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HomeMy WebLinkAbout0101 IYANNOUGH ROAD/RTE 28 UNIT BLDG 101 UNIT 1 - Health 101 Iyannough Rd!Rte28 Hyannis= 'P''. A = 328 15400A w f is I I Commonwealth of Massachusetts Title 5 Official Inspection Form a - Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address 'l / / ON ner Ory ner's Name O�6 v/ page, Ci f I/ information is / G t7 I f required for every tylTown State Zip Code Date of I:7:ti 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. Importamt:Men A. General Information nl filling out forms on the computer, �JVJ use only the tab 1. Inspector: ' key to move your cursor-do not use the return key. Nam-e of Inspector Company Name company Address 4 City/Town r- � O D� I�(�n State �U Zip Code Telephone NuAgber // U License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 �10CR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs urther Evaluation by the Local Approving Authority Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""`This report only aescribes 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. t5ire 3113 TifleS Of ficial ins Pee ti on Form SubsulaCe Sewage Disposal System-Page I of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Z c__ Cw ner Cw ner's Name information atifor a required for every Q Y's7►l page. City/Town State Zip Code Date ofl spection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / alwayscomplete all of Section D A) System ses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15,303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 exfiitration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•YY13 Title 5 Official Inspection Form:Subsurface SewageOisposa System-P89e20W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for voluntary F�ssessments � 0 ..L a Viol Property Address /-ON Ora ner Cw ner's Name (/` G✓ information is Q / required for every G��ls page. Cityrrown State Zip Code Date of Inspectio B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditlonally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh tNns-3113 Title 5 Official ins pec tion F orm Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary/Assessments z2 Property Address � C/ //arr /'�i S Z_ON ner Ova ner's Name information is Gi ✓t✓1 I f / ✓ ,q.. /�/ required for every �// � page. Cilyfrown State Zip Code Date of 1 ,pectin B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow Ism-3M 3 I*We 5 Official Ins pec tiro F am Subsurface Sewage Dlspossl System-Page 40 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form a Subsurface Sewage/Disposal System Form - Not for Voluntary Assessments / C%✓10 W Property Address Z-- z Ow ner Owner's Name information is �� �� / O 9 .2 S, required for every G✓i✓��� i ' ✓ b — page. City/Town State Zip Code Date of nspecton B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high groundwater elevation, ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or — f tributary to a surface water supply. ElL�' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ L� 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.] ❑ �T e system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ The system fL'I,g. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems; To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. t51ns•3113 TiUe5Official Iris pectlonForm:Subsufwe Sewage Disposal System Pape 5of 17 i Commonwealth of Massachusetts w t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments R t✓)0 H ✓1/- I�' Property Address /> w � / Ow ner Cw ner's Name l/J� inormation is requiredforevery page. CitylTown State Zip Code Gate o Inspecti n C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes o ❑ umping 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 CM R 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ru•N13 Title 5 Of ficlal Ins poc tion F orm subsLeace Sewage oisposal system•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / /J S Z_Z G Ory ner Cw ner's Name information is �/7 �O 6®� at yC required for every �''��r page. City/Town State Zip Code hate of Vspectidn �}(' D. System Information l Description: �_/D < �d� / a �lo� �� �L aw �✓ Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes C�_'No1__ information in this report.) Laundry system inspected? ❑ Yes 01--(0 Seasonal use? ❑ Yes L 1_9_0 Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes C(.t. Last date of occupancy: Date Commercial/Industrial Flow Conditions: p �TlC2- Type of Establishment: Design flow(based on 310 CM R 15.203): canons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes No Industrial waste holding tank present? ❑ Yes Ll- No Non-sanitary waste discharged to the Title 5 system? ❑ Yes No Water meter readings, if available: t5ins-3/13 Title 501ficial Ire peclionF oral Subste ace Sewage Disposal System-Page 7of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address P 6—r C/ Z— z z�- Ow ner ON ner's Name information is Gcrl required for every page. Cijrrown State Zip Code Date of nspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type offSSy�m: 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): t5f ns•3I13 Tide 5 Of liclal Im pec Um Form:Su bsuiace Sowage Disposal System•Page B of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address �- Ow ner Cw ner's Name Information is required for every Ghh� Of-c� � oZ 5` f page. City rrown State Zip Code Date of I spectio D. System Information (cost,) Approximate: of all co ponents, date installed (if known) and source of informa 'on: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material construction: -'' cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: .-----�-0-------- feet Material instruction: concrete ❑ metal ❑ fiberglass ❑ polyethylene oth r x in 9 ❑ e (explain) ) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: r1 Sludge depth: tyre'Y13 Title 5 Olficial Ins pecVon Form subsurf ace sewage Disposal system•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form Not for Voluntary (Assessments Property Address / // ON ner CW ner's Name information is f /% 0d 6 a/ 51 required for every page City/Town State Zip Code Date of nspecti n D. System Information (cont,) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Je How were dimensions determined? �� �o Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 01 H or-) o� 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 15ris•3/13 TiUe50fficial lmpecUon Form Subsurface Sewage Disposal System-Page 10of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal system Form - Not for Voluntary Assessments rY o/ � �i✓1 O 14 k! WC G Property Address ner Av ner's Name inf / information is c,2�f required for every page. Cityrrown State Zip Code Date of Irfspectio D. System Information (cont,) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Holding or Tight tank must be pumped at time of inspection) (locate on site plan): 9 g Tank( Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No l5 m-3113 Title 50lficiai InspecUonForm Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address v Ile O,v ner Cw ner's Name /� J .� information is �l 6P / required for every State Zip Code Date of I spectio page. Cityrrown D. System Information (cont,) Distribution Box (if present must be opened) (locate on site plan): L� Depth of liquid level above outlet invert �.. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): y � Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Tido501flcial InspecUonForm subsuface SewageDispose1 system-Page 12 ct 17 t5lns• 113 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address ow ner Ow n&7s Name information is i �0)-6 0 required for every Stale Zip Code Date of Ifispection page. i,R crown D. System Information (cont,) Type: �J/� � �_.. leachin pits number: — 9 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: El overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 0 S±1j, �G a /, C, ..r, 4 e-lf . 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 t5ins•3r13 Tile 5OfficiaiinspectimForm Subsurface sewageoisposal System•Page 13of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Ov ner's Name information is required for every page. CltylTown State Zip Code Date of fispecti6n D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): Ons-3113 TWo50fficfallnspeOcnForm Subsurfaco Sewage Disposal Systom•Pago 14of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Asse ssments e Disposal Sy stem N ry s Subsurface Sewage sp Ytem Form d � Property Address G � ner pw ner's Name Information Information is required f or every State Zip Code Date of nspec n page. City/Town D. System Information (cont) Sketch Of Sewage Disposal System: Prov+de 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 tic water supply enters the building. Check one of the boxes below: "7 �w _A; AeL I Commonwealth of Massachusetts _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4:5zki 0 cl ai (7 �J Property Address Owner Owner's Name _ 4 information is ���� required for every _ — page. Cltyrrown State Zip Code Date of Ins ection D. System Information (cons) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) L 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: 5 �� �vqs7�Ile c-/ A� O! a N. -r'4 s Before filing this Inspection Report, please see Report Completeness Checklist on next page. I t5iru 3113 Title50fricial IrspectlonForm.SubsLOace Sewage Disposal System•Page 16ot 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments of / Q_ I G✓J 0 A,7 Jo c " Property Address ,F.4 Ow ner Owner's Name /� Q information is r A4 required for every page. City(Town State Zip Code Da of Insp ction E. Report Completeness Checklist B Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed D System Information—Estimated depth to high groundwater ketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15irr-3113 Me50fficial Inspection Form SubsLrface Sewage Disposal System-Page 17 d 17 r r f 3261 Main Street Route 6A / Eiarnstable Village MA i' 02630 January 10, 1986 Barnstable Board of Health --- ---- Town Hall 617 362 £3133 367 Main Street Hyannis, MA 02601 RE: Septic System Construction Lot 15A Iyanough Road/Route 28, Hyannis (Our File No. 3-1664.00) Members of the Board: This letter is to inform you that the septic system at the above referenced site has been installed in substantial compliance with the plans . One minor change did occur. The leaching pit was installed in the area originally designated for the reserve. All structures are capable of withstanding 11-20 loading and will have covers adjusted to grade . If you have any questions or comments please do not hesitate to contact this office. Very truly yours , -- —— BSC/CAPE COD SURVEY CONSULTANTS Engineers Surveyors Scientists St phen A. Wilson, P.E. Architects Project Engineer Landscape Architects lsaw36 Planners Cape Cod Survey Consultants r COMMONWEALTH OF NL.aSSACHUSETTS EXECUTIVE OFFICE OF EN'tiZRON1IENT_LL-AF-FAIRS q ' cue c DEPARTMENT OF ENVIRON`YIENT_U PROTEC°TIO\: TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS-TENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORTH PART A ��� �)4� P��D CERTIFICATION Property Address: oaf Owner's Name: ,Sri �►y _ ooe Owner's Address: O ,� 4 v o oa6ol Date of Inspection: Name of Inspector• please print) G3✓� / A!�P l Company Name:,L !/i0—% f S Mailing address: Po OTC AAFE A 4 OoL64�.2— Telephone Number. CERTIFICATION STATEMENT I certify that I have personally inspected the sewrage disposal system at this address and that the information reporied below is true, accurate and complete as of the time of the inspection.The impecZon was performed based or.m� training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CIr R 15.000). The sz stem: (/ passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: Q� The system inspector shall submi a copy of this inspection report to the Appro-,in2 Authori v(Board of_-Ieal :or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design Jqo%:of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional pf ice of-tie DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and one acrb`,;r`_ - authority. =M> r Notes and Comments 73 � Y Y X Y' This report only describes conditions at the time of inspection and under the conditions of u e at thaw time.This inspection does not address how the system will perform in the future uto nder the same; r diffett conditions of use. t Title 5 Inspection Form 611512000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEINM INSPECTION FOR-11 PART CERTIFICATION(continued) Property Address: /0/ �� q h oy 4 1?d [fi n� 9 flT Owner: /� A&n ol Date of Inspectio 8/ Inspection Summary: Check A,B,C,D or E/ALNV--kYS complete all of Section D A. Sys m Passes: I have not found any information which indicates that any of the failure criteria descrrbed:n=10 CNiR 15.303 or in 310 CVIR 15.304 exist.Any failure criteria not evaluated are indicated.below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health, vvii1 pass. Answer yes,no or not determined(Y,N,--NTD) in The for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is stiucn-,ally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System«-411 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 Cornphance indicating that the tank is less than 20 years old is available. \TD explain: Observation of sewage backup or break out or high static water level in the distribution box due to brcke_�or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System wail pass inspection i.f approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: I The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The sys,eI.A-1h pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 1 T:+]- G i_....__..:__ n_...__ R Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR AI PART A CERTIFICATION(continued) Property Address: ®/ l�chpH.s(^ �ot oowl Owner: q Date of Inspect' n: / C. Further Evaluation is Required by the Board of Health: I Conditions exist which require further evaluation by the Board of Health in order to dete,=dne if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of health determines in accordance with 310 CNIR 15.303(1)(b) that the system is not functioning in a manner which will protect public health.safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System-,will fail unless the Board of Health(and Public Water Supplier, if any-)determines that the system is functioning in a manner that protects the public health.safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is v.-thin 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 30 feet of a private t;.-at.r 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 cohform bacteria and volatile organic compounds indicates that the well is free from pollution from:that faci'_iz and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than-5 ppm, provided tha-no other failure criteria are triggered.A copy of the analysis must be attached to this form. i 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /0 Qv10u �4 D�bob Owner -K, Date of Inspectio / D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes No� _ �/ ckup 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 ogged SAS or cesspool I/ 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 A da� fio.v Required pumping more than 4 times in the last year NOT due to clogged or obstructed piT)e(s). Numbe_- �f 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. ny .portion of a cesspool or privy is within a Zone 1 of a public well. _ ?ty portion of a cesspool or privy is within 50 feet of a private water supply well.portion of a cesspool or privy is less than 100 feet but-greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis_. performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia . nitrogen and nitrate nitrogen is equal to or less than 5 ppm,prodded that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/'No) The system fails. I have determined that one or more of the above failure criteria east 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. I E. Large Systems: To be considered a large system the system must serve a facility with a design floe of 10,000 gpd to 15,000 gpd- You must indicate either"ves"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-M7P-_) or a-Mann.e d Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a sicnifica t aii-eat. 0-- yes" in Section D above the large system has failed. The owner or operator of any large.syster_ onsid,- d significant threat under Section E or failed under Section D shall upgrade the system in accordance;, _<l�3 15.304. The system owner should contact the appropriate regional office of the Depa.*tmer_t. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNT_-A-RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE.CTION FORM PART B CHECKLIST Property Address: y 4e(j, crIrAr 6.60/ Owner: ao Date of Inspectio / Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes :�o Pumping information was provided by the owner,occupant,or Board of Health !/_Were any of the system components pumped out in the previous two-w eks? r/ 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 par of this inspection 4/ Were as built plans of the system obtained and examined?(If they were not available note as\rA) 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 fo_the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum: Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. v — Determined in the field(if any of the failure criteria related to Part C is at issue approxi=nat_on of distanc: is unacceptable) [310 CvfR 15.302(3)(b)) Page 6ofiI OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSME-_7N TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPFCTIOS� FOR-m PART C SYSTEM INFORII'IATION Property Address: H® G v►N r� ��Q/ 0.��ner• Date of Inspectio : �{ OW CONDITIONS RESIDENTIAL Numbei of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 C� 15.203(for example: 110 gpd x u of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)):_ Sump pump(yes or no): Last date of occupancy: C01D,IERCIAL/1,NDUST _ �� r Type of.establishment: 2�,L 0715; tC e .._. 010v,C��f _ 4�el _ 94 y Design flow(based on 310 CMR 15.203): Sot opd !� Basis of design flow(seats/persons/sgft,etc o t.+ F!le Grease trap present(yes or no):/" Industrial waste holding tank present(yes or no):/GQ Non-sanitary waste discharged to thelitle 5 system(yes or no}tea , - Water meter readings, if available: Last date of occupancy/use: rt, OTHER(describe): GENERAL INFOR'NI4TION Pumping Records Source of information: /e­o J` �y�n, C, w�- JJas system pumped as part of the inspection(yes o nr nr o): If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE YSTEM eptic tank; distribution box, soil absorption system —Single cesspool _Overflow cesspool _Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) _InnovativeiAlternative technology.Attach a copy of the current operation and maintenance cor_i_aci(cee obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed if kno )ands ce o information: Were se-,wage odors detected when arriving at the site(yes or no): T41. G T„c„o r; „ C �ii cinnnn Page ?of 11 T FORM INSPECTION FOR —NOT FOR VOLUNT-ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIZII PART C SYSTEM INFORMATION(continued) Property Address: 0/ Gno�.c (� 0 Qc.b p/ O«-ner: 7cU Date of Inspecti n: BUILDING SE«'ER(locate on site plan) Depth below grade: Materials of construction:_cast iron 4--:T'O—PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: aj� Material of construction:_t- concrete_metal_fiberglass_Polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no): —(attach a copy of certificate) � ' Dimensions: Sludge depth: .Distance from top of sludge to bottom of outlet tee or baffle: a� Scam thickness: _ P / Distance from top of scum to top of outlet tee or baffle: < Distance from bottom of scum to botto of outlet tee,or baffler How were dimensions determined: /�Le 5 g(i/et— Comments(on pumping recommendations,inlet and outlet tee or baffle condition.structural inteQri y, liquid let els as F)a ied to�outlet invert, e vid ence�of eaka ge.etc. : a^ �t7r1 C„lv GREASE TRAP:/v locate on site plan) —( P ) Depth below grade:_ Material of construction:—concrete_metal fiberglass polyethylene other (explain): — y _ — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition;s iucturaiuid is-..!� as related to outlet invert,evidence of leakage, etc.): Page 8 of i l OFFICIAL, INSPECTION FORM—NOT FOR N'OLUN'TARY ASSESS -IEN TS SUBSURFACE SE«'AGE DISPOSAL, SYSTEM INSPF.CT7ON FORAT PART C / SYSTEM INFORMATION(continued) Property Address: ` / p26o/ Owner: 67 r i Date of Inspectio : g$ TIGHT or HOLDING TANK:4!�(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(exolain): Dimensions: Capacity: gallons Design Floe: _gallons/dav Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): I DISTRIBUTION BOX: if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:/�%`'tom 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.): PL"TNZP CHAMBER:&(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): I T41- Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNT PART C T r �j SYSTEM INFORMATION(continued) Property Address: (/ L� (^ Owner: Ct fJ� Date of In.specti V. SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: "Type leaching pits,number: leaching chambers,number: leaching galleries;number: leaching trenches; number,length: leaching fields,number, dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments (note condition of soil, s igm- of hydraulic failuZ(' re,level of pondin�g,, damp soil. conditi � on of vegetation, etc.): O��l // — CESSPOOLS: -/V(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 laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,ievel of ponding, condition of vegetaron. etc.): PRIIVY":/Z(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of pondin;; condition o`vegetation. e-c. i Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY"ASSESSMENTS SUBSURFACE SEINAGE DISPOSAL SYSTEM INSPECTION FORT PART C SYSTEM INFORVIATION(continued) Property Address: Owner: /G t4 Date of Inspecti n: SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmaf s or benchmarks. Locate all wells within 100 feet.Locate,�vhere public water supply enters the building. /I fid AL �l— Igo _ 1 T;+j. ti Tnce�o tinn��r„ o Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR_NI P A,RT C SYSTEM INFORMATION(continued) Property address: /0/ G� R� / N f pool Owner: Ili CA Date of Inspection: / SITE EX-1 Slope Surface water Check cellar Shallow wells Estimated depth to ground water lq-4 feet Please indicate (check) ali methods used to determine the high-ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Ob ed site (abutting property/observation hole�i j� 150 feet of SAS) hecked with local Board of Health-explain: '61jG 0 s Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You muywc e how you establis ed the high ground water elevation o ow E P✓ / 1GG/+ (avl h G Tiflo 3261 Main Street Route 6A Barnstable Village MA 02630 January 10, 1986 Barnstable Board of Health Town Hall 617 362 8133 367 Main Street Hyannis, MA 02601 RE: Septic System Construction Lot 15A Iyanough Road/Route 28, Hyannis (Our File No. 3-1664.00)- Members of the Board: This letter is to inform you that the septic system at the above referenced site has been installed in substantial compliance with the plans. One minor change did occur. The leaching pit was installed in the area originally designated for the reserve. All structures are capable of withstanding H-20 loading and will have covers adjusted to grade. If you have any questions or comments please do not hesitate to contact this office. Very truly yours, BSC/CAPE COD SURVEY CONSULTANTS Engineers Surveyors Scientists St phen A. Wilson, P.E. Architects Project Engineer Landscape Architects lsaw36 Planners Cape Cod Survey Consotants COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENMONMENTAL AFFA,. DEPARTMENT OF ENVIRONMENTAL p1tOTECTION -� J, , 0(.k OFFICIAL INSPECTION FORM TITLE S NOT FOR SUBSURFACE SEWAGE DISPOSALS VOLUNTARY F FS RM MENTS PART A ORM Na CZZ CERTIFICATION1-3 , Property Address: O/ .Z _ Owner's N a` �o�GO Owner's Address; o / ° © w ✓1 o H �Q_I � -� -� e Date of Inspection: &'pi / Name of Inspector; ase L ,� l Company Name: ✓p t)_ - .'vti/// rrr Ma ling Address: o �C- _ o / Telephone Number. CERTIFICATION STATEMENT I Certify that I have personally wed the below is true,accurate and mete to of the�ge disposal system a this ad&=and that the fo t trainin8 experience ormed based on my in the Proper ftmctian and ewe of the Poa The' rted Inspection was approved system inspector pursuant of on site sewage disposal ems.I am a DEP �n 15.340 of Title S(310 CMR 15.000). The system; Passes Conditionally Passes Needs Further Evvalliaation F L0�Ong Authority Inspector's Signature: ne q3tem inspector Am Date: 0 0 within 30 days of comthm pleting CON°f this won report to the App oving A gpd or gtea ,the' inspection.If the system is a sharedrit 'Board of Health or DEp The original sad be and two t�owner shall submit the mprt to them 01 has a design flow of 10,000 authority. system owner and copies sent to the buyer, iopWe regional ce of the /M • g Notes and Comments v ' ri1 C4�P— k le ec� /1e/aql N CfviONKC/ r" -371 report only describes conditions at the ' l oS conditions Inspection does not ad time inspection and under the conditions of use trons of use dress how the system w71 perform in the future under the same orrt that different r n Page 2 of 11 OFFICIAL INSPECTION FORM_ SUBSURFACE SEWAGE DISPOSAL R VOLUNTARY ASSESSMENTS PART A SYSTEM INSPECTION FORM CERTIFICATION(continued) Proper2Address.- 2- G n oN (� 2� GNN0Owner: oDate of : g Inspe¢don Summary: Check A,B,C,D or E/AL AY complete an of Section D A. Sy�. I have not found 15.303 or in 310 CMR 15.3304 exist�o�AyOn which gWure akerianototeva�l of the failure aitenia 310 CCAManted are indicated below. Comments; i B. Sy Conditionally Passes: Odor more system components as described in the"Coo�o W systems upon completion of Pass"section aced to be MPlacement or repair,as approved by the Board of H�will per. Yes,no or no (Y,N,ND)in the for the followin g statements.If not ed„ply --The septic tank is metal and over 20 years old'or the emsting tank is inSltration or exfiltraiion or�u tank(whether or not)is y A metal septic teak will placed with a 'fig�c tank as approved the Inumnent Ystem will Pass inspection if the Pass inspection if it. structurally��not leaking of Health. indicating t> the tank is less than 20 years old is available. Baking and'if a Certificate of Compliance ND explain: Observation of sewage backup or break out or hi obstructed oval ofF�1th) ken,settled or uneven V on boxevel in Systemthe on box due to broken or inspection if(with baoken Pipes)are replaced — obstruction is removed 69r][but ion box is leveled or replaced ND explain: The system required pass inspection if(with approval more,than H 4 times a y��to broken or obstructed P►Pe(s)• The stem s3' will broken pipes)are replaced obstruction is removed ND explain: Page 3 of 1 l OFFICIAL INSPECTION FORM_NOT FOR VOLIINTARy SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE CTYASON FORTS PART A M CERTIFICATION(continue Property Address: � h eu R� C Owner. Co 6 01 E Date of Inspeetion: C• Further Evaluation is Required by the Board of Health: -1/Conditions exist which require further is ihiling to Protect public health,safety or the Board of Health in order to die if the system 4 1' systemis not Paso unless Board of Health determ lm in accordance withbeing in a manner which w�protect public health,�CMX� 1��the _ 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 an system is humdoning in a manner that Protects the public pp � y)determines that the health,safety and environment: The system has a septic tank and soil absorption systeiii sum water SUP*or tn'lutary to a surface water supp (SAS)and the SAS is within 100 feet of a "e Vaem has a septic tank and SAS and the SAS is within a Zone 1 of a public water The system has a septic tank and SAS and supply. the SAS is within 50 feet ofa privatie water MWO we& private spy wseptic � and the SAS is less than 100 feet but SO feet or used to tank determine d st me a **This system passes if the well water bacteria and volatile organic co performed at a DEP certified iz well O ';for colifonn the of ammonia nitrogen and nitrate nitro is from Pollution from that facility failure criteria are triggered,A�,of the analysis e attached to to or less this f Provided that no other om 3. Other. I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F ASSES SMENTS PART A ORM r CERTIFICATION(continued) Property Addrmmm- obF�le- �S�?0 Owner. a o � Date of �r E A System Failure Criteria applicable to allE s3stems.You most indicate"yes"or"no"to each of the following for aQ insPec cons: Yes No of age into facility oic r system o0 "— — °r P°gII8 Ofu to the s M onfent due to overloaded or clogged SAS or l the F�fogged SAS or cesspool curd or surface waters due to an overloaded or . Static liqjid level in the distribution box above outlet invert due to an overloaded or clogged SAS or depth in cesspool is less thaa 6 below invert or—' —/ volume is less ROWH'ed times Pumped �thn 4 limes in the lastyear N to than%day rlow ogged Or Obstructed Pipes) Number won of t>T SAS.cesspool or privy is below hi portiongh ground water elevaticox Any cesspool or privy is within loo feet c)f.a surface water suPPIY Or tributary to a surface portion of a cesspool Or P11i'vY is within Portion of a c within SO of a Zone I of a Pic well. Any Peron of a cesspool or privy is less than 100 feet but pivate water well. supply well with noquailty greater than SO feet from a private water analysiPerforn at a DEp ce 1abora o o 111'hble System Passes it the welt water analysis, indicates that the welt is free fro'" and volabk organk compounds � �and n pollution from that fac�7ity and the pace at Sonia are triggered.A coPY of the an qual to or less than 3 PP>�provided that no other failar�e criteria analysis moat be attached to this form.) (Yes/No)The system&b I have determined that one or more described in 31 of the 0 CUR IS.303,therefor the above farlure criteria exist as Health r *%em fails.Tlmsystem.o determine what will be necessary to correct the fail owner should contact the Board of E. Large Systems: To be considered a large system the system must serve a f gP� aci6ty with a design flow of 10,000 gpd to 15,000 You must indicate either`yes"or"no"to each of the following. (1°he antena�to large systems m addition t and�,e) ye no — the system is within 400 feet of a surface drinkmg water supply _ . _ the system is within 200 feet of a tributary to a surface drinldng wad yummy one st of a loomed in a nitrogen sensitive area(Interim We��Protection Area—1WpA)or a ma system Is Pic water sgply well piled If you have erect"yes"to any question in Section E the "yes"in Sectio above the large m failed The system is considered a til�cant threat,or answered significant threat under Section E or failed under Sectiaa�er or operator of any large system considered a 15.304.The system owner should contact the appropriate regional o O systemf the m �with 31t1 CUR Pap 5of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART B CHECKLIST property Address: X P Ow noa note Owner: s" Date of Inspection: e Check if the ko-nowiniz have been done.You most fixficate es"or"no" as to each of the followin Yes No — — g infornntion was provided by the owner,occupwa, or Board of Health — Were ate►of the system cow Pumpd out m the pxmous two weeks the system received normal Bows m the P[ieM-two p eek period Have large vohmm of water been introduced to the system recently or as part of this mspechon — _ Wp{e as bails plans of the obtained and exangned� (Ifthcy were not amiable note as N/A) as the faalny dwelling wed for signs of sewage back up as the site inspected for signs of bra&out ere all system compote excluding the SAS,located on site tl, Of the W��� co wed,a t robe of the tank mspeced for the condition ems,depth of liquid,depth of shy and depth of scum Wu t*faciW owner(and woe of sewage ifddf fi+om MAW)P vided with mformabon on the Proper The size d location of the Soil Absorption System(SAS)on the site has been determined on Yes no xisting information For example,a plan at the Board of Health. DeW is Unacceptable)[310 C fieldd in the UR 115.302(3Xb)l related to Part C is at issue approximation of distance ' . Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTAR° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE Y,ASSE ORM PART C L"1'ION'FORM SF/, TEM INFp$MATjM Property Adar,e Co i Owner.- Date of hLva:on: P " r RE3iD1�NTUL FLO COMffMNS DEMW Sow based as 310 C�R•13.203(for t )' �\ N�ber of residents: tl of beer (7 Does fesideace have a garbs — \ ls y on a (Y�or no): � fixed�a���or no):— (¢ e in�Oction rewwwj--� 91,Y Seasonal use:(yes or no).Water meter — sump pump(Yes rea or no):Table(last 2 years usage( lam date of occaparW COTYP�RCIAUINDBSTBIAI, ant: 370 Design flow(based on 3-1-0—CA M— 15.203): a �, Basis of design flow(seats/perMWscA Grease trap pesent(yes or no): etc.): Nhxk strial waste holding tank pint(yes or no):— Water waste&charged to the Title g system(yes or Lag date of occup�� e. yj l OTHER(describe): Pumping Records GENE INFORMATION Source ofinformadow ti Was system puaved as part of the If M es or Reason foo r ��_ ' 9 Pumped dew F SYSTEM —Septic twk d M nlxMon box,soil absorption system —single cesspool —Overflow cesspool —hiw —Shared system(yes or no)(if yes,attach previous owner) faon records,if any) technoh� Attach a c ) oturrnapobtainedflom system Mon and maintenance co —Tim tank _Attach a ntracx(to be copy of the DEp approval —Other(describe): Approximate age of all c0MP° (if r")and i�ormabion G Were sewage odors detected when arriving at the site(yes or no): � Pap 7 of 11 OFFICUI,INSPECTION FORM— N40T FOR VOLUNTARY SSSIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM SPEC ON FOPM ` PART C INSPECTIONI FOB SYSTEM INFORMATION PrPeKY Addresr Owner. Co dvz6 0/ Date of Inspection; BUMDING SEWEy(1oc�te on siteplan) Depth below Bade; Materials of oonstrn�� f Distance from private Water weg or .VC �t � Commemon=ddon off of lealmg�etc): i SEPTIC TANK;_(lam on site Pbn) Depth below grade: p2 6 oaf ceoa evlaan) — --polyethyteae Htank is meal list age:Cerfificaft) _ Is age a / ificate of Camer p (yes or no):_(attach a copy of D X Scum thick to bottom ofoutlet .�baBIe: oZ -� �G Distwmfrom Distance from to to bOf oattlet tee outlet baffle. CQ f/'P✓f How were&=sjor s nad outlet tee or� 40 Comments(ova puping recomm� o� as to outlet iavM evi I t and outlet tee or baffle H mo d Condit n,struchual Weg Yty,liquid levels GREASE TRAPs4ft oa site per) Depth below Material of ce�tion:_�� (explain): ' _fiberglass_polyethylene_ D�sions: Scam thidmei : Distaace from top scum t0 top of outlet tee or bade: Distance from bottom of scum to bottom of outlet tee or ba Date of last pumping_ _ Commenu(on pumping recoma=ft as related to outlet invert,evidence ofl ka ml0 ° kt tee or laaffle conditioq"'tcual,eakagie,etc.): integrity,liquid levels Par 8ofIt OFFICIAL INSPWT[ON FORM_NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYS ASSESSMENTS FORM PART C ECTION FORM SYSTEM INFORMATION (oontdu,e� Property Addrem �,y R� Owaer•: o o //� D ate of Inspection: TIGHT or HOLDING TANK: {tank must be pumped a time of inspection � t )(locate on site plan) Depth below : Material of construction concrete metal flbergLW_polyethylene ems: o (eXptain): Design Flow: nmddq Alarm present(yes or no): Mann level: Alarm in working order(yes or no): ammmIts(Condition of alarm and float switches,etc.): DISTMUTION BOX- (lfpvsmg mum be oPeIIWocate on site plan) Depth of liquid level above outlet invert: t4 Comments(note if box is level and Q leakage into or out of box,etc,): d>stnbut<on to outlets etlnal,�, � a f solids c�rryov���, of PUMP CHAMgM&(locate on site plan) Pumps in working order(yes or no): Alarms in woddng order(yes or no): E-'"'.nmenns(note condition of Pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFISUBSC7 SL INSPECn0N FORM-NOT FOR VOLUWARY', � URFACE SEWAGE DISPOSALDISPOSALSYSTM INSPECTION. � CTTON FORM /0( / Gh oar 5 �� Owner: C064 �` Date of InspectVr o SOn ARSORrrjM sys TM : an sitePlan,cfeawasm ff SAS na located twpW why T 1W amber S4 :. 4/ / leaching pHadis.==bw -leaching ftwhes,amber, overeow cesspool, Comas ornodition�� .TYPE of tech°1°�y: ec) � , soil,signs of hydraulic fad level of pond 00 /G �P soil,condition ofvegetatiion, r o h CES&VOW Must be pampad as pert of HLp0cti0nki0pie on sift plan) Depth-tapaf iav� of so".1aw Depth of sit I"= cfcmogcd hu ication o€Com no):te� ofS4 up'-f c fig-l—k-d ofpon vegetz on,ck PRI�y-��pocabr oa site Pam) Dime Depth of so}id Cow f %goof hydrahy*. .Wx&bMkvd of cioa a�' eta): Page 10 of I I OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM ASSESSMENTS FORM PART C 'M INSPECTION FORM SYSTEM 1"ORMATION Property:Wdlon- SXXTCH Address: 4D/ der. of OF SEWAGE DISPOSAL SYSTEM sysim Provide a sketch of the j benchmarks.Locate all wellsw �cluding ties to at least two p within 100 feet,Locate where Public water supply entersthe bu&hw, °! I OY— I G L � . 3 �c� �� ~, ' • , Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION Property Address: ©( /?1 Owner- od Date of inspection; / p SITE EXAM Slope Surface water Check cellar Shallow wells �Lf Estimated depthto grond water��feet 44 ( Please md=k(check)all used to l� � detemune the bigIt water ele : Obtained from system design plans an record-1f Checked,doe of design plan reviewed: qxezved�/� �local of /obsexpl aon hole w1am �'tltta 150 feet of SAS) Checked with local awavateM install — Accessed USGS database-explain: (�h docurnenwhon) You inud dwAxft how you established the higb ground water elevation: / `^� r s 9 A NG /O N M A-- /�lzo h e, - c fc ; 000 to O000 11JT 15 �_WOQ � t S ST LE LA'S HAKE ADD9fSS i 09 0WN R ,ATE HERMIT ISSUED , 0ATE C 0 M P L I A N C E iSS 1EDT _ � 2.? � --� R � o � � � -s � '� � � �o � �. � � �' � � � � �. o _ 1 '�, � �. �� � s � �" �� � �� O � i, .� �� d �� No l � Fxs...��` ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �i QNG 7devA1...................0F....... <S729'�O3b G.f2fjvTZ�]D Appliration for Bispaaal Workii Tomitrurtion Frrutit Application is hereby made for a Permit to Construct (><) or Repair ( ) an Individual Sewage Disposal System at: ...� 1 . G..n�1'�l� ...... 1�✓... ,. Lae:...IS.......................................... Location-Address _ or t No. ..... - = �kov .sQclaPfz. -----------------•------- `II caner _ Address a -------_----•-------.--•.. .............. YI.Cd?/1/..S Installer / Address U Type of Building Size Lot_.,I.9;,.�=d_t--Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic V6) Garbage Grinder W<,) Other—Type of Building UFF>C ��T/if L a yp g __ _ �_._._ .__.. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures .............. ,. >t_!��'Z/�14 ;./$1�7_.GA ------.. ....................................................... W Design Flow.D-ffizz-.._ _.gallons per person per day. Total daily flow____..___ .4j.Z...................gallons. WSeptic Tank—Liquid capacity.1.613Q_.gallons Length_8'=_$"_ Width.'.=-O_`.r_ Diapw4e�_-----------__ Depth.6��..`.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----------I--------- Diameter.....I.o-_______ Depth below inlet..5: .7_!._ Total leaching area...a._!F_:7..sq. ft. Z Other Distribution box ()<) Dosing tank ( ) '-' Percolation Test Results Performed by.._C , � s __s?c��.�.�_ lcaa.�;�/fn� Date_._ q:-z-- Test Pit No. I................minutes per inch Depth of Test Pit....f_Z..._.._. Depth to ground water. F rxq Test Pit No. 2......2......minutes per inch Depth of Test Pit.-.-,/.K......... Depth to ground wat .............. � a0 l02Qc'saT_.F 4[._ ./._ `_`__.l..4.!g"..1c dH/.T ..._-- -� ---0 HEN. y Description of Soil..5_Th/3rll=( r�..rr! t2l+tm.._ 4? �-..�A!� � Ct�l�Uc[..¢_.Z"�T..._... �_.._ ALLY] � 'W1L""�D1V__. ---- - -'.-.�._ .4U�!l 7-k. vi W J y _ iFo:30226 ��I3.d T1-F_e_�� m 1 s'�'! �0�4 G...�eN�_ .5ak?#1t..1- ----------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable-BPI I� ;3aA AV ��� Agreement: 7M n The undersigned agrees to install the aforedescribed Individual Sewage Dis osal System in a ordance /itlr/9�8f . the provisions of iI'L U 5 of the State Sanitary Code—The undersigne r s o place the s s em in operation until a Certificate of Compliance has be issued t oa iealt Si ned.. g � _ Date Application Approved By............. :1 ... ....................... ..-- .................... Date Application Disapproved for the following reasons---------------•----------------•-----------------------•------------------------•------------------------•...... -•------•--------------------------•------------•------------. --•-----•--------•... •----••-------•---•-----_--••-- Date PermitNo.... .... ................. Issued-....................................................... Date FEs..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF -HEALTH '?ZJ[cJ QJ .. ..............OF........ Appliration for Uhipaiia1 Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct (><) or Repair ( ) an Individual Sewage Disposal System at: .....l.Z�.(. -._. n h...._?:4..---.. ..5........... .........���p, ..,�?z .,.. �'!$'' .................................... Location-Address or x.:(7�C7 ... �IG _.ag--'------------------------- - Owner --�`., Address a :...�� 5... .�, 17411/S'...................•---•------..................•.............. Installer / Address Type of Building Size Lot.... _a,06J.'.t.Sq. feet U Dwelling No. of Bedrooms...........................................Ex ansion Attic�., g— p (,i/p) Gar age Grinder (N) Other—Type of Building OFF-ICA/1KAR M.1.No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures --------------- 'E. ,St"I 1.L,..._J..4,1:7__ Psi?.-. ...- .................. W Design f.JP..gallons per person per day. Total daily flow.- 3Z-4,.�..................gallons. WSeptic Tank—Liquid* -capacity. 6DO.gallons Length._6'-.a" Width--5rno * .,............. Depth..e..L6.". x Disposal Trench—No..................... Width....._-------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._.....-1...._... Diameter-__-__/a�___... Depth below inlet___.%f*.7.... Total leaching area..._��a�.sq. ft. Z Other Distribution box ( >o� Dosing tank ( ) aPercolation Test Results Performed by.... 4e-�c _. rttt ._ �t1tS�l7 !!tSDate.._.�a.`z.'. $'......... Test Pit No. 1................minutes per inch .Depth of Test Pit......1 ._.___. Depth to ground water.._. DF._ GL, Test Pit No. 2......Z.....minutes per inch Depth of Test Pit...../Z__...... Depth to ground water ....... �A,Ps oT S7'..t /_T_'`L_J...O'�2.tJ r2acs►�-- 1 _.l `_t-1.'tf�f 1_.�c1/�l/I2F.------ ---STEPt+'N Description of Soil... Tls'.t3Y'!!"i �._mFx�.tum--- e4 -._�e�1 _G1ttLL.�,._?" 7---------- ......,�u.YAi.. C3..0 OJ end---10P. -2!1.4.4....Aj-v12b � �� WILSON-• y V TR$Tlt�iBLt.__)Yl. Y21_thiA Ot`t�5G JU--t. �lk3G-•---------•----------------------•-------------------- -- •o 'pNO. ...... Q U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------ �is� --ls-r 6�a SS�ONAL E� -•----•-----••--------- - -- ---------•-------------------------------------------- •----- - --•-------------------------------•----------- ----•......---•-----.--•- _.. Agreement: i``j1(,> 1 t_rj5*�r (Z- �'-�r Pe i �= r-, / 5 The undersigned agrees to install the aforedescribed Individual Sewage D osal yste in ac rdance witl��_pt the provisions of TiTLL 5 of the State Sanitary Code— The prldersignedJuirhl. o place the sy t m in operation until a Certificate of Compliance has bee sued b f� r It Signed......f ••. •... ---- ..... Date Application Approved BY —;�.-..... Gr= `� �!`� = ..... --•- --- ----------------•- _ Date Application Disapproved for the following reasons------------------------------------••----------------------------------------------:--•-•---•---•---••......---- ...........•----------------------•---------•------•-----------------•----...---------.........-------------••---•-••---••••----•-•--•-••-•----•--------------•--•-•••----•---•-----•----•------•-•-•--- Date PermitNo..... = ---------------- Issued..................-..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V ..........................................OF.................................................................................... �rrifirttr laf (�uli �trr C '(!,>W ~` , THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) Y .................................... ---•-••-•----•-•.............•••--------•-•--•----•----•--------•--••--.........••-•-•......._..••..._.._ i Installer has been installed 1'n accordance with the provisions of 'I I T 1Z 5 of The State Sanitary Code as described in the application for Disposai Works Construction Permit No----- ...... d-ated-.-----�/_����................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUINCTION SATISFACTORY. DATE....................j.... .� �......................•.......... Inspector.... THE COMMONWEALTH OF MASSACHUSETTS fff .2jy� BOARD OF HEALTH 1�,jCsl�v�i in/5 OF.-------•--------•-•......•••-•............................... .................... FFF...�. ._.......... Q T Permission is hereby granted...........)_,'ts-:_1�s=_ I�` ' �( 3N6 �' �`� to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............../ I...._ ci v.. 1.......... �Gs.xr�----------------------............................................................... Street �- as shown on the application for Disposal Works Construct3ol,_Permit No�.�. -� ated...... x>2 ��__`--_--- ........................................ V ................. Board of Health DATE 2 ' FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r 3261 Main Street Route 6A Barnstable Village MA 02630 BSC January 10, 1986 Barnstable Board of Health Town Hall 617 362 8133 367 Main Street Hyannis, MA 02601 RE: Septic System Construction Lot 15A Iyanough. Road/Route 28, Hyannis (Our File No. 3-1664.00) Members of the Board: This. letter is to inform you that the septic system at the above referenced site has been installed in substantial compliance with the plans. One minor change did occur. The leaching pit was installed in the area originally designated for the reserve. j All structures are capable of withstanding H-2.0 loading. and will have covers adjusted to grade. If you have any questions or comments. please. do not hesitate to contact this office. Very truly yours, BSC/CAPE COD SURVEY CONSULTANTS Engineers Surveyors Scientists St#phen . Wilson, P.E. Architects Project Engineer Landscape Architects lsaw36 Planners Cape Cod Survey Consultants AsBuilt Page 1 of 1 obbCATI0 % 0 ( SEWX,G ; PERMIT NO. V I L L A G k -$IN5TA LLER'S #VANE ADDRESS IiD6 R OI9:'HEN DATE PERMIT ISSUED DATE COMPLIANCE ISS1) 1D . 1-2 i k �T � CLOD <;'i1�Ni Q151, ZC; t � L 7 v 7 Rquo'. j o http://issgl2/intranet/propdata/prebuilt.aspx?mappar=32815400A&seq=1 5/14/2012 _.B Date. 5 (� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM V NAME OF BUSINESS: w/�v � ✓i tt_elo, BUSINESS LOCATION: l- �'✓�� v aicvP /A-4^ o D MAILINGADDRESS: a' a5y�j Mail To: TELEPHONE NUMBER: -77P e&ee Board of Health Town of Barnstable CONTACT PERSON: ,2Z1 , L/ P.O. Box 534 EMERGENCY CONTACT TELEPHO E NUMBER: 77 y ` 767 Hyannis, MA 02601 TYPEOFBUSINESS: cw C-O -Z_ sa_-w Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antif reeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor &furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Try :�_. +,_., . .cv.;"^r+;.. r ....- ,�•,,_ :t '..a, Z :.z .. ..r,. .fi R%. a-u'>ti",' ".?P'4).M1'Ktt',y!+:"�V` .R fir.. ,.,,h,,.'. ;C7/� C� TOWN O•,P.;4 BARNSTABLE COMPLIANCE. CLASS: 1.Marine,Gas Stations;Repair j X satisfacto 2.Printers I 3.Auto Body Shops BOARD OF HEALTH i O unsatisfactory- 4.Manufacturers "" 5.Retail Stores COMPANY A413M./�/ o k Sa (see Orders ) l J 6.Fuel Suppliers ADDRESS 1 v / : ,���ays h l� , Class: ?.Miscellaneous ay QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN, OUT #&.gallons Age Test Fuels: .. .__.,. Gasoline,Jet Fuel(A) >, l Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: C degreasers f • t '( Miscellaneous:` r i i I I , I f I l DISPOSAURECLAMATION REMARKS: s 1. Sanitary Sewage 2.Water Supply 'h @ Town Sewer KPublic ,!, O On-site OPrivate 3. Indoor Floor Drains YES N0 O Holding tank: MDC O Catch basin/Dry well i O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC " O Catch basin/Dry well On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. -in Person (s) Interviewed Inspec a D4ee 1� 7i M6V TOWN OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 1 �V?l A (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 6/ /Z' t/ Class: �_ 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) 7Z transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: /Z DISPOSAIJRECLAMATION REMARKS: ;r00n-site itarySewage 2. W ter Supply ownSewer Public OPnvate 3.Indoor Floor Drains YES NO r O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC 0,O Catch basin/Dry well On-site system 5.Waste Transporter Mime of Hauler Destination Waste Product YES I NO 2. P on (s) Interviewed In P ector Date ? SOIL TEST PIT DATA. INDICATES INDICATES SEPTIC TANK DETAIL ., \ < � � DISTRIBU-T�ION BOX DETAIL LEACHING PIT DETAIL: REVISIONS r+ PERC- � - OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE NO DAT E t1NDWATER ZO O 9 TEST gRO NOTES I SEPTIC TANK SHALL BE STEEL 1 INLET AND OUTLET TEES TO 8E CAST IRON OR 11 MANHOLE COVER LOAM 8 SEED TP X�` TP * TP TP REINFORCED CONCRETE- SCHED 40 PVC, TEES TO BE CENTERED UNDER - NO. OF OUTLETS: BROUGHT TO FINISH GRADE OR PAVEMENT MANHOLE COVER. - NOTES - , 7- GRD. EL. Z5. GIRD. EL.� GRD. EL. ____._______. GIRD. EL. _ _ � SEPTIC TANK TO WITHSTAND M-17 LOADING UNLESS UNDER PAVEMENT DRIVES OR I I I. DIST BOX TO WITHSTAND H-10 LOADING 2 "MIN OF 1/8" GW. EL. � GW. EL. _A) 'q GW. EL. ___ _ GW. EL - _ TRAVELED WAYS,WHEREIN�H-20 LOADING I I UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" 12"MIN. FILL SHALL APPLY. I - � PRECAST I TRAVELED WAYS WHEREIN H-20 LOADING WASHED �7 DIST / SHALL APPLY. STONE - -' o�`— �' ': 3 ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER ( CONSTRUCTION TO BE WATERTIGHT BROUGHT TO FINISH GRADE BOx r- 2 PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF PVC INLET PIPE ° I O O c O C7• O OO I I INLET PIPE EXCEEDS o.08 FT./FT. OR IN - - _J PUMPED SYSTEM. D o c o 0 0 0 0 0 0� NOTE: BOX TO BE LAID LEVEL. D' WITHSTAND H-10 LOADING Iz"MIN ��-- J o e , ' D GENERAL NOTES: • COVER t _ 3. FIRST TWO FEET OF PIPE OUT OF GIST x �, LEACHING PIT TO ' • PLAN VIEW a °� ❑ o r� o 0 = a o ❑ I. .THIS PLAN IS FOR DESIGN AND ------ -MANHOLE COVER w ,T ., ,' UNLESS UNDER BROUGHT TO FINISH GRADE '� ' PRECAST ., fo O� PAVEMENT DRIVE OR CONSTRUCTION OF THE SEWAGE REMOVEABLE /4' TO -`— pNORMAL WATER LEVEL COVER � � 1-1/2" o o s-1 0 o Q o G ❑ TRAVELED WAY WHEREIN DISPOSAL FACILITY ONLY. � m o� 2- ALL CONSTRUCTION METHODS AND DOUBLE LEACHING PIT Go H-20 LOADING SHALL APPLY. / ° ❑ ` o o o ❑ B� D.E. E TITLE 5 AND LOCAL BOARD WASHED Q PROVIDE -- � -'�:-�"--" U.1 STONE v MATERIALS SHALL CONFORM TO MASS. ' _ INLET TEE A (n0 }In85 I I I WATERTIGHT � � ° ryA a — PRECAST — I,. - - JOINTS(typ) •i •I' •, i• �" E, o c� o 0 0 0 ❑ � I- R� OF HEALTH REGULATIONS. •' 0" IN OUTLET Li r-� 9EE i I �o IEPTIC 1• i, LIOUID DEPTH TEE ' NOTE 2 ' ''I �� jx ° • o 3 ALL PIPES LOCATED UNDER PAVEMENT _ TANK4" INLET 1 I I I -- __ a ❑ o ❑ a o Co 0 o M I '�LI1 1 4"OUTLET 1 �' r — �' e a <• OR TRAVELED WAY SHALL BE • ' I —F 0 0 'ca `n SCHEDULE 40 0R EQUAL. 6 MIN 4 ALL SrR')C'URES SHALL BE DESIGNED L. - J _ - - �------ 1J E--------� — -- --- DIA - --- �• - - - - - - - - - - - - - - r �• A c r k s , TO WI-H,S-4ND Pi-2) LOADING f o BOTTOM ON LEVEL STABLE BABE o;�9>' 0.� BOTTOM ON oo—A LEVEL STABI� - --- - -- -- 16) DIA �r CROSS-SECTION �,dG//, BASE PLAN VIEW CROSS-SECTION VIEW CROSS-SECTION DATE: , DATE: � ��:�;--- __ INVERT ELEVATIONS. CONSTRUCTION NOTES: DATE: DATE: _—T 4 I. IF -ENCOUNTERED, ALL UNSUITABLE SOIL TEST BY: TEST BY: TEST BY: TEST BY: ZONE HB �� � SHALL BE REMOVED WITHIN A WIDE ;'4-7i' OAJ ���/�j`� �T /7N J� /n r45 _ _ _ INVERT AT BUILDING ZONE AROUND THE LEACHING F,:CILITY WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: SETBACKS INVERT AT SEPTIC TANK(in) �T--- ' AND SHALL 8E REPLACED WITH CLEAN 4,o NZ� �)� AN AND GRAVEL IN ACCO DAt .E WITH -------- -- — ------ - - - - -- ------ ' - FRONT ISO INVERT AT SEPTIC TANK(out) TITLE t. PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: SIDE 30' INVERT AT DIST. BOX(in) Z3 �e) —__--_-- MIN-/INCH _.__ ._..__ MIN./INCH -__--- -_-.__-_- MIN./INCH MIN./INCH 2 2 THE EXIS. !NG SEPTIC SYSTEM, WHEN REAR 20 INVERT AT DIST. BOX(OU0 Z 3. 77 FOUND. !S TO BE PUMPED DRY a FILLED INVERT AT LEACHING PIT Z5,.(a'7 WITH SAND DATUM: h� BOTTOM OF LEACHING PIT /6.0�'� VERTICAL DATUM: /� ` �, �' D NOTES U.S.G S. MAXIMUM GROUND WATER ELEVATION /) PROPERTY LINES SHOWN ^BSERVED GROUNDWATER BENCH MARK USED: 7_0 4A-) iv o< Y A E T `� I ,' �- � \ \ W G B.M. WERE COMPILED FROM DEED ELEVATION _ NA, {oYz 8� A)6 A/ ot 5 5E 7" 5� +� �'L� �) • TOP OF BOLT ON MAIN DISCHARGE BOOK /389 PAGE 268 AND qs E L E V = 29.19 PL. BOOK 352 PAGE /2 AND DO NOT REPRESENT AN ACTUAL ,d SURVEY ON THE GROUND. � HYD \ ``. 2') TOPOGRAPHIC SURVEY BY AssEssoRs MAP 32B \ TRANSIT & STADIA METHOD. LOT 154 /9,000 S.F- t \ .O �0 � N/F W/L L IAM FINKZ-E <•� 25 64 \'F, 59 i25 DESIGN V CRITERIA. A� Fo \\ C 1J �F � 12.E SIGN' '�-y DESIGN FLOW: 2 8 D Cx'k POSTS • 20 9r r 25 - � �Epn� rq��� q < ks 25 \ O I 2 Sty .` 4x 9 � c� F Cis 2 The BSC Group k,ST � -, A,Z REQUIRED SEPTIC TANK: to ` r�Aa.� \ ELEC EX�ST�NG 25 40 35"ter. G t /SG %� _ 33 2 _. GAL. `� 2 STY. W/F SEPTIC TANK PROVIDED: _ / GAL. T 2 ' 26 4 ti Cape Cod Survey Consultants BUILDING l \ I SIZE OF LEACHING FACILITY REQUIRED: P y t I \ I DESIGN PERC. RATE. =- C �� MINJAICH FOUND. EL E V=26 41 1 1 - _ -_ __ 3261 Main Street 1 i ---�.- - Route 6A Bamstable Village MA h i - ---- 02630 B.M. - - - ---_ - -- B �,,R (FND1 NW COR C.BASIN RIM 617 362 8133 ELEV.= 22 02 - - IN �/� PROJECT TITLE: o N N/F SIZE OF LEACHING FACILITY PROVIDED: i \MARGO WHARTON SEWAGE DISPOSAL WG %- ie SYSTEM DESIGN \ ` 1' /— ` 'I'c5 i7�3 • � - S � r, PLAN OF LAND - 12 LOT /53 p �OF U.., 2/H, .` h/ ceQ - 0/ ST,IL�C, F 7 XIN - - g BARNSTABLE111MA. LEGEND ( HYANNIS ) "r U-6- LOCUS PLAN- 25 x 50 EXISTING SPOT ELEVA TION LOT 154 �\ \\ �gxNsrA9cE EXISTING CONTOUR TP TEST PIT LOCATION - U.P f PREPARED FOR: W G EXISTING WATER GATE • �� ���G�S N. BRIGHAM UP EXISTING UTILITY POLE AIIII- PEMBERTON EXISTING FIRE HYDRANT �Q� s _ R HYD ® DATE: 10/ 19/85 EXISTING CATCH BASIN - a, COMP/DESIGN: S.A.H. CHECK: S.A.W./C.F W. PLAN VIEW I DRAWN G.G.M. - G UNDERGROUND UTILITIES WERE COMPILED FROM AVAILABLE FIELD. R.E.G./ T.J.Y. SCALE: 1 - 20 0 RECORD PLANS OF UTILITY COMPANIES AND PUBLIC AGENCIES FILE NO: AND ARE APPROXIMATE ONLY. BEFORE DESIGN AND CONSTRUC- SCALE; I" = 2,083' ± • ■ DWG. NO: 1020 SHEET 0 20 40 FEET 6o TION CALL DIG SAFE 1 - 800 - 322 -4844 . JOB N0 3-1664-00 OF