. Barge-et als Owner Owner's Name information is required for every Hyannis MA 02601 Decembe.r.2, 2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) t Comments(on pumping recommendations, inlet and outle* Uee 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, ❑ pol_yethylene ❑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,- Pate Corriiments(condition of::.alarm and floatawitches, etc.)'' "Attach'copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No. t5ins•0g108 Title 5.otricial Inspection Form:Subsurface Sewage Disposal System•Paget 1-of 17 Commonwealth of Massachusetts; _� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form_-Not for Voluntary-Assessments 67 Hamden Circie Property Address Joanne.F. Barge etais Owner Owner's Name required, is Hyannis, MA. 02601 December 2 2010. required forevery Y page, Gityfrown State Zip Code. Date of Inspection D.- System Information Distribution Box-(if presentmust'be opened)(locate on site plan): Depth of liquid level above outlet.invert °at outlet inverts Comments (note if,box is level.and distribution to outlets equal any evidence of solids.carryover, any evidence of leakage into or out of box, etc.): Few:solids in sump. Distribution box appears structurally sound: Pgmp.Chamber(locate on site:plan): Pumps:in.working order: ❑ 'Yes ❑ No Alarms in working.order: ❑ Yes ❑ No Comments (note condition of pump chamber;condition of pumps and appurtenances, etc.):. Soil Absorption-:System(SAS) (locate.on si(e'plan,:excavation not required) If SAS not iocated;'expiain why: t5ins•09168 Title 5,0ffi6el Inspection Forw Subsurface Sewago Disposal System.ePago 12 of 17 f Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F.Barge:et als Owner Owners Name information is required for.every Hyannis MA 02601 December;.2 2010 page. City/Town. State; Zip code.: Date ofInspection D. System Information (cont) Type: ❑ leaching pits number: ❑ leaching chambers number:.. - z leaching galleries number 1: leaching trenches number, length,: ❑ leaching fields number,,dimerisions: El overflow cesspool number:. ❑ innovative/alternativesystem Type/name of technology-., Commerits(note condition of soil,.signs..of hydraulie'falure,; level of ponding, damp soil, condition of vegetation, etc:):' Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Cesspools (cesspool'must be pumped as.part of inspection) (locate:on.site plan);. Number and configuration_ Depth—too of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of,groundwater inflow ❑ Yes ❑ No t5ins r 0,9108: Title;5 Official Inspeclion Form:,Subsurface:Sewage:0isposal System.,-,Page 13 of 17 �_ . ICommonweatth, Massachusetts - ' Ti,tte 5 0f lci�al Inspection Form _ Subsurface Sewage Disposal'System Form,-Not for Voluntary Assessments .67 Hamden Circle Rroperty'Address Joanne F. BaMe-et als _ Owner Qwneft Name, information I required for every Hyannis; MA '02601 December 2, 2010 page. City/Town State, Zip Code Date.of Inspection D. System Information (font;) Comments.(note condition of soil, signs;of f y.draulic failure,,level of pon.ding, condition of vegetation, Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments.(note:eondition of soil, signs of-hydraulic,failure,:level:of pond ing, condition of vegetation, etc:):. t5ins:•09108 Tille 5 Olricial Inspection Form;,Subsurface.Sewage Disposal System•Page 14 of'17 f Commonwealth of Massachusetts =� Title 5 Official Inspection Form s Subsurface Sewage'Di"sposal System Form-Not dr Voluntary Assessments ' 67 Hamden Circle Property Address Joanne F. Barge et_als Owner Owner's Name informationIs required for avery Hyannis MA 02601 December.2,,2010 page. cityrrown State Zip Cod_a Date.of Inspection D. :System Information (cone:) '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 400 feet. locate where public water supply enters the building. Check one of the boxes below_. ® hand-sketch in the area below ❑ drawing attached separately .Y1 q VCC1_ S. W tsm5.;omoa,. TiAo 5 0ffia ot nsP�on Form,Subsurface Sewage Pa go 15o117 .. :Commonwealth of.Massachusetts u=_ Tittle 51 OfficLL gal. Inspection 'Foem Stabsurface Sewage Disposal System Form Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et als Owner Owner's Name information is. required for every Hyannis MA 0260.1 December 2, 2010. page. cityrrown` State. Zip Code Date of Inspection D. System, Information (cont.):. Site Exam: El. Check:Slope• 0: Surface water Check.cellar. 0. Shallow wells Estimated depth to high ground water: 5 It feet Please-indicate all methods used to-determine the high ground water elevation: Obtained from system design plans on.record Ifichecked, date;of design plan reviewed' 10/24/07 Date. Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with:local Board.of Health -explain: 0 Checked with'.local excavators;.installers-(attach documentation) ❑ Accessed USGS database--explain: You,must describe how you established the,high ground,water elevation: Approved design plan on file.with Board of Wealth shows bottom of-soil absorption system to be 5 feet above the adjusted high.groundwater table.. Before filing this Inspection Report; please,see Report Completeness Checklist on next page. t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts RVTitle5 Official Inspection Form Subsurface:Sewage,Disposal System Form -Not for Voluntary Assessments 67 Hamden Circle Property Address Joanne F. Barge et.als Owner Owner's Name information is required for every Hyannis MA 02601: December 2, 2010 page. Cityrrown State. Zip Code Date of Inspection E. Report Completeness Checklist N Inspection Surnmary A, B,,.C, D, or E Checked Inspection Summary D (System.Failure Criteria Applicable to All Systems)completed ® System Information — Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tSln :;09106; Title 5 Official Inspection Form;Subsurface•Sawage Disposal System-Page17 of 17 TOWN OFF BARNSTABLE 4 LOl' ATION C 7 I�I�/4`L1 G� C//'c1�� SEWAGE # VIL?.AGE l7�GJ���/S' ASSESSOR'S MAP &rL�OT 2 q/—30 9 INSTALLER'S NAME&PHONE NO.,s08- yz0-97 SEPTIC TANK CAPACITY lm) LEACHING FACILITY: (type)S7C04k OF �!/�7FC C Y (size) �L X 2fl NO.OF BEDROOMS �// BUILDER OR OWNER ✓,01yo4-G PERMTTDATE: COMPLIANCE DATE: // 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) iFeet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fac' 'ty) Feet Furnished by _ __ 1 7 1 i I . , 6�,yam;�7 , . hz ,h� I��jC�i -,- l ,g _. \� • s �� ', + I - - ' J No. .2 LI AW Fee (f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpprication for Migpoal 6potem Con0tructiou Permit Application for a Permit to Construct(e:�- Repair(4y_�U_P_grade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No.6 7 H ohh C� zo Owner's Name,Address,and Tel.No. cJ �1s J,,Wha,6 6#rqe Assessor's Map/Parcel �Z 9/_ 999 -G Instl/aller's Name,Address,and Tel.No.StVg-Z814—7_�2 Designer's Name,Address and Tel.No.s'D$ 477's-S � Type of Building: Dwelling No.of Bedrooms 1:5 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 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) Z��'T c� I Raw5 p/% 1,11 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by OA U ly A& Date Application Disapproved by: Date for the following reasons Permit No. 10 Date Issued (� No.i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for �Bigpogal 6pgtem Congtruction Permit Application for a Permit to Construct(LY Repair(grade O Abandon O ❑.Complete System ❑Individual Components 1 Location Address or Lot No. Owner's Name,Address,and Tel.No. {�y�.��is 5 Jo�tir9� ��rq,� .�• Assessor's Map/Parcel a Q 4 041-G ' Installer's Name,Address,and Tel.No.fOS-?& 7752 Designer's°Name,Address and TeL`No. ✓ass pti V,e ti►rros �ih shy �vv�/<S Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder } Other Type of Building No.of Persons Showers Cafeteria Other Fixtures `+• Y Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets y Revision Date Title " Size'of Septic Tank , Type of S.A.S. Description of Soil -f c C,,,-£ f 7•ry ii V, /f` Nature of Repairs or Alterations(Answer when applicable) ;rW,°� �pu/5 per' �d�r/=G G',S/ G.11r�i�TS �// r� hD Spy�rT • � ', i Date last inspected`: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-sit4ewage disposal system in, accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of - Compliance has been issued by this Board of Health. E - Signed 'l Date Application Approved by ' Date ® E Application Disapproved by: } r" Date or the following reasons - Permit No. ({ ———————Date Issued 10 — -4_—= —`` —— THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (G.) Repaired ( Upgraded ( ) Abandoned( )by l/11,,S-egi V,.- A_5AeZ__ S' at G f�40�G!/G� //^G�/, f7�G/��/j has been constructed in accordance with the provisions of Title 5 and the for Disposal/System Construction Permit No. dated Installer t/gSG��1 Q-� li�a�f�r�s Designer #bedrooms `� Approved desi n flow gpd The issuance ,f h" e lit sh of be construed as a guarantee that the system i unction as design �-- Date Inspector (5 .. W } fi No.,'l 4 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ligpogat *pgtem Congtruction Permit Permission is hereby granted to Construct (�� ) Repair (��4--) Upgrade ( ) Abandon ( ) System located at /7 /7�i>'s�aU/s Gi CZL and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Con st ru c tionust be completed within three years of the date of this pt t Date Approved by &-A _ Town of Barnstable P# Department of Regulatory Services Z4 0-7 tB Public Health Division Date a 200 M in S treet,Hyannis MA 02601 i 39 ' Date.Scheduled ®D mime Fee Pd G -a) Soil Suitability Assessment fox.Sewage Disasal Performed Br. kv, Witnessed By., � LOCATION& GENERAL INFORMATION Location Address Owner's Name _36 q y n e /?a r 4_ (Q 7. /�Ot C'►I C1CK✓l i l'CLc 1-� v►hr`.� Address &7 H-q m Assessor's:Map/Parcel:-.. `Zcl j L ?j0 Engineer's Name f%(C Q NEW,GONSTRUMON. REPAM _. _ Telephone V. Land Use e 5, Slopes(%) Surface Stones • U Distances from: Open Water Body � ft Possible Wet Area 7 i Yo ft . Drinking Water Well O ft Drainage Way / ft- Property:Line. 6 t ft Other ft SKETCH';(Streetname,dimensions of lot,exact ocadons of test holes&perc tests,locate wetlands�n proxrrmry to`holes)` z 4.7 f GILAktiS rAE C 91A DIVISION c�C.� �� Parent material;-(geologic) Depth to Bedrock - - Depth to:Groundwater. Standing Water in Hole: r Weeping from Pit Facer) Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH.WATIM%4B4 Method.Used: 'EC-1(r P it tr Zoe G C_ Depth Observed standing in obs,hole: In, Depthao soil mottlaa:, . N f;tom In. Depth to-weeping fconiside of obs.hole: _ ln, l3rountlwater Adj stmt nt ' ft. Index Well.# AN vo heading Date: g Index Well level ._,� AdI,fhCtbr„ A { Clrnui►awater Level $ PERCOLATION TESL' vuwt . 3 observation Hole# 14 6" Depth of Perc Time ut Start Pre-soak Time® `.7 V►!l`� S Time(9"-6") r End Pre-soak t J 7i'I J�� Rate Min./Inch Site Suitability Assessment: Site Passed Sitc,Failed:�— Additional•Testing Needed(M. Original: Pub►ic.Health Division Observation Hole Data To Be Completed on Back=-----___. ***If percolation test is to be conducted within 100' of wetland,you must-first a BarnstI a Conseirvation Division at least one(1) week prior to beginning. n.GnnmR/nDAO/R7l1pkA nnr - DEEP.OBSERVATION HOLE LOG Hole# 6 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m)- r (USDA) (Mansell), Mottling (Structure,Stones,8outders.. 77 o, S to'f(�- 8 0 lay '1.,•C Sam Z_,5 '�..�. z DE EP OBSERVATION HOLE LOG Hole# — Dapth from Soil Horizon So�i Texture Soil Color Soil Other- Surface;(rn:) (USDA)' (Mansell). Mottling (Structure,Stone§,Boulders. R.) �. . � s i✓ to 2�/ , DEEP OBSERVATION HOLE LOG Hole P�fi9m Soil Horizoo Soil-Texture SoihColor Soil ;. Surface(in) (USDA) - (MUhSell) Mottling (Structure,Stones,:f)ouldars. DEEP OBSERVATION HOLE LOG Hole Depth frorn Soil Horizon Soil Texture Soil ColorSoil - Surface (USDA) (Munsell) Mottlin. g (Structure,Stones•Btiuldars,. ,t Flood.Insurance Rate MAn� "' r _ , Above 5(f0year flood boundary No Withlo 500 oar boutda No" Y ry -A Yes thin 100yearfloodboundary No Yeses U�73 b th oI1,�UccurrlD�s Pervious Mate .. es at l rw east four eet.of natucall occurring pervious - t . ; _Y urr g P ous material exist in all areas observed thrpughout tha area proposed foTTthe soil•-,absorption system? _`eG5 If not,what is the depth of naturally occurring pervious material? Certification 67 !I certify that on .(date)I have passed the soil evaluator examination approved by the DepartmenC of Environmental Protection'and that the above analysis was performed by me consistent,with . the;regtured trarntng,expertise and experience described in VO.CNM 15'.017: Signature Dale r :4 Q:\SEPTiC1PBitCD7oaMDOC '' ` I E Town of Barnstable Regulatory Services g Thomas.F;G.eiler,Director Public Health Dlvislon Thomas McKean,Director 200 Matn,Street,Hyannis,MA.:02601 Office 5086 =4644. Fax: .508-790-03..94 Installer&Devioner Certifies004 -o m Date:: 12 Sewage Permit# 2o07_yflo Assessor's Map\Parcel 0'q Des g >I•• ;; . iq/r,ee�.5 In >-t�tS ns*aller: Oe '� VO Aadess; Address: �'t &"vv�-e4 M; I s was issued a permit to install a (installer) septic sy,atmt �a- 1 fGi vK c�t� C;r kit based on a design-drawn by _ (address) dated (tiesigrter) I ceafy that the septic system refere above was installed su g to . nced bstantially accordin the �lesin, which may include' or approved changes such as lateral-relocaton.of the on box and/or septic tank: septtc system re renced above was installed with ma}or changes (i.e. s . n>'lA lateral relocation f the SAS or any vertical relocation..of any coiztpQncut of the septicsystern) but in accor ce with State&Locai Regulations. Plan revision or ceidas btii t by designer to follow: SH OF.M, PETER T, yGn WENTEE CIVIL -0 9 No.35109 0 `ss/ONALN� . (Affix Designer s Stamp.Here) P B :I D B 'COIAN E: L.NOT BE ISSUED UNTIL ;BOTH'THIS FORM A1�TD AS BUII,T CARD ARE 1D BY'TEE BARNSTABLE PUBLIC HEALTH DIVISION TIiANI{YOU Q:He9tblSep.#0 signer.CertiScation Form 3-26-04.doc 1.0j�ATION SEWAGE PERMIT NO. -) f- e14 -7 - rl Vl l L A G E INSTALLER'S NAME & ADDRESS + BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED_ „_ �� �� --' � (' 1 -� � � � �� �. � _ < �„ � � v `-� "� � �' �, -�.. -� C t� �' (�'1 �� t.J i I i =__.___ i I � ' � ._� 7)-/ 3 a� 5-- � No...........1 0\ ......9:. F�$.............................. THE COMMONWEAW-TH'-O'P MASSACHUSETTS �,nBOARD OF HEALTH --vo- W' ''{ ......... .OF......... ,@&- .......... Appliration -fur I oiial Works Tomitrurtiott Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an In ividual Sewage Disposal System ..... ....�If3 IV_ a- ocation•Ad . s or Lot ------------- . I Address 4 a .._.. J -------------------------------In Address UType of Building Size Lot-----f l...Sq. feet �-, Dwelling—No. of Bedrooms...............G __-_-_--.-_-..__-..--Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria (. ) Q' Other fixtures _ -. ----------- ---------- /� W Design Flow..................��__ _----........._ Mons per person per Jay. Total daijy flow__--_______. .30....._.__......_..gallons. W Septic T.utk—Liquid capacity. �allons Length------ Width.._........ Diameter__-___-..----_ Depth--------------_ x Disposal Trench—No.........:........... Width..... ............ Total Length........../..... iTotal leaching area--------------------sq. ft. � Seepage Pit No /............. Diameter_._Xs___ _____ Depth below inlet._..�._�.._.... Total leaching area �_ �_,�__sq. it. Other Distribution box ng tank ( ) aPercolation Test Results Performed by._ orl"WI V---__- ... Date..... . ..7...... Test Pit No. I................minutes per inch Depth of "Pest Pit.................... Depth to ground water... .f.. f14 Test Pit No. 2......•.........minutes per inch Depth of Test Pit_________________- Depth to ground water.......&V - _----- W yp ODescription of Soil-------------------- Av ------------------------.-__--_---.---.------- ------ ------- ----- ------- ----------------- x W VNature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- ---•----•--•-------------------------------------•-----•--•--------------•----•------------------------•------•---------------------------------•-----•---•----•....._..-•----•--------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliaiRi y the boar -if �eat', - } - - --- Date Application Approved By--------- L f ,.... 7� ...{, � Date Application Disapproved for the following reasons:..._.. - --------------------------------------------------------••----------•--...----------.----- Date /�' /_ Permit No.------•---------------------------------------•------_.. Issued---'l nz!-7-�----•---.-•-----•------- Date ............................-- -------- No.......... � 4 F.Eiic ./�... ....... THE COMMONWEALTH O* MASSACHUSETTS BOARD OF HEALTH ....----OF. .. r'1 ., � ' »............ ' I�Vvitrtttiun -for Utspviitt1 Workii Tonstrnrtinn Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Ire �.a,. Al ,,Location A dr or Iwo Z f f ss Est i ............. � 1 n� Owner p'^ / ro Address W ..................,,++�..a+r t,4 �d ---- a es Installer ' ' Addrses C UType of Building `,' Size %....Sq. feet Dwelling—No. of Bedrooms______________ --_---_____---__-._-___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of,persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -------------------------------------------- Mons er erson er c--a Tota1 daid flow _ _ ____ ' W Design Flow................. --- ------------g� P P P � Y• � >Y --�,-=----------...-----.gallons. WSeptic Tank—Liquid capacity. 0gallons Length_____ ...... Width.<e'.'.......... Diameter................ Depth--------------- x Disposal Trench—No_____________________ VVidth..._ll...._.__.._. Total Length_.__.__._;*_.... .t Total leaching area------- ____..______sq. ft. Seepage Pit No Diameter___-_:, :______--._ Depth below inlet_. ........ Total leaching area- . _7_---sq. ft. z Other Distribution box (f) I5osing tank ( ) '-' Percolation Test Results Performed by � t...__ fi/ A = s Date. .Er °" r*' Test Pit'-No. 1----------------minutes per inch Depth of "Pest Pit..................... Depth to ground water-_-:-_.--_---._- O (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....... ............ O Description of Soil------------------- � ,�=-- --- 4n- a) xf - ------------- - U --------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI.of the State Sanitary Code—The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been issued by the board of health! e ----------- - . f`'51 e(j� . . .it,Gr��' ............Date------• --•-• Application A proved B ----------_ / f ---------------Date._--.--------- Application Disapproved for the following reasons:`____________________________________________________________________________ Date Permit No:--- ----:--- --- -- .. Issued - `---.: ......... Date THE COMMONWEALTH OF MASSACHUSETTS• BOARD OF HEALTH ...... O F.... �W..: .. .... . der "firnte of Ir mpiinnrr THIS _TO CERTTAY% Th;i i t" e Individual S ge I�> posal System constructed ( ) or Repaired ( ) ' 3 staller C r has been installed in accordance with the provisions of Aqie4v XI of The State Sanitary Code as described in the �-.,apPplication for Disposal Works Construction Permit No.-- �.._.._ ............... dated..... r. . .,, THE ISSUANC OF THIS 1GERTIFICATE SHALL NOT,BE CONSTRUED A A GUARANTEE"CHAT THE SYSTEM WILL F `�� SATISFACTORY. DATE a . =•-- - Inspector .................................. :--------------------------•--- == J THE 'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...... ..... ...... FEE.-{ ------.-••---- Bispntitt1 Nqrki5 TTon.9trurfiv t Prr tit Permission is herebyanted..... r = � ........ to Construct ( ) or-Repair ( ) an Individual Sewage Disposal System at No. '" =- l f I{ " is .. tr ' : street as shown on the application for Disposal Works Construction Per -rt', o._ ._ _ _.. . Dated_. }.7....'7 .. 1 --- - ......................... ra. 1L Boar of Health DATE---•-•-• --r---- ......... V -------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LEGEND i, Ap a gUMPUS ,n BRISTOL RD CHESTNUT ST r�.-.9 7 r EXISTING CONTOUR to Z � - x 98.46 EXISTING SPOT GRADE COUNTY SEAT ST % 0 p CHERRY ST 19 N TEST PIT LCP 14034 w EXISTING WATER SERVICE �111 G EXISTING GAS SERVICE CIR o a 110, z 1 —�IIW— OVERHEAD WIRES �I EXISTING TREES (>8" CALIPER) LOCUS Ci A2 `, � Q� BENCHMARK LOCUS MAP N.T.S. DRAINAGE EA5EMENT /DH 100,00 101.9 5 V"V"`�-�-V 3 0 CENTER OF CATCH BASIN �, H GC3\� Np Aar J EL.= 101 .42' (A55UMED) CUT PAVEMENT ALONG BACK EDGE APN 29 1 -309 { � o�� PETER T. �`✓° OF SIDEWALK, REMOVE DRIVEWAY & , { McENTEE GENERAL NOTES: RESTORE WITH LOAM & SEED �;�' � `� 101.68 ,,�' I�+i31 2�5F ; >� � � o CIVIL "' Q P O '. ! r ; N N No. 35109 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �•A Z ?�• DRIVEWAY f { ; N �� ��,/ � tiV �� BOARD OF HEALTH AND THE DESIGN ENGINEER. 001 '-_ ' f r' r' j tuft ��SS ���` 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 12 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE G } I I I I �� ® �K LOCAL RULES AND REGULATIONS. A 1 2�35 {n 9 1"5 Z�`. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 101.80 x TP 1 N % '�% r f� r� / 0)" ,r ' I DESIGN ENGINEER. INSPECTION PORT n. I 1 I j f�j; /' / o. 67// /'/ � 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TT it STY / / // ENG NEER BEFORE WCONSTRUUCTIONACO N INUESQRTED TO THE DESIGN V' IGAP ZAGE // �o I I I IaI I I / r'" ,' % • FRfllli`'�/' '/ " ' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. rG /T.O.F. = 104.29 y .......... ...__ _ ._. ..� 1 Z �0 Fr-10-�i;.j ;' j, / ., i , ` ,/ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 102.30 2.50 x b ffi _1.01.,.95-- " I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER. Z 8. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. STIPOUT TO "C" HORIZON — !�S -- _ r (SEE NOTE 11) p 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 03 •2 f�l gam', _- -�a `� � 11 TO A CONDITION AGREED UPON BETWEEN ,OWNER ANp CONTRACTOR. r - `" - 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY- EXISTING S.A.S. 78.05' THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING TO BE PUMPED, FILLED WITH 3 NO2°37'57°E M CONSTRUCTION. SAND AND ABANDONED "— r' ' —. 1 1. WHERE WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS PAVED SIDEWALK IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). CONTRACTOR MAY TIE INTO EXISTING PIPE AT THIS LOCATION IF PIPE INVERT EDGE�•i OF Z. 'PAVEMENT IS EL.=100.43 OR HIGHER ����' �O�' �U�'� �0�• PROPOSED SEPTIC SYSTEM UPGRADE EXISTING SEPTIC TANK TOP OF TANK, EL.=102.65 HAMDEN CIRCLE 67 HAMDEN CIRCLE, HYANNIS, MA. INV.(OUT)=101.30± Prepared for: Joanne Barge, 67 Hamden Circle, Hyannis, MA 02601 Engineering by: Surveying by: SCALE DRAWN JOB. NO. Engineering Works HOOD SURVEY GROUP 1"_20' P.T.M. 214-07 12 West Crossfield Rood 18 Route 6A DATE SHEET NO. l Forestdole, MA 02644 Sandwich, MA 02563 CHECKED (508) 477-5313 (508) 888-1090 9�27�07 P.T.M. 1 Of 2 . „ NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:100.41 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. ELEV. TOP FINISH GRADE: 101.5(MIN.) FOUNDATION (Existing) EXISTING F.G. EL.102.7t F.G. EL.102.5t MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 1 -INSPECTION PORT � L = 53' g 4" SCH 40 PVC 4" SCH 40 PVC LL. 10" EXISTING 6 ° 1000 GALLON 14 ® S= 1% (MIN.) 0 S= 1% (MIN.) INVERT o . . ° ° " . ° ° . . ° ° SEPTIC TANK INV.EL=101.30t 16 W ;a (SEE NOTE 12 -SHEET 1) PROPOSED 3 ROWS OF 3-CULTEC C-4 UNITS x 8'/UNIT ADD AFFLE (EXISTING) D BOX INV.=99.95 LENGTH=24' INV. EL.=100.19 SOIL ABSORPTION SYSTEM (PROFILE) INV. EL.=100.02 SPLASH PAD TO CONSIST OF EXISTING UNDERLAYMENT OF FILTER FABRIC EXTENDING 16" IN FROM INLET N.T.S. NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ESTABLISH VEGETATIVE COVER CULTEC N0. 410 FILTER FABRIC PIPE INVERTS PRIOR TO CONSTRUCTION. BACKFILL WITH CLEAN SAND 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 12" MIN. (NATIVE OR RC SAND) 6-4' POLYSEAL OUTLETS ON A MECHANICALLY COMPACTED SIX INCH CRUSHED _. 21' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 2" s 1-4" POLYSEAL INLETS 2 3) INSTALL INLET & OUTLET TEES AS NEEDED. BREAKOUT=TOP OF UNIT > 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE '; TOP OF UNIT ELEV.=100.41 , J AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. INV.ELEV,=99.95 x. BOTTOM ELEV.=99.70 - IIIItlllll EXISTING SUITA 00 48" (TYPICAL) MATERIAL 5' MIN. ABOVE BOTTOM OF SEPTIC SYSTEM PROFILE o ADJUSTED GROUNDWATER EFFECTIVE WIDTH=12.0' 06 N.T.S. , ADJUSTED GROUNDWATER, EL: 94.7 USE 3 ROWS OF 3-CULTEC C-4 FIELD DRAIN UNITS Top View Section WITH NO SEPARATION BETWEEN EACH ROW & NO STONE N D-BOX SOIL ABSORPTION SYSTEM (SECTION) N.T.S. CULTEC CONTACTOR FIELD DRAIN CAM � SOIL LOG DESIGN CRITERIA �� DATE: SEPTEMBER 20, 2007 (REF# 11,944) NUMBER OF BEDROOMS: 3 BEDROOM MODEL FD C-4 R STARTER 4 DIA. INSPECTION PORT SOIL EVALUATOR: PETER McENTEE PE CSE SMALL RIB LARGE RIB WITNESS: DONNA MIORANDI-HEALTH AGENT SOIL TEXTURAL CLASS: � CLASS I ° � MET. DESIGN PERCOLATION RATE: <5 MIN/IN Elev, TP- th De Elev. TF'-� DepthRM IMMMM DAILY FLOW: 330 G.P.D. -17 zvkan ^� ° ° ° 102.1 0" 102.1 0" DESIGN FLOW: 330 G.P.D. MODEL FD C-4 E MIDDLE/END FILL FILL GARBAGE GRINDER: NO SMALL RIB LARGE RIB 48' ° 100.8 A 1 16" 100.8 A 16" x� PROPOSED SEPTIC TANK: GALLON CAPACITY � n p� SANDY LOAM SANDY LOAM , dL•.�1�L:11SI .16 f� ° 10YR 4/2 10YR 4/2 LEACHING AREA REQUIRED: (330) = 445.9 S.F. 100.4 B Z0" 100.4 B 20 .74 2" SANDY LOAM _ SANDY LOAM USE 3 ROWS OF 3 CULTEC C-4 UNITS WITH NO STONE 1OYR 5/8 10YR 5/8 FOR AN SAS HAVING THE DIMENSIONS: 12.0' x 24.0'. 98.8 40" 98.8 40' C C PERC BOTTOM AREA: (GENERAL USE APPROVAL FOR 6.7 SF/LF OF C-4 UNIT) 8.5' M-C SAND 3 UNITS x 8.0'/UNIT = 24.0 FT 4" DI A. 8,0' 2.5Y 6/4 52.. 3 ROWS x 24.0' x 6.7 SF/LF = 482.4 SF 3" 57.GRAVEL M-C SAND 2.5Y 6/4 DESIGN FLOW PROVIDED: 0.74(482.4 S:F.) = 357.0 G.P.D. 8.5" 8.5" ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 5% GRAVEL -� t- LARGE RI 94.7 AD1. GW ._ 94.7 ADJ. Gw - PROPOSED SEPTIC SYSTEM UPGRADE SMALL RIB 91.2 srcI. Gw _ ,3," 91.2 STG. GW _ 131" 67 HAMDEN CIRCLE, HYANNIS, MA 90.9 134" 90.9 134" Prepared for: Joanne Barge, 67 Hamden Circle, Hyannis, MA 02601• CLILT£C CONTACTOR FIELD DRAIN C-4 CHAMBER STORAGE = 7.692 CF/FT PERC RA (TE <2 MIN IN. ( HORIZON) ALL CONTACTOR FIELD DRAIN C-4HD HEAVY DUTY UNITS ARE MARKED WITH A COLOR STRIP£FORMED INTO THE PART ALONG THE LENGTH OF THE CHAMBER. D WI Engineering by: Surveying by: SCALE DRAWN - JOB. No. CULTEC,Inc. PH: (203) 775-4416 TM STANDING GROUNDWATER AT 131" Engineering Works HOOD SURVEY GROUP N.T.S. P.T.M. 214-07 CULTEC Contactor®and Recha " INDEX WELL AI W-230 - ZONE C 12 West Crossfield Rood 18 Route 6A P.O.BOX280 PH: (800) 4-CULTEC WATER LEVEL = 24' - AUG 2007 Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. 878 Federal Road FX: (203) 775-1462 Plastic Sepdc and Stormwater Chambers GW ADJUSTMENT = 3.5` (508) 477-5313 (508) 888-1090 9/27/07 P.T.M. 2 of 2 Brookniald,CT08804USA www.cultec.com CULTEC :�F6tly 1/XS I �INiSN G�AD¢� =�4,K_ r- FINISH Gq/I�E �•�wJ.rN G�Aa� - -, O vest Tip N K _ q{O O vEler'- Top of F70NIVO ,Of COVd'low -ICY ARAOI& L f✓s _�G.X..�_ i j I ���'9/�.airy'a�*U/��//�(./l�.�l�//y/�c�a`J�iy{A��//��..-i�"!/!.�/�r•!�� L� '=P�it Sr. y, 6 Dwe4-L IN - 4-�G___�- � -- �1 3 CELL-A R { �_ D I S ry �L T ELE✓ = 3X2S� �'Q� � 1_� �Ef NI4sKEa Cc.vc T `D ic��sNfa sra.v� 1. t � � �. G � C• O � I � �1 .SEPTI C TANK _ _ _ _ ro QE VE'L- ! • o 1 I i/.�►YJI'! �, A9077 AV O f ter /VaT LEr9CNJ/VG PiT DES� G J1/ C.Q/ TER/A i .0 c a RU o M.3 3 G,A G• oE�e v,y y - 3 3� { I GfJ,P(�>�'G E GP//vriEP /voiVE �x 4- ro rA� �Ai�y FLas•✓= 33 c ver✓v� ,-=4 .,-�: L E/9C�y 1NG ,9,2EA RE,;2 D 9Y L EACwi/✓rr �9�E'EA P�Ov/U�fD : �e��-si - S�a E .,vu ,•1 i1"4 lea d ://o pAL A=sa z z , ,, �3oTTwY 5rt FQ = Sti - s CG/4[ =30•o0 i/ >orar 4IS7 Got- .W 7-07 Z ! 1 9 T , z - M t. _ o y 44614 M 1 o -- o a I 24 GSA UE L �d/tip t� _A_._ i t To t � � 1 J'AND Exp -e-4 + __ lax? -------- /22-.L9 wArrR 4 x • I �'�Pv r'USED SE WAGE' 15/SROSA4 ')' ,AV: P44,4- M,X?a/:y �iPOPOS�D I�bYEL L INC, f'ECC. SPATE' S ALE • /"= T — _ _ y wr >,>.-�,,,,.. �i-`ti y_, .+ Ow/VEP : CEvr9� .SxC��i .f'r•�4LTf' >.�GCfT ;�cssw AloiPMAN GIPOSSMAN R f t7, T Po/XT AM .