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HomeMy WebLinkAbout0151 IRVING AVENUE - Health 151(aka 155)tR V-IN Hyannis A = 287 — 068 t" a 6 C� } �j. Commonwealth of Massachusetts ,� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) u� Property Address John Wilson t Owner Owner's Name information is required for every H annis Port MA 02647 05/20/2021 y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information cSt S�l� on the computer, use only the tab, Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road _ Q Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ® Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails In ector's Signature Date The system inspector shall submit a'copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. r Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v � 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 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 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is H required for every annis Port MA 02647 05/20/2021 y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further.Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ��i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water . ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **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: This 6 bedroom home has an H-20 1500 gallon septic tank with a D-Box feeding a leaching trench with infiltrators and stone. At the time of the inspection there was apx 18"of liquid in the septic tank. the septic tank was pumped on 3/18/2021. The receipt is attached. Per owner the house has seen little use since the pumping. The D-Box has been parged in the past. At the time of the inspection the liquid level was at working level but at the water line is some sign of decay. The leaching was dry at the time of the inspection. 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doe•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 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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. El ® 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 ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n 151 Irving Ave(Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 _ page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for 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 r El ® ' y t y• 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? I ® ❑ 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: In 2020 - 140,424 gallons were used and in 2019- 87,516 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Dec 2020 Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n c � 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Scott Frank Septic Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallon (Guest house) gallons How was quantity pumped determined? drivers estimate Reason for pumping: maint l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Note there are 3 pipes Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r Commonwealth of Massachusetts i� Title 5 Official Inspection Form r, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-20 1500 gallon Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 30" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 _ page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. City(rown 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 011 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 l r— c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 -apx 34' w/infiltrators ❑ 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is Hyannis Port MA 02647 05/20/2021 requi d red for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. I viewed the leaching with a camera. 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 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 TOWN iOF BARNSTAB�J X r l ; LOCATION IhV 1 �4r 'STAGE# v aQ Li I VILLAGE S �c- ASSESSOR'S MAP&PARCEL= f ` G INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _�_' (� O 0fr LEACHING FACILITY: (type) (size) NO.OF BEDROOMS WX '0 Q Q)X n OWNER PERMIT DATE: �J 1 �T� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY e , a: = 2,5 _ 4 e d 1�n 9� 4 A.' V' �O G Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is Hyannis Port MA 02647 05/20/2021 required for every y ' page. City/Town 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 t t t x 3 y I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151 Irving Ave (Guest House) V Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 _ page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells r Estimated depth to high ground water: 14 plus feet feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /n 151 Irving Ave (Guest House) Property Address John Wilson Owner Owner's Name information is required for every Hyannis Port MA 02647 05/20/2021 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 II Scott Frank Septic 61 F Bodick Road Hyannis, MA 02601 508-775-1056 scottfrank9597@gmail.com INVOICE BILL TO INVOICE# 3613 John Wilson DATE 03/18/2021 155 Irving Ave DUE DATE 04/07/2021 P. O. Box 327 TERMS Net 20 Hyannis Port, MA 02647 SERVICE ADDRESS 151 & 155 Irving 03/18/2021 Pump Main House, 2000 gal 1 550.00 550.00 03/18/2021 Pump Guest House, 1500 gal 1 375.00 375.00 -------------------------------------------------------- MM E --------- ----_..-.._-_....._.__......_..-._...._._-.._.._.- NT 925.00 ALANCE DUE $0.00 O Thank you for your business. We look forward to serving you again in the future. �1NT Town of Barnstable Inspectional Services Department # BA MAS& ` Public Health Division 659. A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7021 0350 0000 1549 3587 June 21, 2021 WILSON, JOHN B & LESLIE Q TRS 155 IRVING AVENUE HYANNIS PORT, MA 02647 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 151 Irving Avenue (Guest House), Hyannis, MA was inspected on 05/20/2021 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Needs Further Evaluation by the Local Approving Authority" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box is rotted and needs to be replaced. You are ordered to repair or replace the distribution box within one (1)year from the date you receive this notification. Failure to repair/replace the distribution box within the deadline period will result in future enforcement action. rlz ' - �' PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\151 Irving Avenue(Guest House) Hyannis.doc No. s 11Iq Fee C>v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for MispoSal 6pstem Construction permit application for a Permit to Construct( ) Repair(v) upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Adddrpsss or Lot No. I IZ� r f V�, Owner's Name,Address,and Tel.No. 66 Asse��ssor�S�vtap7P c t P.o.•�e,,c'�a—r , {ntv,:s Y•QY Installer's N Address,and Tel.No. Designer's Name,Address,and Tel.No. cka .SU`Lj �1 Type of Building. Dwelling No.of Bedrooms It 0 1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) k)( 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 Iterations(Answer when applicable) C 5ku� Date last inspected: Agreement: The undersigned agrees to ensure the construction an oiaintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Codd 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 Date IL)-y .}- Application Disapproved by Date for the following reasons Permit No. O f 3 7 Date Issued y' I No. 2G�c� ' 4)L/ Fee e THE COMMONWEALTH OF'MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 r . 11pplltatlon for -Misposal *pstrm ConstrUttlon permit pPlicat:ion for a Permit to Construct( .) Repair(Ve) Upgrade( ) Abandon( ) ❑Complete System qJn iv"S idual:Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor s NYaA IJf? k4tP•C) Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Sc fit- ` . 1 :a Ica K Type of Building.- e Dwelling No.of Bedrooms Cot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) •- Other Fixtures° ,Design Flow(min.required) _�J( t� gpd Design flow,p'rov�id d11h''' y gpd r , ,�4 , Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) 1-v etil f'e r n Cam✓+ G� i ) e� . ;J� c1 n e v ��� � 1'"`!r��.t `` y Date last inspected: 'v Agreement: z,; I 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 Er.4ironmental Me 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 (l ,� _ Date ).V L Application Disapproved by Date 1 I for the following reasons . Permit No. Date Issued r . -- --_ �- . _ THE COMMONWEALTH OMASSACHUSETTS x `` BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( yo')0 Upgraded( ) - - . Abandoned( )by U C at , ,�r, k,., .rn 'k}as been constructed in accordance with the provisions of Title 5 and the for Disposal Sys- Construction Permit No. 2C)2JatTdy / •Installer Designer #bedroomsl /k Approved design flow gpd �( �..- The issuance of this permit shall not be construed as a guarantee that the system"will fun 'on as designed. `�.., Date 7.r ! C d f Inspectoi'-_ ,_.t_ -N ---------------------------------------------------------- No. r v .( � Fee �2j— s THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Mis oral 6pstem Construction 3permit Ef .&?rni9 ion is hereby granted to Construct( ) ^Repair( "'' Upgrade( ) Abandon( ) System_located at � � \ C' ��v.. 1,__. ►.,.�� Q, 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 . C / Approved by � r No. �C `"_ ,� Fee J V BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYtcatiou _for Yell Cougtructtou J)ermtt Application is hereby made for a permit to Construct( ), Alter( ), or Repair( an individual well at: he � � Location-A ss Assessors Map and Parcel Sai�n g Lsl i e. w1ls a n 1S1 S.Y ytnc AQc �AuCQ )6 Foq Owner Address Installer-Driller J Address 0 2—,�3 Type of Building ✓ Dwelling Other-Type of Building No. of Persons .� SC 11 SS y� Type of Well ,rvi � t d-0 '1 t Capacity Purpose of Well C,c+ cttiln Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate Aofom. lia e a een issued by the Board of Health. Signed7�D at Application Approved / - Date Application Disapproved for the following reasons: Date Permit No. �� ! " f Issued 0 Date 0 BOARD OF HEALTH TOWN OF BARNSTABLE Certiftcate of Compliance THIS IS TO CERTIFY,that the individual well Constructed �, Altered( ), or Repaired( ) by L.l. Installer has been installed in accordance with the provisioiJ of the Town of Barnsth=J-01) of Health Private Well rote tion Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector t No. �l Fee r BOARD OF HEALTH TOWN OF BARNSTABLE ` 1�J +, ZfppYication ,f oeAVell Zongtruction Permit Application is bereby.rdade.fora permit to Construct°O;'' Alter( ), or Repair'O an individual well at: � r4Y�C e 1Oj1' �p Location-Address t ' Assessors Map and Parcel n �� s�t � � ) �S v, 151 I TY v l ,�r t�1v �tl��n+n1s ov 'Owner N j {� r ' J Address t r' t"i-+� � hl'.rw\T►� , '�c�.1 G,(I I/ (1 0C24x�k ~' �.C�.,-� t� 1}��. ��✓e�a y� � av V�-�� M t Installer-Driller' . x "Address 014 I 3 ' Type of Building �� Dwelling J�- - :.t .Other,-_Type of Building ^`{ t 4 ]( No p of Persons) _Y`4 7 y i+ .� r'riu+""'... rt.�i- it�Y'-k1.K =�Fi`#r_• .x � t+3- r Type of Well �Y Otis ? y� 3u w, w :- . >_...., •; YP F,ce V " ::< U�sl� Capacity o13 C � Purpose of Well 7V_,c.,v t^, Agreement: 4 The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well'Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has -een issued by the Board of Health. Signed I ate Application Approved Bye Date Application Disapproved for the following reasons: Permit No. �r / l� Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY;that the individual well Constructed(-,,)", Altered( ), or Repaired O t'` Af 1 Installer at 7\ ', y/t.pit VAZ/-e- AV r kn i�\I �Ck V4 �. has been installed in accordance-with the prdvigi6fts of the,Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated :T//b) /_�L ,l THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ----------------------------------------------- BOARD-OF HEALTH `TOWN OF BARNSTABLE' . ._ Vern Construction Permit Fee Permission is hereby granted to r0. t Dj" - t 1 ) ,,, J,-Installer to r Construct Alter( ), or Repair O an individual well at: �y No. >. 1 C11 4 , EYIV V� C'P �� I .. + l-�y(/ro 1A Y P� �� r i . .-4 - J Y"G✓ ,».a'r S,treet' f ..Q"'. ! ✓€ ff / .. ,. as shown on the application for a Well Construction Permit NO.(:Y_ ) — ___ Dated '3 IQ A 1 Date � / 7 Approved By r ,a • 1 I N07'OB'00'E 52.68' —._� m -— I Aim >D= Im` 6m i' t �nT � c o Ao� 7Qa I 13s 16 lo�� cx�e X / ��./\\`�, ��•j �_ sV w :3 20�}, FLED rgIE/ \ DRIVEWAY Q4 FLED zavE zaV 1' ' N14g7' ______- ---- ill O - i ___________ ter-`----_______� $ ---,------------ r- � COD o '' I w i Lg§ SHED Ai . Nam' Fl =VE El.elq ; I 1 , -COD Sri r- PROPOSED GARAGE ADDITION MXYM UNDQUW FBd1Cg0 g RAM CJ) TO RESIDENCE OF WWUIIU ARCHMM W- JOHN WILSON u 151 IRVING AVENUE HYANNIS PORT,MA ¢8 IA, LOCUS INFORMATION DISTRIBUTION BOX DETAIL (H-10) °f� � iautr us es' 1 f nnc aouaxx err,swm r aWr.msa ww , fL RFrOioKG LG M3-.+ Locus �' ss[ssoxs nw: m, t r_,fr I.:-O O• - [�i°rwa,n'• ,� 3 r` / ~ zaarlc omrnc.: m-t 'j0'il LOCUS MAP �o I S Lt,SIS, wwwn LOT$ZE: .J.sW S.F. r r SOr.Za'00'E 43.00' H I wnmc[ry scxsnW[ I lOxF. war Iry•zaa n uous I I zswrcossnr a,[o/I°A• .1 ,.r�,.wo[a,cr ra a w,rec waR s:o,[°r nre eruos o.w n n,ro ar[PoAr oataer: Ar ., [.%% ..<orr[cmri w c°a°n[m.sWHcna axu z wmllw,. m I� I •.1� e.mn,.,c oau sw,.rr rew ro.a«.wo w,+.ore ou°e 12 PLANelnw¢.rxe+ arz NOTES twacnaaa.[.ncxr[cR SEPTIC SYSTEM I nr:° DESIGN CALCULATIONS a.o' REPAIR I®�I.00I tV ap.2.OVEA rozrq.-_ JoOOp " �" 51 IRVING AVENUE J0-w '� IN ES GENERAL NOT rgyf �+f.4, HYANNISPORT °artan ro°'"r aaan.o"°mrrwmror a o.ss..nc oro a MASSACHUSM- S 3 uo uroe[w T I � •,*nm om, . °, wrw ro a,o w ism°ua (tlARNSTAtlIF.Cvn����v� v...•r SITE PIAN nioeaeco � .. r.«raa.s S I+ 1 �r } corm.S+°K n.�,,cios°s♦'a Orxa iaP.lNL V.Rm+�s a 500r GALLON SEPTIC TANK (H_20) urv`�' "..v,n n,.r,.LL r,s„rm 1Jr.IohnR n.mta S y I V.— REr..° o-w.+erap0aaoie+c Z r.r uru,semv r" o-m rm!g rmo see wsn,xixon n mo+,. _•• a.J / °' ap65,w'x`.,un ,"`.�r'va'"w.a,.`.rur,,*<w,wod.,c °c Dora.aqa w, _IX,$C \o• mm.c,a .as.nc vs.,o�ea.r acr.,m o«,m,s s.w,°s.r —oY——� a "• r \ �N7&23 SOw ` ' arruE ac mvrcm vw.awwr xn wmm nws w�rws. _ r;ux cvaa• _ 1 y t2J.69 �_'=yi_ . O�yy s.s,n rs .,:mc w�o�-s.rc.0.rm.n.,un..wrro,°i c,an w r_r �� -_``�- h-w°-+r._n.N.,•awn ar n�w�s ow m u[star a maRunOx. JOHN WILSON , 1st PANG AVENUE �Q00 GALLON PUMP CHAMBER (H_20) HI-NIS POUT.A 0260 SYSTEM PROFILE I _r.�ma rro��, n� BSC GROUP °r i w..i°°"` �a aruxi I =c-o• — .w .:..... s< r,sn Dora a+ui rF srm mvaa®ca°uxrt. 349 Rout['28,Unit 0 o'tanso Ora[ u��r�*��rv'�yw� W.Y—outh.MasachuX'lls 508 778 8919 'x ra _ _ r-w - I a i ur �� ��nwi ,ie•.m w.°:°°°.�e°",�`w""".r..m,',K w„d, ®<�. .r u..r.i., _.s rw noa. o-ce. tat E-—— ———J � � _'�_=�.�s�: �xboc�".�,I r •��.o"`n�cno.w wo."m��s�m�a`",..u"'r�mc��a wu:'o r.m• �.!» 1 .ems,.r 1 r x annoe r.re soe r niacw a nr,nuAry ova.0..c..wo. eurLWla. �-`�! vec.xa ai..-0z vec[! , or , Ad x0:5-OY3900 J No. Y" Fee Z BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYiration jor Yell Con!6trurtion i3ermit Application is hereby made for a permit to Construct , Alter( ), or Repair( ) an individual well at: 1 111 l ry yw Ave , 4-1 9 yu.w r;S $ 2�� C b 6 cation-Address Assessors Map and Parcel j ohn wkk ,F on 9.0,6c)X -32-1 , 4mar ig pork , PahlL o)-(147 Owner Address �)igornoy)d Net E a: 0QX 2`79,3 ,()f WyS l W-- 02-(053 Installer-Driller Address Type of Building Dwelling X. Other-Type of Building No. of Persons Type of Well � 1-5 cy)e.d 4® 1P VAC, Capacity 15 q Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed r 7 e Application Approved By Z. Date Application Disapproved for the following reasons: Date Permit No. 1�`� � ^�" Issued 2l ate ----------------------------------------------------------------------—------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Comphanre THIS IS TO CERTIFY,that the individual well Constructed(�, Altered( ), or Repaired( ) by NQ)y)u!iyh W�eAr 1�t�1CIG�a �rlG til Installer at YV t YICA Y 1 Q0 - has been installed in accordance with the provisions o the Town of Barnstable Board.of Health Private Well Protpction Regulation as described in the application for Well Construction Permit No. •—OVrDated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector �No. � i _ Fee (f �� •--_ / T BOARD OF HEALTH -tj TOWN OF BARNSTABLE + 0[ppftcatton _for Vern Congtructton Permit Application is.hereby made for a permit to Construct�), Alter( ), or Repair( an individual well at: l 151 Il�vi'vira 'Ave',* H-\icannl:� �on��~ a Location-Address Assessors Map and Parcel' k's + r Ohn WA40V) P.o. nx32�I1��►r�r��+�c Owner r `� Address Qt,ri�O�d we..11 t�l I he . b. (3ox �`7S3 a(�r�Q�nS �v► C�2(c�s3 Installer-Driller `� Address y Type of Building Dwelling X Other-Type of Buildin No. of Persons . . g ... s� Type of Well flL�'bFGI • `'I V/Ci Capacity —�P1-�., Vo Purpose of Well ph Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. . . . ` Signed l�Z62. iI J Dae s y ' Application Approved By i � 1 rc• c. Date j. Application Disapproved for the following reasons: 3 Date Permit No. y"�' ' Issued 2�2 Date t" BOARD OF HEALTH TOWN OF BARNSTABLE p Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed ), Altered( ), or Repaired( ' by �P��OYJrA We II t\, k11tinr� . Inc- �• _ J Installer t at. M4 [-tom Cf YtY'11—r,, has been installed in'accordance with the`�provisions oPthe Town of Barnstable Board of Health Private Welf Protection Regulation as described in the application for Well Construction Permit No. r/UZ- Zr( — Dated 2,1 t � l _ t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL ' SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ; BOARD OF HEALTH TOWN OF BARNSTABLE Veer congtructton Permit ._.- No. Fee q J y Permission is hereby.granted to 1J�� '`t lje✓ �. Installer `to Construct� ), Alter( ); or Repair O an individual well at: No. i ��I 1 +�Vl I " #-i�,r rtit�,t x or+ P ° Street y� as shown on the application for a Well Construction Permit No. �� U Dated Date ) L "!2 Approved By <0000 BORTOLOTTI' CONSTRUCTION,, INC. -45INDUSTRY ROAD, MARSTONS MILLS, MA 02648 41 508-77.1-9399 508-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ` A1�� Property Address: Date Of Inspection 11 ctor's Name: Owner's Name and Address: ,0 V 7 CERTIFICATION STATEMENT$ I Certify that I have personally Inspected the Sewage Disposal System at this address and that the informa- tion reported below is true,accurate and complete as of the time of Inspection. The Inspectioln was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis posal Systems.Th ystem: - Passes ConVr asses NeeEva t By the Local Approving Authority Fail 00 I 1 �164 Inspector's Signature Date: / G TheSystem Inspector shall submit copy of this Inspection Report to the Approving Authority with 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 Offie of the Department of Environmental Protection. The Original should be sent to the System Owner and copies sent to the Buyer,if applicable and the Approving Authority. INSPECTION SUMMARY: A) SYS.TE ASSES: I have not found any Information which i ndicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated below. , B) SYSTEM CONDITIONALLY PASSES: One or more System Components need to be Replaced or Repaired. The System,upon completion of the Replacement or Repair,Passes Inspection. Indicate yes,nor,or not determined.(Y,N,OR ND). Describe bases of determination in all instances. If"not determined",explain why not. The Septic Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil- tration,or Tank Failure is iimminent. The System will Pass Inspection ifExisting Septic Tank is Replaced with a conforming 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): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)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(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed 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 the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt.marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH.(AND PUBLIC'WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feel to a suncoe / water.supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public ' r water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for,conform bacteria and volatile organic compounds indicates that the well is free from•poliution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less• k: than 5'ppm. D)SYSTEM FAQS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR'15.303, The basis for this determination is identified below.` The'Board of Health <,a should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an ; overloaded or clogged SAS or cesspool_. StaticAuid level in the distribution box above outlet invert due to an overloaded.or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6"below it►vert 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 -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant yt threat to public health.and safety arid the environment because'one or,More of the following conditions exist R ; r The system is wittun 4Ol)Feet.of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinldive" ater supply'' 3 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local ,regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: ,Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast 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. ZThe facility or dwelling was inspected for signs of sewage back-up. s The system does not receive non-sanitary or industrial waste'flow. The site was inspected for signs of breakout All`system components;excluding the Soil Absorption Systent,have been located on site. _ The septic tank manholes were uncovered,opened;and the tnteior of the septic tank was in-` spected foi coudition'of baffles or tees,imaterial'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 or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART U CHECKLIST(continued) The facility owner(and occupants,if different from owner)were provided with information on the proper,maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION -770 �q�s FLOW CONDITIONS ✓ (o(Qo spy (74dt;�,,& Design Flow: �ons Number of Bedrooms:�� N Aber o Current Residen Atd,v� Gatbage Grinder. Laundry Connected To System Seasonal Use: Water•Meier Readings,if v '(able: Last Date of Occupancy: '/ � CO MERCiA nND iCT IAI / (� Type of Establishment. Design Flow;__gallons/day Grease Trap Present: (yes or no) Industrial Wade Holding Tank Present: Non-Sanitary,Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and-source of information: System Pumped as part of inspection:dg/ If yes,volume pumpehdLjpHoqs, Reason forpumping: '; TYPE &SYSTEM: ,`/ ` Septic Tank/Distribution Box/Soil Absorption System (Oj � "We Single Cesspool Overflow cesspool Privy , Shared System(If yes attach prev'ous inspection records,if y) 4,Z—Other(explain): TFITIETTE AGE of all oom nents, to i•stalled ' known).a-d source of i if, don; ZZ Sewage odors detected w n arriving at the site: �r-- -4- s SUBSURFACE SEWAGE I)IS1'OSAL SYSTEM INSPECTION FORM a , 1'Alt7 C'. GENERAL INFORMATION (continued) V) e&�V". Oki a ' SEPTIC TANK: .' ./7 G� Depth below grade: Material of Constn►clion: ►►crete metal FRP Other Dimisions-2&&4 /0•SXL.5AS'Sludge Depth: /, Scum Thickness: D ' Distance from top of sludge to bottom of outlet lee or baffle: 3 7 Distance from bottom of scum to bottom of outlet tee or baffle: -dam Comments.: (recommendation for pumping,condition of inlet and outlet tees or ba[Ile_s,depi i,.of,liquid level in relation to oudet'inve structural irate rity evidence of leaks etc.) ALI� 07 �� ��' a � & GREASE TRAP: Depth Below Grade: Material of Construction: concrete_metal_FRP_Other (explain) Dimensions: Scum Thickness: Distance from top of scum to'top of outlet tee or baffle Comments: (recommendation for pumping,condition of inlet and outlet lees or baffles,depth.of liquid, level in relation to outlet invert,stn►clural integrity,evidence of leakage.etc ) T, TIGHT OR HOLDING TANK:�I?C� Depth Below Grade: Material of Construction: concrete_n►etal_FRP_Other(explain) Dimensions: Capacity: _ gallons Design Floe- gallons/day Alarm Level: _ Comments: (condition of inlet tee,condition of alann and floal swi(ches, e(e.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: )66--u 6V zul�el Comments: (note if level and dis ribution ip equal,evidence of solids ca •over,evidence of eaka into or out of box,etc.) 02 _ it//, PUMP CHAMBER: 5k .. . I'wnp'is to wolfing"order:—� — "Comments.(note conditio pT imp hiniber,.condition of pumps and appurtena ces,etc. � ~4 t loon lltrw ��" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: 4A, Leaching pits,number: Leaching chambers,number: Leaching galleries,number.Leaching trenches,number,length: r/kaQ� Leaching fields,number,dimensions: Overflow cesspool,number: Co :(rho don of soil,signs of hydraulic fa' re level o pondin condition 9f vegeta onIT f 'PAPf � ' V CzSSPOOLS:_,&�d Number and configuration: Depth-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: iMaterials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soilk,signs of hydraulic failure, level of ponding,eonditionvEvegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) "s -G- • y � f code SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con(inued) . SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atieast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. q( —� 0 h, v DEPTH TO GROUNDWATER: Depth to groundwater: /7 Feet Method of Determination or Approxim tion: I?, Ay*1 7 r i 4x L4 1 i 11/8/21, 11:13 AM ShowAsbuilt(1653x2338) As9uill - PaNc I,df 1 I TOWN OF BARNSTABLd I%.C. 'Srl o2A:Z � LOCA�ON/SS L/i Vince�j. �YGG BBW �A..S70 U VILLAOH 4L6n17'.5 Av A ASSESSOR'S YAP 4 LOT.;2 8...7.A4 Sl I4 INSTALLER'S NAME G PHONE NO A b E CJSNLO 775 F2fid SEPTIC TANK CAPACITY Zrw a /[i:.f t EACrmro PACUiTYi//tYPOI; (_ o.OF BEDROOMs fcs PRIVATE WELL O PUBLIO WATB BUILDER OR OWNER t'e4l"'A/V - ...._.... .. DATE PRItwT IS UBM _r� /-%' DATE COMPLIANCE ISSUEDn /- - ' :VARIANCE GRANTED; �I I _ 41, 4) n1 i http://issgl2/uitmnetipropdatWprebuilt.aspx?mappar-287068&seq=2 7/25/2016 https://itsgIdb.town.barnstable.ma.us:8431/Home/ShowAsbui It?mp=287068&sq=2 1/1 f) ' 10114 4"F BARNSTABLErltA LOCATION� 1 ���'+ 4W SEWAGE # VILLAGE ft Aill '__S �,,�° ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 _SEPTIC TANK CAPACITY 1-5-O., I I LEACHING FACILITY:(type)j,::o l7f�XC2o� (size) NO. OF BEDROOMS .�� PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER ' DATE PERMIT ISSUED: 0 `�- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i .1 ./h t �(" A �� I lb r� 00 r` No.._� 5...a la�$...3a.:.�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH AMA TOWN OF BARNSTABLEgar Conpwctla M Appliration for Uwvaoal larks-& t �g Date Application is hereby made for a Permit to Construct ( ) or Repair (i.-an Individual Sewage Disposal System at �s's •-:rA V ®to� ?orb .H�/Kim K.,1S`r�!2."�"....... Loca"on-Address or Lot No. isP. ....-..� ..!1.+::... 1 �T N� .......-• .............................................. Owner Address W - •''� -------------------------------------------- ?.:._ � QtO... `1_ ... A.. ................ Installer Addres UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of ersons......................_----- Showers a yP g ------------- --------------P--�- ( ) — Cafeteria ( ) d Other fixtures ----------------------•----------- --- ---------•••-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a ------------------------------------------------- •-------------------------- ------------------------ ------- -----------------------------------•--------.----- 0 Description of Soil...............................................................................=........................................................................................ x U -------------------------------------••---------••---------- ---------------------------------------------------•---------------•------------•-----------------•-•-----------•--------------- W U Nature o Re airs or Alterations Answer w en app�}cable ----- - __ _ �_..1 ._.._Gnt�IC.... ;� " Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment de—The undersi d further agrees not to place the system in operation until a Certificate of Compliance ee ssue by the b d of health. Signed .... .. . ......' : .......... - 1/", C! Date Application Approved By ............ .` �, s%.--------------------------...... -- ............--... ...-----.................. .f a.-.1...�- - Date Application Disapproved for the following reasons- ---------------- --- ------ ---------------------------------- --------------- --- --------------------- --- ------ ----- ----------------------- --....-------------- ---- -- --.........................----------------....--------.... ----.........-----------------------.-- --.......------ -- -------............................... Dace PermitNo. -----?...a........� ---------------------------- Issued -------------- Uace ' THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH TOWN OF BARNSTABLE i 1 AVVliration for Uiipnvial Works Tonotr�t ir' rye mitIL Application is hereby made for a Permit to Construct ( ) or Repair ( v)'an Individual Sewage Disposal System at: / ..;C S / - l JZ .r / 1v�� ArE {-� ANn�1S '?d2 ?"' f Gu97 1400_.'--- .s o... P - •-•-•• •--••........-Address \ ... Y---------------------•-----•-•-•---• -_......... ---- Location-Address ________________________________or Lot No.Y ...........S �'1 �)`/1. fJ n..._W ..................•---- ...--••••-....----•---•--•--------.........__..__...__ Owner Address �. .A ... C 0............................................ �'_9.9.---- !'=-Lllq 12�n (1T1-1.._...--------•- Installer Address Type of Building Size Lot----------------------------Sq. feet I—t Dwelling—No. of Bedrooms......_____.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria,-( ) PL Other fixtures W Design Flow___ _______________________________gallons per person per day. Total daily flow______________________________..............gallons. WSeptic Tank—Liquid capacity____.__.__._gallons Length________________ Width_..__._____.___. Diameter_....______.____ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area____________:_-_____sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( -)- aPercolation Test Results Performed by---------------------------------•-•------------------•••-••-----....----- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water.................... r=t = Test Pit No. 2................minutes per inch Depth of Test Pit---_................ Depth to ground water.._____._____________.:. 44 -..................................................................................................................................................... O Description of Soil_____________________________ ..............................................-----------------•------•--------------------------------------•---•-------••....•--•---- V ................•--------------------------••---•----•----•--•------•-•-------•----•-------•••-------•------•--------------•-------------•-•-----...-----•-------------------....--------•--------------- W ----- r----•--------•----•---------- U Nature of Repairs or Alterations Answer when•applicable\ ___/�y')._P-0_-),• b© . .......c Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in'-accordance with the provisions of TITLE 5 of the State Environmental-Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance'hfas-been-issued by the board of health. Signed r .N I ., --------------------- �-3°.-9 L--- .Dare Application Approved BY q -,r,^ - L��-..- %�.. 1 1�r.ca... Dale Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------------ ------------------------ -- -------------- ------------ - -------------------- ---- ----............... ------------- ------------------------- -------------------------------------------- ----------------------------------- Date PermitNo. ------. --------.-T?e--------------------------- Issued -------------- ...................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE T er#tftrate of Tompltttnre t THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by...... f � p--�-C--�---------------------------.................................--- . ------------..........----..........................................---------................... Installer ram++ _ at . S/...-1.�7.5'......-a- �1.V. N G ?9 V' 3 H la tip�f '?a .4.... �G t��s-� �.u�iR.:..4'.� has been installed in accordance with the provisions of TITLE�5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -......�,_D------57-,"P:%7------ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION-SATISFACTORY. Q DATE...................- .� ~ /_ � �?- Inspector -�---------------- -- ----------- ......------------------- ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE No. •�-_-��/J- FEE--- d:..'�.... Disposal . .ark,a Tulans#r inn rrntii Permission is hereby granted...... 'f'��____._.C_1Z;1.P.e_.0_____________________ to Construct ( ) or Repair (Vy an Individual Sewage Disposal System _ 1 at No..�!�Q.`-- 6tia'S ..---.72!/ /_N G- IR r . )q V_J+N N 1S 3>0 Q. "T_ _..._..-•_... Street r as shown on the application for Disposal Works Construction Permit No. :S���... Dated.......................................... J DATE........... 1------�- -'--------------•----••-•----....---- Board of Health FORM 368o6 HOBBS 6 WARREN.INC..PUBLISHERS � �• .� f TOWN 6F�BARNSTABLE �FIS ` 0--VATIC ° nage SEWAGE # 7- 41 q 7 LAGE jf2j A�nl--<4or- ASSESSOR'S MAP 6z LOT Q STALLER'S NAME & PHONE NO.R DJe'»�e►ttGe�n c. P7/d�/�It!'� S-PTIC TANK CAPACITY 'kCHING FACILITY:(type) l e ar-AIAS! g a.11e.&S' (size) A NQ Se 4-;� n OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER EUIFsR OR OWNER DATE PERMIT ISSUED: 1701w /9,?;! DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓ 1 IT �-4 c°� �S A�Q, kj w ?�� Q SSESs0116 IMIT c,0: -1ARCEE NO.: a��.... ...... \ THE COMMONWEALTH OF MASSACHUSETTS I ; BOARD OF HEALTH -----7'OWn.. ............OF.... ..!:........E ---................................................ ��O - Appliration for Dispntial Works Towitrnrtuan Vamit Application is hereby made for a Permit to Construct ( ) or Repair (*) an Individual Sewage Disposal System at: nn ,,II l ..• !" /.!�. ..!:d l�:....f�y�u�► ...................... ...............................•-•-----••--•-•----••--•----•------------------•--.....---------.-- ocati n- ddress V;' t No. a.�11;!:. 1�SSt!lt� !� _..tc�nn � ........- Owner dress Installer Address Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms___._._....6------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -1AA.P Rid_ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---•----•------•--------------••--------••--••---•-•--..-•---•--•-•--••-•-•-------•------------------...-------• ...................................... w Design Flow:...........................................gallons per person per day. Total daily flow____..._.___-_-___..........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit.No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f4 .......................................................•.................................................................................................... 0 Description of Soil........................................................................................................................................................................ w _ U Nature of Repairs or Altef ations—Answer hen a pli b e.1t?__kZU___. .._5 .. tcsXC Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti T lsw. 'of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y the board of health. c. Signed .r KO 1 "iR,4!b ------------- 3•`30 .. ....... Date Application Approved By........... ---•-- -------•--------------------- -•---- Dat Application Disapproved for the following reasons----------------------------•----------------------------•------------------------------...................... ---------------------------------------------------•------............................................................................................................................................ Date Permit No. .-...1,9/ Issued_ g© ............. +j s° ------------- I THE COMMONWEALTH OF MASSACHUSETTS "aG Phi BOARD OF HEALTH 4tn..................OF....�.4rw; Le................................................. (9rdifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired 4) by............A.... .44.4 ..---•-----•-----......----........----------------------------...------------------•-------•-•-----------------------...---------..........._ Installer --•-------------------------- has been installed in accordance with the provisions of T1 T 1E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................•--...---•-•......-----•--...--.. Inspector.................................................................................... No. ................... THE COMMONWEALTH OF MASSACHUSETTS '! :" BOARD OF HEALTH ....... ......OF.. ."...... �..rl ... Appliration for M-4polial Works Tonitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair .(4-) an Individual Sewage Disposal System at: /,:�.5 _'r+lima• l ic, J.,c.nn,et4 ----•...........:.. ....................................•--•••••-----•••-----••-•---•----------•- •---...----•-------...-••••-•-------•-•-•••-•-•..........-•--•--•-•--....................._-•••••. J n Location-Address or Lot No. f/ A i"1�� �+ -/i:•.mid//,:,✓1, .�J.............................. . .d.. . �•ir�3.�ISt)l'a-•,C J Owner f �j � Address. W fr /tv, l_a.�rg c'' -1 ✓f' cIN .51.:70 t' & -- 5 f (./- l� --......................... ..........------ ••••...-------•••---•----------------.._.:........................................................ M Installer Address �. Type of Building Size Lot.................... .....Sq. feet �.. Dwelling—No. of Bedrooms..........A_----:..........................Expansion Attic ( ) Garbage Grinder ( ) p•, Other—Type of Building No. of persons____________________________ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------•-------• ............................••......................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity-__-____-.-.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-----------............................................................... Date......................................... 0 Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water--___---________--_____. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-------•----••-------•---••-------------•-•------=--•------•--.....------........-•---...------••--......................................................... 0 Description of Soil...............I.......................................................................-------------------••-----------------------•-----------------•--•-•----•------_.. x W --------------------------------------------------------------------------------------------------•----•---•----------------••---•-----------•---•--------•-------•--------------------------••...---- U Nature of Repairs or Alterations—Answer when applic(a�brle/ �! ����� t �`r? Sc'1-t`Cr %rl /-,r_'o a I �lr c.nfr� ? C a,t (J fir-.�praA _ /G ?/,,,-, �lr l'S (.� .5 oYJ2 CrS T �I ltr ----------••--- . ----•• --------------------------- ----------- ---- 1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the-State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. . . '...."..O.t r. �, - 3 . ri;Y . . ---------•---•-...--- -----•--------•-----•- Date Application Approved BY ' r::. `: -----•--------------•------ - v �! Date Application Disapproved for the following reasons:------•---•---••----•--•---------------•----•---•----------------•---•--------•-•--------•----•------...---•-- ------------•-•-•----••-----------------------•------•-•••---------------......---------•............--...---•----••------------•---------------...•---------•••-----•----------------------------------- Date r PermitNo...`+ter... .= f-------------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS tt tt ^ I t' BOARD OF HEALTH � .q....................OF....ti._R•rn.v+Lc: Lt?:................................................. 101lerfif irab of TOutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } b ............ a�n lg. . ..................••----•-•---------•-•----•---• •-••-----•----•----••-------•--•--••----......-------- Installer u = has been Installed in accordance with the provisions of T�Tit of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated---------------------_-----.-------_------_.-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................------------------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----- 1 G�uYI OF . Gr. �( /' �r0... :--..:..:.c..�..__. FEE.---.................... Disposal Workii T' onitrttrtion rrutit Permission is hereby granted.......--'- �%_.......`r=t``�< to Construct ) orkRepair ( <) an Individual Sewage Disposal System atNO.. ~r i>�. tY•gc 9 .... .........................•...................._......-_....._....._..............._..........._......._.__._........ . Street as shown on the application for Disposal Works Construction Permit No.. :....._..:._o... Dated---------.-z..::__.- ........... .. y f_/ ter Board of Health w DATE... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f Ii ESTIMATING WORK SHEET DATE OF ORDER: ��/19 8 ORDER TAKEN BY: WORK.SITE: ( MAILING/BILLING ADDRESS: NAME: STREET: CROSS STREET: 7 75` w c-e 7- TOWN: PHONE: DIG SAFE # �1�3'2� DATE 3/31/611 LOCATION OF SYSTEM S - Q� PERMIT # I WATER DE�PT3$D�$ MATERIALS QUANT. @ PRICE EXT. 4-5 JL� o�ScTO — (- -- � -- '�+� c I ` a- 7) MATERIALS 47�d TAX LABOR EQUIPMENT QUANT.e RATE EXT. -T4X e�tw r—� • �S lC���s _� L�.fi.� (9'Q l U — LABOR & EQUIP. $ SUB CONTRACTORS // PRICE % MARKUP EXT. to, 17�1 yl4A �— ',,�-off 7.) ov SUB CONTRACTORS $ LANDSCAPING AND CLEANUP: ( ) MACHINE GRADE ( ) HAND GRADE ( ) LOAM & SEED ( ) OTHER LANDSCAPE REPAIR $ _ PERMITS $ 35 SUPERVISION/ENG'G $ "a PUMPING/DISPOSAL $ LANDFILL/DISPOSAL $ MISCELLANEOUS $ SUB TOTAL $ QUOTE TOTAL $ PAYMENT TERMS: DEPOSIT REQUIRED $ APPROVED r Septic Services PREPARED FOR: e- u cam: Pumping & Installation 350 MAIN STREET LOCATION: I SS .1 r u cv -c._ WEST YARMOUTH, MA 02 73 L Cp I t TEST DATE 3- a7' S2 DESIGN BEDROOM HOUSE ¢: TEST HOLE NO I o� So' I DISPOSER DISPOSER PERC RATE MIN/IN. 6�a�e1 FLOW RATE (GAL./DAY) I� ( SEPTIC TANK REQ'D SEPTIC TANK SIZE LEACH FACILITY, SIDE WALL � `�_X.Q-9l=:_� (�,Sf= '�yr��s G/D. y BOTTOM a� xo = -'°,P 9-16, 0 G/D. TOTAL USE: LEACHING S' WATER ENCOUNTERED =r 350 MAIN STREET' � PROPOSAL N WEE YAAMOUTH', NA 02673 w TELEPHONE 617 775.2800 ' Septic Services CANNONS 'CANCO '&�P Pumping & Installation ENERGY CORPORATION Plumbing o Heating .i Spr(nklQr i Services TO: Date arc , NIL-. Mu1c_olu► MacPhail re: Septic System +-' >>nnfonwe:�lth Resorts .155 Irving Avenue Market .Place II Hyannisport, iNM North Street, Hyannis, MA U GU1 We propose. to install (1) 2,500 gallon. precast septic tank connecting to' M 1,Ooo gallon precast.. pump' station..: ,...We will connect to the existing plumbing where it exits the d el'lin with schedule #40 PVC i u hout the entire s st A Myers 2". du lex. um in Y P complete with cheick: valves and mercury float. switches"equipped with remote`;'-aitdible'a-nd visual alarms connecting 'to a remote eontrol' panel' with:all electrical wiring`is �= -laded. r The duplex pump station will'-connect with '(2) separate 2" 11nes 'to an H 20 distribution box with accessTcovde-and baffle. :�;The leaching area .60' x :48'�} will. be excavated to. the water -table. and backfilled 'with a ,mixture of clean crushed bank gravel and sand to a level of 4' above the water table..','Two :(2) M ... n i ;10.1 `x 4$' leaching trenches will. be bacicfilled'with.l -of washed stone Each leach trench will have (5) flowdiffusers; . baclifilled with 3' of washed stone: Both leaching trenches will.be''capped:with. 3/8"; washed stone, : t The entire septic system area will be backfilled and graded ao be1conslstentr51, with the elevation at the pool apron. All: affected..areas'Will -be'machine: ` graded. and hand raked. ..Loam' will be applied as: ' eeded to the area of the'" � installation, ready for seeding or- sbdding. V. '. Included in this proposal is .the removal of .the .buried fuel atarage, tank and disposal of some in accordance with all. Local,-;State 'and. l±edernl..regulat;ions. We will install, in .the basement, :;(3) 330 gallon fuel storage3: pil tanks with piping for fill and vent and connection to oil,burner. '•'.:In• the event that the` .. 'water' service will need to be>relocated, all costs are included in 'this w ' f proposal. ' ,f ti for the.amount.of $52 285.Op Price includes all .labor, permits; materials.; and taxes. Also• included are ; pumping and disposal fees at:,;time of instal lation. . ',All work will comply.with 3. , Tit16 V. regulation of State Department of Environmental Quality Engineering ` We'require a deposit of $7,285 00 upon acceptance of this proposal 'and a payment of $25,000.00 upon starting of.work, with the:remaining balance : due• and payable upon your. receipt of our final invoice. TERMS: This Proposal subject to revision d not accepted within 30 this and to approval by Credit Dept.of Cannons. SUBJECT to Mass.Sales Tax•where applicable. ; It Is expressly solved that tide to as materials Is to remain with Canco until contract Is paid In full. - - Unless otherwise stated•bills to be presented each month for all labor and materials on the job site,and are due and Payment as above stated shall COruDtute work st I payable within 10 days of receipt of n balance failure to make r osubje and a bookkeeping and finance charge of gal or per month or an annual percentage rate al 18%,on balance past due 30 days and over.It not paid when due,the buyer is subject to reasonable costs al collection including aBuney's lees. •t All labor and new materials furnished and installed by Cannons are guaranteed,This Installation shall be in accordance with all local,stale and utility codas governing such work. Master Plumber P5715 Master Pipe Filler PM87O3 By YOU are hereby eo authorized to furnish the material and tabor specified above for which 1(We)agree to pay the amount stated in said proposal,according to terms above and on reverse side hereof. WHITE•CAMCO COPY Buyer ' P 1'ELtDw•CUSTOMER COP/ - Flwx 4 GOLD•FILE COPIES Buyer t w . x. a-, - 7_ -R '$yam ,y 1 .. t� '`:` a'-,a ..t + .d ' rK �'y�, �� Uyrr�f�k.�'�}���"r •r , ';t l ,t, " `.. 1 �,� ..9N/i5 f 4 k,,,c' ,a+fri ) B { y'Ssf M ♦.» d h r u n} rx e''',�,..q•{a a ;M�r iS a� ¢ .m^♦' - 7�I ,a. t' M arI 1 y3�*,yr,.t 3«ra�r M a D¢F{F:�ii 0 r,-- ,"M", �?. } - ,a;^' y, ,a� dTr•#t' *-k +X4 )1 y r " , lay ' ..r.:sk.. t -:.3 Pµ� isa_� M`�?w.a` , r tra'ise ..`dra`ys>t.�= " r -, �k . . . r ,e.R Yk<,tr}•��4,k.�,*jS ; 'lt r a A,,y�'rp k ��##1. S a •a.p yi y 5s .t.Y. 'k`. �,s ae-,V+�` � �"'�111-�k n�x3,14 4 ,_�&w 5:,.. . ,..'' ... p l r -- 350 Main St .® W.`Yarmouth,,MA 02673 e.775-6264 . . • "'' . w:�. .. __ -.Division of Canc Energy Corporation ,.,f Lea Septic S®rvices ® Pumping o Installation r' ,. ;K�. 43 ti;, h•cY`rnk, k ,� ?sro 1 »w2.a,+t`yXt 'sr �''..r; M1y,a - $'`�`, s-, ?' 'r" ° "' .Y a •-F�'��kitx bra„» F'F", 1$.npr s r '" �,l+.q :3.-9 'l _ . f ,x wj 'Wy �ti^�z iw ua,rz"-Y' "t1..� a� .t'r+ � •J" '.,r r . '. 9-t j w. "€ ,h r� 1.'+.a`u tn..�a'4,Y s''"1 �, r F t 9fi s.e+ N y 'yaw" ,a t u ,+ sC? �r. ^sz�^ 'x t '§ x a a1. .. fiTs'r: 7...�rF' wh+'"`�'t)y'u t., .u. t,a,' -t ) 'A, d y{, a?�memr`�y j $ .!. , 1�-�j k s s' wiea? , - - s-zw 5 E x. b r :i f r}y�rS]-r'y,4 �`°n1! '+.� 'L,t aw .k ze,+L ra. - ;,, 4i„ e-# N t rda ,:.,s�,A{,1 $.s T'' a t'4 „ ',. _.> ��``�.- ^e-,„ r v .��� k , t Z e :p a rW tt C.tiz pr,. ' rd r *4. d r ��a4 v.•tiw.,f s t r a#,1 _ r t, 5 k�",r4� ?�� h ��.�k, y July 13�: 1987 * .� t-� ..,{a,4: a ,s ,4 s�5 tph, 5k rr. tV 7"',', _x �' w�+.� { 5 . ro r `i,"'i I r -w 7 •v - a i-f"�+t,{,�7," s'° 1�1)"7 a.Wt ,{, µ#.; a »"y�4, - t .¢ .2a 3 "� 4'1 < .5.a'4'. �� :'t'F`"t^* �''"N �i 0'F re+-; w��,j,n.z ra' r 1 _ ,+.. Kt, y d •r —^ y� _ ."... K'r^fit d .;'� S w e- iX �.tr ^s, i ;v 1I ♦,,..�y - - - x 'a"'x Z w7F�. �,?a .qJ a a fit ar+ t "'�.Fa�a4�t+}r 3+Xa.ray.. k� •5 � ,r .?,�.}a Ami'.k�' ' i•1" ,�;s rk +x+'..',n ^k ;°✓,N t �"•' i' .:'r ,t i � .s} vw"'�h * '+ ,`r. 11 ` 4 u F.s�4v-4 l,.rr"' a+a .� ^r e a A. r.. °y, 'sir ,.'Y�6„"•+^+S,p.:- Y „P,ad,'r µ•-t....L+5rfr �A i R,. �. �u_�. �..,�«^.� ro,-aa? `i.�` 4 ,yuA'i >s .r�� i`L�4�51.'k"-ir,S,y"� .; a*I4.` i7 +K`2.c�E as. ..• €• •yaa13 r-� r rA�y :,Y`�,�z..n:_i..r.y>` Y`.+4'�fa�,YF�Y E y F' '�iir";,� " z,.is- ^:'k ``F ♦ty.tix r 4 .,t 9 `4 - 9 ,t, '` •S r^+r`t t 4�t.2 , .1�,M YJt•T v»"i c."`".`"`S'4 r7 -4yv G.�i"�d' T °..+� y,� `". .Mri John Kell P ,,..�a,;�' w ,�� � - �.11— a r <',: ' Y" x 'S;< ° ..ror fir.yy�,iv, a• y ,. , ,k i. °,j'Y"`S't ^D z`1 3`.A� A. 5;` d"�aT{'.9"'�# -y...yW,y?,�11 _L,4 ,µ•.t„' i.`..�r' C:+.:.t';,'s Barnstable;.Board of Health t F i f Mr ti� ` rk. '� �, '�' �Zbwn.Hall ,'e ;'s 4 - — t•�— ,+ l f , ` �` $'r �a. .na• sj rit. - +.'} Hpr 5� °` f,M,�(i ° N-. 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SEPTIC TANK CAPACITY ���� 00 LEACHING FACILITY: (type) ��((��{- r (size) ;x NO.OF BEDROOMS ` \A 3-0 ® Qx C n OWNER PERMIT DATE: rh2�_ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) + t Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ' Feet.., F I L FURNISHED BY��J)/� ���il/rOrf\ V .,3 1 r.L• 1 , • M,� O � � a .. �N Q \- �Ttr�h -� � � � i� �` n I� � o. `0'► ,l � +�_� ` i� i, i, � 4 1. � �r � �