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HomeMy WebLinkAbout0100 HOMEPORT DRIVE - Health 100 HOMEPORT DRIVE, HYAN A lu I 1� Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property AddressMt M1 Brooks Owner Owner's Name information is required for Hyannis t/ MA 02601 10/3/18 every page. City/Town State Zip Code Date of Inspection; Inspection results must be submitted on this form. Inspection forms may not be altered inThy way. Please see completeness checklist at the end of the form. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/3/18 Inspector's Signal a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c� Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Ownef's Name required for Hyannis MA 02601 10/3/18 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u� 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or El ® 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 L,5,n.�p.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owners Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Citylfown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):. 330 Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied t upied t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �- � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 1.5 yrs ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �. lip Title 5 Official Inspection Form /o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Brooks Owner information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2000 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): >10' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.dcc•rev.7/26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts u'x� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Homeport Dr. Property Address Brooks Owner information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 10"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/2" >2„ Distance from top of scum to top of outlet tee or baffle >2.. Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 d-box 18" below grade, no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments l; u 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): . *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ' ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Brooks Owner Owner's Name information is required for Hyannis MA 02601 10/3/18 every page. Cityfrown 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.): Chambers were video inspected, effluent level is approximately 8-10" below the invert, no indication of past hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (,e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Brooks Owner Owner's Name information is required for Hyannis MA 02601 10/3/18 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately � a l� `V U � 1 G 1 C--Z>c p c 5 c�-'Lie- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Homeport Dr. Property Address Brooks Owner Owner's Name information is required for Hyannis MA 02601 10/3/18 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >144" feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per 2000 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping Site is 30'msl and nearby surface water is 8'msl You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Homeport Dr. Property Address Owner Brooks information is Owner's Name required for Hyannis MA 02601 10/3/18 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Double 1-314 x 16 VERSA-{.AMC 2.0 3 100 SP Roof BeamMB01 BC CALC4D 9.3 peslgn Report•US 1 span i No caniilevers 10/12 slope Monday,May 14.2007 07:59 Build 057 File Name: BROOKS,BCC Job Name: BROOKS RESIDENCE DeeCnp�Ion:RS01 Address: 100 HOMEPORT DRIVE Specifier: City.State,Zip:HYANNIS,MA designer: DAV{D GRE+=NLAW Company: BOTIELLO LUMBER Customer: Code reports: ESR-1040 Mlsc: io ;2 L—R... ��7C-.��� .7.—.Y�♦ 'C—�_TLI+L ,. . ,►�L��' _.c�r ¢ [�rt_.-Z 1%fit iC:Tt!-(�tj't— tar. •rr�n—...i-r.ir"rt'• •,4^r:,�•,n•ir': .i: ir'h �i�':7•p ,. v 1.,. i ijr;rr�}�r 'f I If>!r 1'.7G n;. y,DTP F: :n h i ,r. 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(pll) Left OD✓00-00 16-03.00 101 180 12-00.00 2 Unf.Area(psf) Left , 00-00-DO 16-03.00 - 10 Controls SumrnarY value %Allovirable twatlon Load Case s Localton Disclosure Pos. Moment 21678 ft-lbs 50.4% 115% 2 1 -internal Completeness and eC who w ul4 rely on of input must End Sheaf 4413 Ibs 36,1% 115°/, 2 1 -Left be verified by anyone who o 2 1 output as evidenoe of suitability for Total Load Defl, U452(0.431") 39,8% 1 paNcularapplloatlon.Output here based Lhre load Defl, L1707 (0.276") 33.9% 2 on building code-acceptod design Max Den. 0.431" 69.0% 1 properties and analysis methods. Span I Depth 12.2 rJa 1 installation of BOISE engineered wood producfs must be in socordance with current Installation Guide and appncable Notes ----- building codes.To obtain Installation Guide Design meets Code minimum(U180)Total Wad deflection criteria, or oak questions,please cau Design meets Code minimum(U240)Live load deflection crtterts, ,80o)232-0788 before 001100n. Design meets arbitrary(0.625")Maximum load deflection criteria. BC CALCO,8C FRAMERM.AJS^', Minimum bearing length for BO is 2". ALUOISTO,BC RIM BOARDTM SCIS. Minimum bearing length for 61 is 2". BOISE GLULAMTM,SIMPLE FRAMING ,. Entered/DisplayW Horizontal Span Length(s)=Clear Span+ 112 min.end bearing+ SYSTEl111M,VERSA-LANW.VERSA-RIN 1/2 intermediate bearing PLUS®.VERSA-RIM®. Member Slope=0.consider drainage. VERSA-STRANDS.VERSA-STUDS are trademarks of Boise Wood Products, L.L.C. ConnecUon Did ram — b4 .• d a c i a minimum=2" c= 12" b minimum= 3" d= 12" Member has no side loads. Conrectors are,16o Common malls Page 1 of 1 10/10 'd 6L-c',bL1b909 'Oty Kid 0II�'1�9 d�a £0:80 NOW 1002-tit-Aw Yb LvL- 3Di�e� -ties rt,.p e ;-- � ` fit`1 z)vr ��- X*IZ d PCS �X8 C S Ib:oc P IAsrL �, ND r'b r32Q 7•�S r. Le u e( �( s r h Zvawt SW10 FC'S L-�l ST 70 I�V�r r SCALE: I� U �� APPROVED BY: DRAWN BY DATE: r, b'� 6 1 y ( 4 1 s ; s i � t i — i S , e 1 i i t. 1 t t< n1 t i j r f 3 \ { , 1 { 1 3 _ 1 �"� --�' �� 7 - -- i �: _t r'.. ` 4 . �,- r: ; _......_. � 3 .. -� ,, , � t .... ... ._ .__ , 7 } i { �• � f {{ .i`� _ _ .....___ k ` w_ r .; 4 ., i.. { yr r } '��w ��.Vy1 ! � - V ,..1 f i � � ... ~Y f �k `` a ��� . . � . :; . r• f -._ - _ - t ., ! t f', �: t 2 ' 7 i I i t t { 4 � � t tS �, i ' [ t } � C 7 i l , 2 n e. rha+el L dam.do — r I+`1�hnis n.a-<-Q c� q'Pl.at1� _ ��STG•� 2��oSa�r V � - COMMO' `"7EALTH OF MASSACHLSETTS EXECUTIVE OFFICE OF E1'VIRONME\TAL AFF_AJRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION �c4pe ONE n7\TER STREE'�. BOSTOK DL9 0210c i61" 292.550k, TRL DY COX:: Secretan ARGEO PALL CELLUCCI DAVID B STP.-'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 100 Homeport Dr. , Name of owner John Camille Boullie H is Addressofowner: p n nx 1 ' , E nAnnis Date of Inspection: Name of Inspector: (Please Print)Wm. E . Robinson S r . I am a DEP approved systems inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Wm. E . Robinson Septic Service MaaingAddress: PO Box 0 9, Centerville , MA Telephone Number: -R 7 7� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-siteysew ge disposal systems. The system: es Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: t L Date: a`0--<> The System Inspector shall submit a.copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to tfte system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revdsed 5/2/98 PjRVIofI] �. � rted or Recyclyd Vann SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION fcontinued) 'roperty Address: 100 Homeport Dr. , Hyannis Jwncr: John Boulli Date of Inspection: INSPECTION SUMMARY: CheckOB, .C, or D: A. SYSTSdYI PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. STEM CONDITIONALLY PASSES: ne or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon c mpletion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if Iwith approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2ofII I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:100 Homeport Dr. , Hyannis Owr1ef: John Boullie Date of Inspection: .3 74-& C. RTHER 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 the public health, safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revise-6 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icoftnued) Property Address: 100 Homeport Dr. , Hyannis Owrw: John Boullie Date of Inspection: 7 r D. SYSTEM FAILS: O You st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility-or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. 1 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You ust indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facitity with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone 11 of a public water supply well) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2 /98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address: 100 Homeport Dr . , Hyannis Owner: John Boullie Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N,A. V _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. V _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: `' _ Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) The facility owner (and occupants,if different from owner) were provided with information on the propermaintenancil'-0f Subsurface Disposal Systems. revised 9/2/98 Page 5ofII Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 Homeport Dr . , Hyannis Owner: John Boullie Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Desig��g.p.d./bedroom. Number of bedrooms Idesign):� Number of bedrooms (actual) Total DESIGN flow `/,N Number of current residents: 0 Garbage grinder(Yes or no): X,© �/ Laundry(separate system) (yes or nov40; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):AL 0 Water meter readings, if available (last two year's usage (gpd): _ 1999 122, 250 gal. Sump Pump(yes or no):-A-- Q 1998 114, 000 gal. Lest date of occupancy: a-? '1 COMMERCIAL/INDUSTRIAL: Type o establishment: Design fl w: gpd ( Based on 15.203) Basis of esign flow Grease tr p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non•san' ary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last to of occupancy: OTHE :(Describe) Last d occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) d If yes, volume pumped: gallons Reason for pumping: TYPE OFF,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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other ISO APPROXIMATE AGE of all components, date installed lif known)and source of information: -S2�v0 8 > :(p�,..Q I.S S Sewage odors detected when arriving at the site: (yes or no)�� d revised Page 6(if II i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) +roperty Address: 100 Home-Dort Dr . , Hyannis 0 ►ner: John Boullie Date of Inspection: BUILDIN6EWER: (Locate ,n s e plan) Depth below rade: Material of nstruction:_cast iron_40 PVC_other(explain) Distance rom private water supply well or suction line Diameter Commen : (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:_ (locate on site plan) D� Depth below grade: Material of construction:_ oncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 6 I G Sludge depth:_ ► ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6 + Distance from top of scum to top of outlet tee or baffle:_ 7 1 Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: / o,z2--coLZ ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation,to outlet invert, tru_ s tural inte ity, evidence of leakag , etc.) LA � !�/ ,�S�Cr-® Cn $ �� �a w b< �.� �� GR E TRAP: (locate n site plan) Depth b low grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimens ons: Scum ickness: Dista ce from top of scum to top of outlet tee or baffle: Dist nce from bottom of scum to bottom of outlet tee or baffle: D e of last pumping: Com ents: Irec mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evi ence of leakage, etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM INFORMATION(continued) .1roperty Address: 100 Homeport Dr . , Hyannis Owner: John Boullie Date of Inspection: 3 ar-er-15 TIGI T OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locat on site plan) Depth b ow grade:_ Material f construction:_concrete_metal_Fiberglass_Polyethylene otherlexplain) Dimension Capacity: gallons Design flow: gallons/day Alarm pr j)sent Alarm IeJel: Alarm in working order: Yes_ No_ Date of revious pumping: Comm ts: (conditi n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, eviden ofsolids carryover, evidence of leakage into or out of box, etc.) PUjco AMBER:_ (locsite plan) Pumworking order: (Yes or No). Alarworking order(Yes or No) Coms: (notdition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roP"Address: 100 Homeport Dr. , Hyannis Owner: John Boullie Date of Inspection: 3 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) �✓�Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Corn ents: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ (locat on site plan) Mat ials of construction: Dimensions: De h of solids: Co ments: 1 to condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) �—evise,_4 5/L;7C Page 9of1) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Noperty Address:100 Homeport Dr. , Hyannis 'caner' John Boullie Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) A J 1 PT d revised 5, 2/9 , Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ropeny Address: 100 Homeport Dr. , Hyannis Owner: John Boullie Date of Inspection:3—g—,7,cs-�t;�c� NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow. Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater ZSFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions/ Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/96 Page 11of11 TOWN OF BARNSTABLE 1:OCriPION /�� t' /oA r l: SEWAGE #AO&P f VM;LAGE' - ASSESSOR'S MAP & LO n � INSTALLER'S NAME&PHONE NO. GTIA456.,-- SEP`T1C TANK'CAPACITY �� LEACHING FACILITY: (type)� �� e! � ` 4 C (size) � NO.OF BEDROOMS "BUILDER OR OWNER PERMTTDATE: OMPLIANCE DATE: . cf t I Separation Distance Between the: Maximum Adjusted Groundwater- ble and Bottom of Leaching Facility `'Feet' Private Water Supply Well and aching Facility (If any-wells exist on site or within 200 feet// f leaching facility) Feet Edge of Wetland and Le Chung Facility-(If any wetlands exist -V-'' within 300 feet of ching facility) Feet Furnished by �`: ,. yF�°�..' .'�,1. �^� .. �M _ � ��, ...;�, �,�� � w � '6 �- , �' '� � � A �, ,,, � r � �,A 1 � � '/ F �r/� 1 u ` �^"� 1 -_...-�.�____ .`Y lfff No. �� `A Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatfon for Migpool *p5tem Cow5truction Vertu Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name Address and Tel.No. 100 Home-port Dr. , Hyannis John l Camille Boullie Assessor's Map/Parcel Z! p— ' 3 2._ P 0 BOX 13 74,ED e nn i s 02641 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system Consisting of a tank, D-box and. 2 concrete leach chambers with stone all around.. 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 Envi onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is su d by this Bo of eal\h. �y Signed 1 — Date3— -a` 0 Application Approved by Gea Date Application Disapproved for the following reasons Permit No. Date Issued No. Fee50 THE COMMONWEALTH OP MASSACHUSETTS Entered in computer: r " Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS � �. 2pprication for �Digooar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )0 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components � Y Location Address or Lot No. Owner's Name,,Address and Tel.No. 100 Homeport Dr. , Hyannis 'John /ACamille Boullie Assessor'sMap/Parcel ' 3 = P 0 BOX 1374,EDennis 02641 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E Robinson Se ptic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow . ✓' gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs.or\Alterations(Answer when applicable) Title-5 septic system consisting— of: .a tank, ,'D-box and. 2 concrete leach chambers with stone all, around. ^. 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 Envir nmental Code and not to place the system in operation'until a Cer[ifi- cate of Compliance has been issue by this Bo of ealki. Signed DateLi ) Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by Wm. E Robinson Septic Service at 100 Homeport Dr. , Hyannis has been constructeo in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z" dated yaw Installer Wm. E Robinson S r. Designer t i The issuance of this permit h 1 ia o e co trued as a guarantee that the syst nc 'on d i need. Date Inspector Yee �J" ---7--,..----------------------------------- No. w I'1-r— Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS /3 Z PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwi5po5al *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 100 Homeport Dr. t Hyannis and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc 'on/must be completed within three years of the date of this pe It Q Date: Approved by ��J ' 116/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND•APPLICAtION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WPTHOUTbESIGNED PLANS) I, William E. Robinson,S,%reby certify that the application for disposal works construction permit signed by me dated concerning the property located at 100 Homeport Dr . , Hyannis meets all of the . s following criteria: • The fieostem is connected to a residential dwelling only. There are no commercial or business uses sated with the dwelling. Th oil is classified as CLASS I and the percolation rate is less than or equal io:5 minutes per inch. are/no wetlands within 100 feet of the proposed sepuc system — Thorart:no private wells within 150 reel of the proposed septic s}sten, Ch a is rco increase in flow and/or change in use proposed G et a no variances requested or needed. • e /ttom of the proposed leaching facility will Mt be located less than five feet above the maximum adjusted groundwater table elevation: (Adjust the groundwater table using the Frimptor method when applicable) Y If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation _ +the MAX High G.W. Adjustment . — DIFFERENCE BETWEEN A and B SIGNED : DATE: if (Sketch proposed plan of system on back). y:health folder:cert �l �. �9 ��. �.'" TOWN OF BARNSTABLE LOCATION �/y Z? "A SEWAGE # VILLAGE - / ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. /1 a �l /'�'ESQ y ' s,— 1-7-01 SEPTIC TANK CAPACITY :� -�---- LEACHING FACILITY: (type)!` '� `� — C. (size) FACILITY: NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 3--�v�cr-Cs�� COMPLIANCE DATE: `-S a` Separation Distance Between the: . Maximum Adjusted Groundwater ble and Bottom of Leaching Facility Feet Private Water Supply' an� aching Facility ..(If any wells exist . on site or within 206 feet 6f leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of h ing facility) Feet i' Furnished by 31) IL 1/^LJ r T TOWN OF BARNSTABLE LOCATION 160 SEWAGE # VI :LAGER ASSESSOR'S MAP & LOT Q-V-/;3, INSTALLER'S NAME & PHONE NO.- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) pait�cAE—1 (size) (,v NO. OF BEDROOMS PRIVATE WELL O BLIC WAS BUILDER OR OWNER e�TbA..w Zo i ( l',-c DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /�� ' o � � c 8 rr 2a 3&S- /3 - N ......»....... FEB.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' . .........OF:......k.�/:g-V,...G.M... aa�.�-- = ...._ . Appliration for Disposal Works Tonstr rtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ............ um:�s(2a:C ...D U...( ................................ ..........�`' k-y_G.y.,&,+ 'PDX CT Location- ddress 'or Lot No. ............... .._._. ► d.11 .................................... %5! Yr a :4.e... .....................:: •--•------•---_-_--_.._--__ O er Address •••-•-••-•••••• �.. rr................ ................... . .......................................................Installer Address Type of Building Size Lot.................._......._..Sq. feet U Dwelling—No. of Bedrooms.... ...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ___. No. of ersons_________________....____:_ Showers — Cafeteria 04 ' 0 Other fixtures ...........................................................=........................--................................ ------------ •------------------- W Design Flow............57-$ 3O___________________gallons per person per day. Total daily flow ...................gallons. WSeptic Tank-Liquid capacity............gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No....../--------_.... Diameter.___._ f?__..... Depth below inlet....-'(......... Total leaching area..................sq. ft. Z Other Distribution box ( . ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth-to ground water......................... . Test Pit No. 2............____minutes per inch Depth of Test Pit..................... Depth to ground water........................ a, ODescription of Soil.......................................................•--•---•-•-------•-----------------------------------..:_._..---------._....---.._...._._...•-•--..---•--•..... V =--•••-...._..-•-•--•-----•---.....---•-•-•--•---..._... W ...---•----•-•--...•••••••...••••-••---•••----•.._...•--•-•--•--•••••--•-••••-••--•------------••---------------------•--••------••-•---•--••---•--•••--••••--=-••-•••--•----•-•._....... UNature of Repairs or Alterations—Answer when applicable---------f-00 �______ !" P.1 .......... ----------------rS TI ------.... ' �-------e.Xi -......................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage,Disposal,System in accordance with the provisions of iITL L 5 of the State Sanitary Code— The undersigned further agrees not to place-the system in operation until a Certificate of•Compliance has been issued by the-board of health. . v .� " Pat Application Approved By--•-•-••-••." :.. �'�`-•-••-.............................-•...........:.•--_-_.... �`2 ate Application Disapproved for the following reasons______________________ ........................•..... D •--......___. .................................................................................•----------------------•--•--••....._......_..---------•-•--••••-•------•----•-••--•---••--•--•----..__.....__....---- Permit No..-. .............................................. Issued e..1-.......... * G' Date • c7 fig- No.Zr,_�,--•--.._... Fles........................c� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 777 Application for Disposal Works Tonotrur#ion "truti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..._.......�d[) .......... ......... -1�v.. -ss�R<..a!22 ---........................................ -__... .. .... ....... . Location-Address or Lot No. ' ............... � ...�. R* e �• \ .....................•.. .................. .............................................................. Oy.ner � Address....._... ... - .. W - vwil....... _ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures -----------•-•--••--•-------•-•. . . WW Design Flow............ :5;7...................gallons per person per day. Total daily flow.......... � ....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../............. Diameter._.... f?__..... Depth below inlet....a........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-1 Percolation Test Results Performed by.................................................••------•--.............. Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------ ----------•--------- 0 Description of Soil.....................................•-•----------------------•--...------. U -------------------- ------------ -....... ------- •-•--------------------------------- •--------------------------- •------- ----------------------------------------- ------- -------- --•------- UNature of Repairs or Alterations—Answer when applicable--------- _06--_•_--4?± :-____--�..... .? `-`J�0(.._..._-" � t1� .........-2c ------`�' ` �``'� -C 5.5 p qo 1.,-•-----•---•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I - 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the- board of health. 9 Sign��'�n-��� = �r� � d Date Application Approved By............. ..........•...............`...:-`-.. .......... ?�?v Date Application Disapproved for the following reasons:-•-•---••-----....-•-•------•--•----------------•-----••----•-----------•------•-------------.........•-••••.. ..........-•---------•---•-•---------------------------•-----...------.............-----•--•-----------.........---.......-------•----------------•----------------•-•-----------•••.........._....._..._ —G V Date PermitNo......................................................... Issued------- l•..Date ,� ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............cN........OF.......\ 2 5� 1l�k? -e....:................................ (Intif irtt#e of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �)� by.............................. �A(?'' c �n,�-�?....:.5 ,'t Installer - has been installed in accordance with the provisions of TIT ?_ 5 o he State Sanitary Codas described in the application for Disposal Works Construction Permit Noa..................Z;rU..... dated.......... z__.7.. �..._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE ✓ SYSTEM WILL FUNCTION SATISFACTORY. --� DATE.....................A.. " ) 0 / Inspector -'�.._ •--•----•..................••---..._....--•-- v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH -� Lev �....... �tiA�Zyt r-�` �'�"- ............................... EE No ...........: F v- Disposal Works 101.1unsirnr#ion ermit Permission is hereby granted.......... ---------•-••---•-------------•-•------••••---.......................... to Construct ( ) or Repair an Individual Sewage Disposal System A nn _. .5 �a T �12!v- _ ------ c. c� a '� r Street ` � as shown on the application for Disposal Works Construction Permit N..__�5....2` �D'ated.._.__._`-__._ ?leg__.... �--- --Y ................................................................. -- � Board of Health DATE......... `T_r-�-------•----------•-------------------- IN s s 18=� 5-3" stair risers 7.65" 13 risers new treads 1 Q.5" `� eliminate this as a bedroom � eI off this floor and insulate 0 replace elechic panel 0 0 10 © © remove this wall and fireplace remove this wall b � N IS O 6l a ss through w N X M kitchen ��-/' IUI F A ° existing live room new kitchen window ° y wW exisitng LO 0 1- © ® 1�� 3 1 L1_1- 1 F tv IJ9 O ew front door 1, 111111 2'-211 rn x011 ---- ----- GFI m �3'0'xW-8' exisitng stairs down 3 g►► 7 N exis' ath 3=5" X-2"' (00 remove tuba d p t dryer end er i cn 1 0 T-Of 0" N 1 X-4"-� 48 1 W o r = master bed path exi "n exisitng X N Q M 0 vl �1 Q 24'-0" T►21' 3'0'x4=8" first floor 3'-0"x4'8" scale 1/4"r. 1' new design 2nd i=oor addition for Mr. & Mrs scoff Brooks 100 Homeport Drive Hyannis, Mass 02601 t by �. Doug Williams Custom Building Co. Box '069 s Centerville, Mass. 02632 A 277" , „ 2=7 closet u s ors 2'6'xe-8•— ) a 1 2'- " 2-8" '--5" closet storage X IT-2" oc Ln 1 !r w b FO carpet CO w A co CA) .1 1` 77 N bed#2 b carpet A m X k bed#3 iV N 2'-8'x 8 8'CO b, Q 4-5„ _3=11" 10'-2" At w 1'- 1' 2=11 1_ cQ cm Tub/Sho I ------------- 1 2 00 X 'O Me 01 ro-I cn Fol rn .p m o0 0 1� v m ,�- 1 closet closet 3-0•xe� 23_911 GFI w family room t W O Cb W carpet 2 sky' hts here w 0 X s 1 1� 2 0" =0" o 4 " 3' n 6=8" 12= " 12- 3'-0"x 4 8' 3'-0"x 4'-8' second floor scale 114" = 1' Mr. & Mrs. Scott Brooks I Gv Homeport Drive Hyannis, Mass. 2nd floor addition Doug Williams Custom Building Co. Box 1069, Centerville, Mass. 02632 508-775-1500