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HomeMy WebLinkAbout0100 KELLEY ROAD - Health 100 KELLEY ROAD,;HYANNIS o e o ° `� o (/ TOWN OF BARNSTABLE LOCATION SEWAGE# a D VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. i SEPTIC TANK CAPACITY ��_�/��� LEACHING FACILITY:(type) �n��s (size) NO.OF BEDROOMS OWNER i PERMIT DATE: COMPLIANCE DATE: 71fflaK Separation Distance Between the: j Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ' within 300,feet of leaching facility) Feet FURNISHED BY A r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments D M 100 Kelley rd f-•` Property Address h.� Dennis Fuentes Owner Owner's Name information is Hyannis ✓ MA 02601 8-12-17 required for everyr"h page. Cityfrown State Zip Code Date of Inspection 6� 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 A. General Information s filling out forms 07 C on the computer. J use only the tab 1. Inspector: key to move your cursor-do not David J. Burnie use the return Name of Inspector key. David J. Burnie LLc � Company Name 3 Perry's way Company Address E. Harwich MA 02645 Citylrown State Zip Code 508-285-7783 or 774-216-1440 S1386 Telephone Number License Number B. Certification ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the`inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ����``°\11 �Qyiyi '8i'onally Passes ❑ Fails ❑ Needs Further Evalua�i*by tl�Nde�al kp �6gring Authority � • J. m = o BUR NIE #SI386 =c_ o: 8-12-17 Ins e s Si na �� .T 71 �` Date The system inspector shall subn't4t►ra=}*'*this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. . t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 O V6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or.E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system passes. The system is a 1000 gallon septic tank(2 yes 2 distribution boxes) and a leaching field using 3 3050 infiltrators. I 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 structuraik unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Ingpection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8712-17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND.(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I ' C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR' 15.303(1)(b)that the system is not functioning in a manner which will protect public health, F safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 - page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory;,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 wafers due to an overloaded or clogged SAS or cesspool El 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 '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Citylrown State Zip Code Date of Inspection 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 ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or.less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered'"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received.normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? El ® 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? 0. 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 t approximation of distance is unacceptable) (310 CMR 15.302(5)) f D. System Information Residential Flow Conditionst Number of bedrooms (design): 3 Number of bedrooms(actual). 2 # i ..; 334.95 f . DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):.* t5ins-11/10 , ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 6 of 17 �. _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 gallon septic tank . 2 distribution boxes and 3 number 3050 infiltrators I Number of current residents: 1 Does residence have a garbage grinder? ® Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d yes 9 ( Y 9 (gP ))� Detail: 2016= 3900 cu feet x 7.5=29.250 by 365 days= 81gpd.....2015=3000cu feet x7.5= 22.500 by 365 days=62gpd Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(gPd) .. Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑' No Industrial waste holding tank present? ❑ Yes ❑ No - Yes No Non-sanitary waste discharged to the Title 5 system? ❑ ❑ Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owners Name information is required for every Hyannis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont:) Last date of occupancy/use: current occupied Date Other(describe below): occupied General Information Pumping.Records: i Source of information: Owner, not pumped in lat several years. _ � , Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ®• Septic tank, distribution box, soil absorption system ❑ Single'cesspool ❑ Overflow cesspool ❑ Privy ❑. Shared system (yes or no) (if yes, attach previous inspection records, if any) - ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 2ntl distribution box. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1000 gallon septic tank and 1s'distribution box estimated 25 years plus... 2n"d box and leaching installed 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: ;8 .eet Material of construction: ❑ cast iron 040 PVC El other(explain): Distance from private water supply well or suction line. feet Town water Comments(on condition of joints, venting, evidence of leakage, etc.): Normal Septic Tank(locate on site plan): Depth below grade: f 11 et Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal septic tank estimated 25 years old some decay. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge deptl%: 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 18" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape&estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank needs to be pumped, not pumped for many years Grease Trap (locate on site plan): Depth below grader fee: Material of construction:. ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness j Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•11/10 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 F . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis ! MA 02601 8-12-1 i page. Citylrown State. Zip Code Date of Inspection 0. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): . Dimensions: Capacity: gallons. Design Flow: gallons per day Alarm present: - ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No r. ...t5ins•11/10 Title 5 Official Inspection Fops:Subsurface Sewage Disposal System•Page 11 of 17 fi^ Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet*invert Normal level 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.): None working as designed for both d boxes. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required;/ If SAS not located, explain why: located and probed to stone and found dry. Also used sewer camera to view inside. found no standing water. t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 I . i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-17 page. Citylrown State Zip Code Date of Inspection 0. System Information (cont.) Type. ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 infiltrators. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): dry 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 i Dimensions of cesspool Materials of construction Indication of groundwater inflow ElYes ❑ No i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd roperty Address Dennis Fuentes Owner Owner's Name information is, required for every Hyannis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection 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.): L 1t. I t5ms-11110 Title 5 Official Insoection Form:Subsurface Sewage Disposal System-Page 14 of 17 Y ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd �roQerty Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-1 7' page. Cityrrown State Zip Code Date of Inspection 0. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately A a Isf d�oX � �6ox 7,0 r t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 100 Kelley rd Property Address Dennis Fuentes Owner Owner's Name information is required for every Hyannis MA 02601 8-12-1=' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 132" no water per test hole plan dated 6-27-08 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: 6-27-08 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Plan on file 6-27-08 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevatiom. No water to 132" and bottom of leaching is 50" below grade. 132"-50" = 82"... there is an 82" seperation to the bottom of the dry test hole. Gefore filing this Inspection Report, please see Report Completeness Checklist on next page. 65ins•11/10 Title 5 Official Insoection Form:Subsurface Sewage Disposal System•Page 16 of 17 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Kelley rd Property Address- Dennis Fuentes Owner Owner's Name information is required for every Hyannis annis MA 02601 8-12-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C,.D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Postal CERTIFIED MAIL. RECEIPT Q' Only; For delivery information visit our , iC I CO CJFFICIAL USE Ln M Postage $ S p d Certified Fee - eil. p Re tum Receipt Fee N hark p (Endorsement Required) O e 9 p Restdcted Delivery Fee G� p (Endorsement Required) U� I C3 S//J d rU Total Postage&F<4s. Sent TO S`freef,Apt.No.; "Mark p or PO Box No. 100 j{elleb�son r --------- _ _ yanrK MA 02601 City,State,ZIP+4 ------------ :rr . .. y Road H � ' Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: is Certified Mail may ONLY be combined with First-Class Made or Priority Mail& ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for aeddupllicdate return receipt,a USPSO postmark on your Certified Mail receipt is rir■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted Delivery". ■ If a postmark on the Certified Mail receipt Is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000.9047 SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS . DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. 46� ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return.the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back,of the mailpiece, or on the front if space permits. D...Is'delivery address different from item 1? ❑Yes 1. Article Addressed to: ►� If YES,'enter delivery=address below: ❑No -SLIVN Ln fV O f-Mark�Robinson� 'f' o 'y ' 100 Kelley Road 3. Service"TType�....r- Hyannis,MA 02601 ❑Certifie'd--Mail- ETPriority Mail Express- 0 Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number - , � (transfer from service label) 7 014 1200 0001 0358 4459 (� PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES POSTAL SERVICE + • ,. First-Class Mail I Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* Town of Barnstable ° =Health Division'' � 200 Main Street.. Hyannis, MA•02601 I I �TME r Town of Barnstable s^ MASa`� ' Regulatory Services 039. .0� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304. January 9, 2017 Mark Robinson 100 Kelley Road Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS. The property owned by you located at 100 Kelley Street Hyannis, MA was visited on January 5, 2017 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed. 04-3 (A) Outdoor Storage Multiple items are being stored outdoors on this property which are not screened from public view and are not within an enclosed structure as required by above ordinance. These items include but are not limited to: old hot water heater, car parts, tools, wood scraps and other assorted debris. You are directed to correct the violations listed above within (15) days of your receipt of this letter by removing said items from property or storing them in 'an enclosed structure or disposing of them properly. You may request a hearing before the Board of Health if written petition requesting same is received within 10 (10) days after the date the order is served Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER O THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Health Master Detail Page 1 of 1 w Heal h Master _ Logged In As: TOWN\oconnelt Health Master Detail Wednesday,January 4 2017 Application Center Parcel Lookuo Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 292-057 Location: 100 KELLEY ROAD, Hyannis Owner: ROBINSON, MARK Business name: + Business phone: Rental property: ❑ Deed restricted: ❑ Number of bedrooms Contaminant released: ❑ Fuel storage tank permit: ❑ 1 Save Parcel Changes I Return to Lookup I Parcel Info Parcel ID: 292-057 Developer lot:LOT 72/PT OF 71 Location:100 KELLEY ROAD Primary frontage:90 Secondary road: Secondary frontage: Village:Hyannis Fire district:HYANNIS Town sewer exists at this address: NO Road index:0828 Asbuilt Septic Scan: 292057_1 Interactive maps 292057_2 A Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info owner: ROBINSON, MARK Co-Owner: Streeti:100 KELLEY ROAD Street2: City:HYANNIS state:MA zip: 02601 country: Deed date:8/15/2008 Deed reference:23105/266 Land Info Acres: 0.33 use: Single Fam MDL-01 zoning:RB Neighborhood: 0104 Topography:Level Road:Paved utilities:Septic,Gas,Public Water Location: Construction Info Ouilding Nolyear Buil Gross Area iving Are Bedrooms Bathrooms 1 11976 11804 11032 12 Bedroom 1 Full-1 Half Buildings value:$88,200.00 Extra features; $19,600.00 Land value: $69,800.00 I. http://issgl2/intranet/healthMaster/HealthMasterDetaii.aspx?ID=292057 1/4/2017 Town of Barnstable �1NE Regulatory Services Thomas F. Geiler, Director iLUM A LL ,AS& Public Health Division 639. Thom-as McKean, Director 200 Main Street, Hyannis,,MA 02601 Office: 503-36'-464. Fax: 503-790-6304 Installer & Designer Certification Form Dater Sewage Permit# Assessor's Map\Parcel�-6 Designer: !JG - Installer: lkh-za �0_� Address: E - B(i_Y��7 address: Q , c_S/ 6- SSA�vw�" AA4. 10?_S3 q 0 j On 1 d1j&, vas issued a permit to install a (dat (installer) septic system at 10U %Cel%y P�'�� based on a desi�?n drawn by (address)� l2 V Gt.Y✓�vr l�'r'fP�e�G✓ dated (p/ �/09' (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation o'the distribution box ands or septic tank. I certify that the septic system.referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MAss9 A N j lti /'lam 1N (Installe?s'SI2nature ' No. 1140 l (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO B RNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORNI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PU43LIC HEALTH DIVISION. THANK YOU. Q: Heal th/Septic!Designer Certification Form 3-26-Od:1doc a No. ' T, �3 Fee f/ THE COMMONWEALTH OF'MASSACHUSETTS, ' 'Entered in computer: 6/-- . PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Yicatton for �N! Upgr Y *w�tem �Con0trurtton Vermtt Application for a Permit to Construct( ) Repair ade( ) Abandon( <) •❑.Complete System_❑Individual Components 4, Location ddress or Lot No. /00 VD Owner's Name,Address,and Tel.No. ` Assessor 4 Map/Parcel ©� C.(J-� . Installer's N e,Address, d Tel.No.l'.�q 1r7 r t V I A)6 Designer's Name,Address and Tel.No. P�ko V , ! 0 T34X g8/ ;SSTs tivcv�c/f Type of Building: Dwelling No.of Bedrooms /✓ Lot Size d sq.ft. Garbage Grinder ( ) { Other Type of Building S No.of Persons• Showers( ) Cafeteria( )Y Other Fixtures Design Flow(min.required)0 gpd Design flow provided 33 •9� gpd Plan Date Number of sheets Revision Date Title t Size of Septic Tank MOO Type of S.A.S. 0 s — _2 Description of Soil t Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' Agreement: 'y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f ealth. ! " Signe Date 3 e" Application Approved by Date o Application Disapproved by: i Date for the following reasons ! a Permit No. 24�' Date Issued 7 7 0 r �f' J�.�IJI}�^o '^'Y��'`'� q.b�� { ';�s''4�''.j��� �'v�'..c*�,i•`-.. ��.�;,a'1,,,; �7' 20o - A3 ,-,.- -- , . No. 1C`. n Fee (/ �' � Entered in com uteri TH&—,GQI►#)I�AONWEALTH OF MASSACHUSETTS p - " PUBLIC HEALTH DIVISION - TOWN OF B RNSTAB.LE, MASSACHUSETTS Yes Y Zlppli.cation for -Mi5pooal �bpotetn Con0truction-Vermit- Application for a Permit to Construct Repair� v rade F' Abandon PP. ( ) P Pg ( ) ( ). El Complete System ❑Individual Components Location Address or Lot No. /��� L�,, p Owner's Name,Address;and Tel.No ) / /A- . Pyl a, (�aft/ � Assessor's'Map/Parcel D- OWNED Installer's N e,Address,and Tel.No.� �h,� �f'��� Designer's Name,Address and Tel.No. ✓��—'V �� 5 Type of Building: Dwelling No.of Bedrooms DLot Size C 0 O sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures '� ? Design Flow(min:required) (, gpd Design flow provided �/ •9.� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ���(� .Type of S.A.S. - Jo S — f 1 �a , 11 Description of Soil ;\ i Nature of Repairs or Alterations(Answer when applicable) tp w L Date last inspected: Agreement: The undersigned agreesKo ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with;the provisions of Title 5 of the Environmental Code and not to.place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r Signed />'' i�L' Date 3 Q Application Approved by IP_ " Date Application Disapproved by: Date for the following reasons Permit No. �� ? x Date Issued 7 1 o r _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS \ 1 Certificate of Compliance r _ THIS IS TO CERTIFY,that the On-site Sewage Disposal Sy tern Constructed ( ) R\paired (tom) Upgraded ( ) Abandoned(, )by at has been constructed in accordance with the provisions of Titlg 5 and the jo sposal System Construction Permit No. a06 — 3 dated U Installer / / Designer #bedrooms 3 Approved design-flow S / gpd The issuance of this p it s 'all n j G�a construed as a guarantee that the system I�funitipn as designed.10? Cn Date Inspector/ /�; /Vf • ———————— �—— ---- No. ) .. Fee bQ .. . / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Miopo,5al *p5tem ConotrUction Permit Permission is hereby granted to Construct ( ) Repair ) Upgrade ( ) Abandon ( ) System.located at 00 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Co71 Par etion must be completed within three years of the date of this Date Approved by � COC�w; I hod lrie -5J� �cl„u�, 1 ��,��%1��� w, wM -I,,,�" s,,l�,�,�c ► P# .Gown of Barnstable. 4 . Department of Rel atory Services • ' lit Health Division Date— D Pub e$ 200 Main Street.Hyannis MA•02601 „^ ' Fee Pd. D Date Scheduled I Tame so i Suitability Assessmeni for Sewage Disposal Performed By: Witnessed By: AAq LOCATION& GENERAL INFORMATION Location Address , / �// E/ R Owner's Name �0 P 0j DU ./ `....� I o� LSO bPno�l Only �r� :i t Y�!v�! i Address �SDRU t N E L CM ID AW A 9Z61g Assessor's Map/P4rcel: 2 6 2/ J1. 1 Engineer's Nam1.e i NEWCONSiRULON REPAIR Telephone# Land Use l Slopes(%) .F . .Surface Stones /1411 } Possible Wee Area Oft Drinking Water Well __.�:s2._ft Distances from: Open Water Body_ tt�_ Drainage Way ft Pro Line . 70 ft Other ft g Y . , p SKETCH:(street name,dimensioos'of lot,exact locations of test holes&pert tests locate wetlands in proximity to holes) Co� P kof eFQP /12—r-- CD I I Parent material(geologic) I Depth t0 Bedrock _SjA___� Depth to GroundwaWr. Standing Water in Hole:' A1,1Ai Weeping from Pit Face Estimated Seasonal high Groundwater N DtT.MVIINATION FOR SEASONAL HIGH WATT T"LE Method Used: Depth ►,�b,�erved standing in obs.hole —__in. Depth tc soll mottles: ft- Depth toiweeping from side of obs.hole: i in. Groundwater Adjustment lndex Well# . Reading Date: I dex Well level ! 'A .factor.�,.��- Adj.tirnunAwaterlevel.•,•,_, ! Date 'x — PERCOLATION TEST Observation / 3 I Time at 9" Hole# I Time at 6" • Depth of Pero 0$ `t 16 Time(9"•6', Start Pre-soak Time. 2-1 @ End Pre-soak LZ i ' Rate MinJlnch '" / Site Failed; Additional Testing Needed(YIN) Site Suitability Asse0menG Site Passed_L`— Original.Public Health Division Observation Hole Data To Be Completed on Back— ***If P ercola jinn test is to be conducted within 100' of wetland,.-You>m�1 p t first notify the n..,...crahlr.rA servation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ' Other .Surface(in.) ' - (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.9bGravel) 0 - 4- o 'N A 41/_Z 1`) W nGJ v A e • ,, f�►t G. 2 7 Nfl r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon-,• Soil Texture Soil Color'r�, ' Soil. 1.0 Other ' Surface(in.) • •`•C •;,„ ` (USDA) (Munsell) Mottling (Structure,Stones,Boulders. y 1 - C6nsiitency.%Gravel) 1 / DEEP OBSERVATION HOLE LOG Hole#j_, Depth from' Soil Horizon Soil Texture Soil Color Soil ti- "OtherY Surface(in.), (USDA) (Munsell) Mottling;• (Structure,Stones,Boulders: - ' 3 ons itec 0 ve -7 29 Low 51W l lx2ll DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi t 0,1 8' •t $ 241 b � Flood Insurance Rate May: Above 500 year flood boundary -No— Yes Within 500 year boundary No X Yes • Within 100 year flood boundary Not Yes , Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s immaterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per tous material4 •F_____.,__..- .. Certification ' I certify that on (date)I have passed the soil evaluator examination approved by the Department-of Environmental Protection and that the above analysis"was performed by me consistent with the required trat g,expertise and experience described in 3:10 CIvIIt 15.017. D'ate�4 v SiSignature05 ' " Q:\SEFTICIPERCFORM.DOC SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatu �� yc"\ item 4 if Restricted Delivery is desired. X �� r7Dggent ■ Print your-name and address on the reverse ❑ABdressee so that we can return the card to you. B. VI!vedy rfn of Delivery ■ Attach this card to the back of the mailpiece,or on the front if space permits. �^Y D. ddress different from Item tit❑_Yes 1. Article Addressed to: If YES,enter delivery address below: O No I W tQ,1S ���t3a� I j s7. s2, 3. Service Type iN e/ C cvz ' g ®Certified Mall ❑Express Mail ❑Registered $Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Ekba Fee) ❑Yes 2. Article Number (Transfer from service fabeq 7006 215 0 - 0 0 0 2' `1-0 4 2. 0194 PS Form 381,1,February:2004 i 1 Domestic Return Receipt 102595 o2-M 15ao UNITED STATES,POSTAL SERVICE; First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable } 1:11 Health Division I' 200 Main Street-' 1 Hyannis,MA 02601 ++tt i�i}iililiii iiitttii.11iii:iii'i-1Ii1 ' )lilii'ilifli il1ii ii)ii,l T1 fi tl ok Town of Barnstable Barnstable AlMmedcaGdy Regulatory Services Department , P y BARNSrA M p MAS& Public Health Division i639. ♦0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 19, 2008 Wells Fargo Bank Option One Mortgage 6501 Irvine Center Drive Irvine, CA 92618 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 100 Kelley Road, Hyannis MA was inspected on February 8, 2008,by Robert Paolini, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System shows.signs of hydraulic failure. Stain lines in pit were above invert pipe in leaching pit. Observed solids on top of invert pipe in leaching pit. You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1042 0194 Q:\SEPTIC\Letters Septic Inspection Failures\100 Kelley Road.doc i 'Town of ]Barnstable Barnstable�F YHE Tpw , Regulatory Services Department "'�'ca9 RA .sl'AULE. '3 MASS. R Ok .p,� _• . 1639. Public-Health Division °ATfO MAC p' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304. Thomas A.McKean,CHO February 19, 2008 John Perry 100 Kelley Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 100 Kelley Road, Hyannis MA was inspected on February 8, 2008, by Robert Paolini, certified Title V Septic Inspector for.the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System shows signs of hydraulic failure. Stain lines in pit were above invert pipe in leaching pit. Observed solids on top of invert pipe in leaching pit. You are ordered to repair or replace the septic system.within Two (2) years from the date you receive this notification. Failure to-repair/replace the septic system within the deadline period will result in future enforcement action. PER O OF TH BOARD OF HEALTH E omas McKean, S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 6834 Q:\SEPTTC\Letters Septic Inspection Failures\100 Kelley Road.doc I.. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �1 100 Kelly Road Property Address � \ John Perry Owner Owner's Name information is c� required for Hyannis Ma. 02601 2/08/2 ,08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not7 a altered in any way. -X, Important: A. General Information When filling out forms on the computer,use 1. Inspector: , only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number. B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: / ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 2/08/2008 Inspec or'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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 100 Kelly Rd.-12/07, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Sollids on top of invert pipe in leaching pit.Stain lines in pit show it has been full. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is ' structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'F -100 Kelly Road. .y Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.)- t . B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced - ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed - ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b.)that the system is not functioning in a manner which will protect public health; safety and the environment: ❑ -Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 ComMonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address - John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (coat.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a(DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 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 El 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 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts F Tit.le 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ 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. 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 El 1-1 Area 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. 100 Kelly Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road - Property Address. John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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 n'ot available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑• Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection J D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual). 2. . DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 330 Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? - ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Ye`s ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name ' information is Hyannis Ma. 02601 2/08/2008 required for y , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection?- ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool / ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. _ ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1976 Were sewage odors detected when arriving at the site? ❑ Yes ® No 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 18 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: 8'6"x4'1 0"x57' Sludge depth: $ - Distance from top of sludge to bottom of outlet tee or baffle 24 8" - r Scum thickness 5" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 6 How were dimensions determined? Measored 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 J _ Commonwealth of Massachusetts v W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally. i 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.): 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): 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry 1 Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 • every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate'on site plan): Depth of liquid level above outlet invert D-Box not present Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ElYes ❑ No Alarms in working order: ❑ Yes ❑ No 100 Kelly Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. 02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000gallon ❑ leaching chambers number: 1 ❑ \ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.Shows signs of hydraulic fail ure.Stain lines in pit were above invert pipe in leaching pit.Observed solids on top of invert pipe in leaching pit. 100 Kelly Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road Property Address John Perry Owner Owner's Name information isHyannis Ma. 02601 2/08/2008 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ® � Zoom Out J J J J'fl J JIn • ' •20 Feet —= S _. J Set Scale 1" = 20 I Aerial Photos �] (`nnarinhf 9f1(1F_9M7 T—.—of Rarnetahle AAA All rinhfc rocen• http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=292057&map... 2/12/2008 -Comm, onwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Kelly Road, Property Address John Perry Owner Owner's Name information is required for Hyannis Ma. '02601 2/08/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: �® Check,Slope ® Surface water ® Check cellar ❑ Shallow wells " Estimated depth to high ground water: Bottom of LP 35' 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) t, ® Checked with local Board of Health -explain: As-Built Card ❑ / Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain': You must describe how you established the high ground water elevation: USED-Oaherty& Miller model 12/16/94 ground water elevations.USED:USGS Observation Well Data.USE D:Technical-Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. . i 100 Kelly Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable- Op IME r, ' Regulatory Services ,,S,,,B Thomas F. Geiler,Director MASS. i639. Public Health .Division AIEo�,v A Thomas McKean,Director 200 Main.Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of.Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system.in the future . nor does this.Division agree with any technical observation sand interpretations contained within this report. - I -1 In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed"within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Town of Barnstable LL09Z03a08J 0311VIN ° Public Health Division £Z909b00o *q, ";�AB1ma 200 Main Street v� Zo MA 02601Hyannis, roW _ 21'50 0002 1038 6834b1s0d y�y� . aExorn u t ❑Undeliverable as 'c"'' 'arable as Addressed RETURN RECEIPT`'yj"d µ� = NoAddreQUESTED -�` No AddreQ' � Unclai ed �' '"d 1 st NOTICE h . ._ .. .- •�^/LY,w'ri+rr,q,.,-a.sa.•�..n- � ajy,:,..<:a.. •>...�� s FY' :1: � 777 �� ;�.ed,Not Knowh`+� "1_ 2nG NOTICE DAttempted,Not Known _ ❑No Such Street �-''-'Such Street At'TURN ONo Such Number ❑No Such Number ❑No Rece tcle ONO Receptacle 029 N'7E I -10ec 02 a v2,1 Wig/ot3 P NOTIFY :SENDER ®F NEW ADDRESS w , - ❑Deceased PERR y3�/ :°{3'2?•"•ww w_ 'pi^'k _R' 'r� 1rF % G w.._ 1tJ08• �Pe+"—J'r3� i:�l ,;.. ,�;• -...Jr-.a. jir d<'�`.�tr 9T,`.:.•,�x`6►''kzS�'�"'F�*�v,'�.a< 3"a'. � � �-t ten°`� Y i, . 1{ p :'Y .�,i.��:,C•.-r,f. •�.� l;. ._,,. e }:3•jJn a _ jt! t r.i_ -1. - a 4:-• - — _ ti COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature. item 4 if Restricted Delivery Is desired. ❑Agent.• I, i ■ Print your name and address on the reverse X ❑Addressee V 1` I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery 1 V ■ Attach this card to the back of the mailpiece, 1 I or on the front if space permits. D. Is delivery address different from item 1? ❑Yes ' • 1. Article Addressed to: RYES,enter delivery address below: ❑No I ` 3. Service Type ❑Certified Mail ❑E)wm Mail I d a �gl ,!'t o2la�t ❑Registered- o Return Receipt for Merchandise I ,� I ,a .❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?pit Fee) ❑Yes 2. Article Number I Oyaryrftmse,,,tcef 7006 2150 0002 1038'"6834 i£'!" R ►•'s dAnk � ^�n11 $11:Febn!ary 200 I] s�:-o...,rgtisa a. is p �,r,+ 102595-W M-154o V1t Alt lit t#!! ! !4 -�.d._Ilttlt [t!} i4lislslt •+1lEt{ � - - ; Town of Barnstable Barnstable OtIHE Taw � ti Regulatory Services Department ;micaC-1 HARN.WAB�E, I 6 Public Health Division Elm A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 19, 2008 John Perry 100 Kelley Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The•septic system located at 100 Kelley Road, Hyannis MA was inspected on February 8,:2008i by-.Robert,Paolini, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System shows signs of hydraulic failure. Stain lines in pit were above invert pipe in leaching pit. Observed solids on top of invert pipe in leaching pit. You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER O OF U. i BOARD OF.HEALTH, f15 ' omas McKea , S ,-CHOq Apent:of the ,pardrofsHealth d b .-. .r_. . A_ CERTIFIED,MA,IL#,7006.2150 0002 1038 6834 . Q:\SEPTIC\Letters Septic Inspection Failures\100 Kelley Road.doe DATE:-10/10/95___ PROPERTY ADDRESS._100 Kelly Road ______ Hyannis ------------------------ Mass . 02601 ---------------------- On the above date, I inspected the septic system at the above address. This system consists, of the following: 1 . 1 -1006 gallon septic tank. � . a 2. 1 -1000 gallon leaching . pit . ►_ Based on my inspection, 16erti:fy he following conditions: 1 . This is a title five septic system. ( 78 Code) 2. No Distribution box present . 3 . Tee is missing one-e1,o: utlet end of the septic tank. 4. The septic system is in proper working order at the present time . SIGNATUR Name: Joseph P.-Macomber Jr_-- .J.P.Macomber & Son Inc Company-------------------- Box 66 O :� Address:-------------------- Centerville ,Mass _ 02632 P h o n e: 59�-225---3 33 8------- s � THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 3 � Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Govemor Trudy-Coxe • Secretary,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION roperty Address: 100 Kelly Road Hyannis ,Mass . Address of Owner:Edward Leslie ate of Inspection-1 0/1 0/95 (If different) 258 North Street ame of Inspector: Joseph P.Maeomber Jr. Hyannis ,Mass . 02601 Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I cenif�, that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XXXX Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: N, Date: 10/10/95 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: _21 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 6 Any failure criteria not evaluated are indicated below. 61 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, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. w (revised 8/15/95) 1 One Winter Street 0 Boston, Massachusetts 02108 0 FAX(617.) 556-1049 0 Telephone (617)292.5500 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Kelly Road Hyannis ,Mass Owner: Edward Leslie Date of Inspection: 1 0/10 9 5 B] SYSTEM CONDITIONALLY PASSES (continued) i A,/ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken; settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken,pipe(s) are replaced obstruction is removed distribution box is levelled or replaced d/ 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: _4Z 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: Al— Cesspool or privy is within 50 feet of a surface water .A,( 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 FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 1/ The system nas a septiL tdnic and 5011 absorptiun systen•, and is within 100 fee', to a surface: v;ater supply cr tributa.,, tc a surface water supply. A(. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. I The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systen•, 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 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• D] SYSTEM FAILS: 4 1 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 should be contacted to determine what will be necessary to correct the failure. 2/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Al Discharge or ponding of effluent to;the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised.8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 100 Kelly Road Hyannis ,Mass . 02601 Owner: Edward Leslie Date of Inspection:) 0/1 0/9 5 D) SYSTEM FAILS (continued): •` 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 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 AZ 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 1 of.a public well. Any portion of a cesspool or privy.is within 50 feet of a private water supply well. 4Z 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 large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) 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. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 100 Kelly Road Hyannis 'Mass 02601 Owner: Edward Leslie • Date of Inspectional 0/1 0/95 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 at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. 2As 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. The system does not receive non-sanitary or industrial waste flow IThe site was inspected for signs of breakout. 2AII system components, `e�Kcluding the Soil Absorption System, have been located on the site. -,/-The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. 2The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. Zhe facility ov.ne: tand occupants, if different from owner) were provided with information on the proper maintenance of.Sub- Surface Disposal System. Recommendations 1 . New line from the septic tank to a new distribution box. 2 . Install new distribution box. 3 . Install new tee set up in the outlet end of the septic tank. (revised 8/15/95) 4 , 1: t SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .100 Kelly Road Hyannis Mass 02601 Owner: Edward Leslie. Date of Inspection: 10/1 0/95 FLOW CONDITIONS RESIDENTIAL: Design flow:]LgjQ gallons RVAJ4Y Number of bedrooms: Number of current residents:fZ Garbage grinder(yes or no):,�� Laundry connected to system (yes or no):_)k.5 Seasonal use (yes or no):,JA1 G,�. V� �.e, a J �' -V S ,edke Water meter readings, if available: S 6 _ I• Last date of occupancy: 14MA,, COMMERCIAUINDUSTRIAL: � ' Type of establishment:. Design flow: allons/day Grease trap present: (yes or no),A2R Industrial Waste Holding Tank present: (yes or no) Q n-sanitary waste discharged to the Title 5 system: (yes or no) Vater meter readings, if available: Last date of occupancy: OTHER: (Describe) y Last date of occupancy: / GENERAL INFORMATION PUMPING CORDS nd source of inform on: I System pumped as pan of inspection: (yes or WAD If yes, volume pumped: =)_ allons Reason for pumping: TYPE OF SYSTEM Septic tank/diucibuiieci-besJsoil absorption system _o Single cesspool All)? Overflow cesspool Privy A10 Shared system (yes or no) (if yes, attach previous inspection records, if.any) ,V Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: wage odors detected when arriving at the site: (yes or no)4&9 `kO ;(revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 100 Kelly Road Hyahni s ,Mass . 02601 Owner: Edward Leslie Date of Inspection: 10/10/9 5 • a SEPTIC TANK•1-1000 9A11.0v jct4;4 (locate on site plan) Depth below grade: Material of construction: _Concrete_metal _FRP_other(explain) Dimensions: Sludge depth: 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 orbaffle:_tl Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ' L dg 'c y, GREASE TRAP: (locate on site plan) Depth below grade:AO Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance,from top of scum to top of outlet tee or baffle:-&i Distance from bottom nr sr(Im to honom or outlet tee or baffle: Comments: (recommendation for pumping, conditio of inlet and outlet tees or baffles, depth-of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ! , revised 8/15/95) 6 4 � u SUBSURFACE SEWAGE DISPOSAL.•SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 100 Kelly Road Hyannis ,Mass . 02601 i Owner: Edward Leslie ' Date of Inspection) 0/10/9 5 TIGHT OR HOLDING TANK: a (locate on site plan) Depth below grade: Material of constructi n: _concrete_metal _FRP—other(explain) Dimensions: Capacity: r allons Design flow: allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float swiiches, etc.) DISTRIBUTION BOX:,k�we_ (locate on site plan) Depth of liquid level above outlet invert: ; Comments: (no level leve�yl and distributiur equal, evidence f solids. carryover, evidence of leakage into or out of box, etc.) - �t,l!�`T/Gl��/!/,•'lU /,�JA X <<il]� �v-icsLmf('� PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condi ion of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 i SUBSURFACE SEWAGE DISPOSAL,SVSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:' 100 Kelly Road Hyannis ,Mass . 02601 Owner: Edward Leslie Date of Inspection: 10/10/9 5 SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if possible; excavation not required, but n16y be approximated by non-intrusive methods) ' If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (no a conditio of soil, signs of hydraulic failure, le v I of ponding, condition of vegetation,etc.) i CESSPOOLS: (locate on site an) Number and configuration: — Allw- Depth-top of liquid to inlet in e : Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Commen s: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: ^, (locate #1te plan) •:.1..` "' Materials of constructio Dimensions: Depth of solids:�d • Commen^ts.�note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) B (revised 8/15/95) $ "i;::•:; •;t'f.} . I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION (continued) Property Address: 100 Kelly Road Hyannis ,Mass . 02601 Owner: Edward Leslie Date of Inspection: 10/1 0/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: ! include ties to at least two permanent references andmarks-or benchmarks locate all wells within 100' • I 1 1 I I • I DEPTH TO GROUNDWATER Depth to groundwater:/&'� feet ,� met od of dete inat' nor ap ox�/tion: /1d a e �� d7 i _ I (revised 6/15/95) 9 E;r, ,to, \ 1 r. .: .i �'•. •r.rerc-.�rmr.�re.r.r—••F I '1'UHN OF _a � tablo BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTF,M IN9PECTION FORM - PART D •- CERTIFICATION �/ �•••T,•,-T••.-;:.��.TIT.-.�T.T.T.'T,•R:TT..T�trTTn'r.•.•ir.•tt>Tr�O TTRSr Tt11TC..aC�,ri1'rl'M1T4 RR.nTTl'lelSiPt .� RTr'1'f'1•.TI•!'T'7T•1 '� -TYPE OR PRINT C1.EARLY- PROPERTY INSPECTED STREET ADDRESS _ 100. Kellv Road Hvannis .Mass . ASSESSORS MAP, BLOCK AND PARCEL # a , OWNER' s NAME Edward Leslie PART D - CERTIFICATION Y NAME OF INSPECTOR jna p_ph P_Ma enmhPr .Tr- COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66'. Centerville ,Mass . 02632 Street Town, or City State LIP COMPANY TELEPHONE ( 508 } 775 - 3338 FAX ( 508 1 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the. information reported is true, accurate , and complete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: }X,K System PASSED The inspection which"I have conducted has not found any information which indicates that- the system fails to adequately protect public hea1Lh or Lhe environment as defined in 310 -CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specificall.y. noted on PART C - FAILURE CRITERIA of this inspection form . AWInspector Signatur - Date 10/1'0/95 One copy of is certification must be aP'.� provided to the OWNER, the BUYER •( where applicable ) and the DOARD OF )JEAL'I'il. ' If the inspection FAILED, the owner or operator shall uPgrade ' the within one -year of the date of the inspection, unless allowed or re uiay8te' otherwise as provided in 310 CMR 15 . 305 . q s • ". ` p !f C., mcsza.. Seri' Erecu^Ne v,r;,;ce cr tnvlrcnmen,c, DePariment of Environmental Protection ' Warer Pollution CcnTrol Tecnniccl Assocnce ana Training Sec^ons wlw..m F.We4d Trudy Cox* •u•�r.EGEA Thom&* 9. Pawws m 06/12/1)') A'CTN: Joseph P. Macomber, Jr. Joseph Macomber and Scm PO Box 66 Centerville, MA 0263:'- Dear Joseph P. Macomber, Jr: . , I am pleased to inform you that 'you have ascended training, met the experience qualifications, ,and have passed the Title 5 System inspector exam, pursuant to 31d CMR. 15 . 340 . '1'lie passing grade for the exam was 39/52 or 75% . This is an official noCificdtion that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E. P. Training Center 50 Route 20 Millbury, MA .01527 Thank you Very much f0 /O ':' t1l'ne al'ld conSideratiaii in this matter. Sincerely, Kimba11 DEP 'rrain:nq ::r Direccc:' 2 9 0 5) n • Millbury, MA FAX 5:8-755.925J • n• 50&756-77°' n0U10 1 I ^ Water . ConStrvati®n SAVE Tips 0 0 i ME. CHECK{ FOR LEAKS Water Loss in Gallons Du.e to Leaks Leak this Loss Per Day Loss Per Month Size • _ 120 3,600 • 360 10,800 693 20,790 • 1,200 36,000 ® 1",920 57,600 ® 3,,096 92,880 4,296 128,980 ® i,640 199,200 E6,984 200,520 8;424 252,720 9,888 296,640 11,324 339,720 12,720 381,600 14,952 448,560 f ✓(/ V r ��J gee LOCATION ]�, AGE PERMIT N0. 75 VILLAGE Nltf/S INSTALLER'S NAME & ADDRE S /V BUKDER OR OWNER DATE PERMIT ISSUED fZ _ �G DATE COMPLIANCE ISSUED i .� „ r � .� 0 �g� =,L 9 - - �p 1� 7r . _ I .. . �� `_ ,._ I, �� TOWN OF BARNSTABLE 'LOCATION /D 0 A 2 L L Y �GL � SEWAGE # r. ^VILLAGES,4,4oWS ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPAC= LEACHING FACIL=: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility.). Feet Edge of Wetland and Leaching Facility(If-anywetlands exist within 300 feet of leaching facility) Feet Furnished by 10 /A 4 G 0 If S dew �,° �.� i \,- O � � r i� � �� � � � � � i ��-- "'M I ,� .t. • , • { .. :i �. LEGEND ''` ' `.,��, ;w; �, 1, -cod►.4,u .� ..,;, : .?� •������ OF MASs9 PROPOSED CONTOUR � •.c . of � D E M. s PROPOSED SPOT GRADE EXISTING CONTOUR !7 " ,No. 1140 + 96.52 EXISTING SPOT GRADE Rasl 28- -FatmC W— EXISTING WATER SERVICE TEST PIT e' ? \ ��' 0 - - - - - - ;�---------------• ------.-L.----------------------- A . - �-- I -1 ( :�; ,�' .,ka• ;�, ,,.: LLt '. oil i �� i \\ \\\ N - - -- LOCUS MAP N.T.S. n w12 `t GENERAL NOTES: > >y� Q I I \ // a �� R I 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �i ► I I BOARD OF HEALTH AND THE DESIGN ENGINEER. t I E y I _T I I�G , I I 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS r O I I I ! OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE Li 0° ' DWELLING ' I LOCAL RULES AND REGULATIONS. j Q.� j O I o / I I I / 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR �p rt w TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE � I t I DESIGN ENGINEER. / TOP OF F DI`I I / l �p����,, I //� � 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I'"P cEOf-- ©�i!' W.4 EL = 52.07 J / I / I v- FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 1 P O ENGINEER BEFORE CONSTRUCTION CONTINUES. 1 i 7Feyl� (,pG,1 nay i / I / ! 0 W 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.i 0) 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF I I // I ° / / HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PA V E D DRIVEWAY I / 14? I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. { c // N I I 8 TOLA CONDITTION AGREED DISTURBED UUPONRING CBETWEENTOWNERION HAND BE C ONTRACTOR. RESTORED ---------------- � ��� / I y 0rod / 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE / \-O { y� / �O / THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I �O OF O /i I J� �/ / I CONSTRUCTION. i10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY I / y 1._-.-.-_-._-._-.-_-- 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. ag160.00 ftca a� 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED) 16. PROPOSED SEPTIC SYSTEM IS NOT LOCATED WITHIN NITROGEN SENSITVE AREA. r' 0� °0- G 0C, 52• v��` PROPOSED SEPTIC SYSTEM UPGRADE PLAN 100 KELLEY ROAD, HYANNIS, MA \ Prepared for: Mike Dedecko SURVEY REFERENCE: MAP.- 292 Engineering by: Surveying by: SCALE DRAWN JOB. NO. LOT.-057 DARRENM.MEYER,R.S. Eco-Tech EnvYronmenteJ 1"=20' DMM PLAN OF LAND BY WHITNEY & BASSETT ENGINEERS. DEED BOOK:13140 PO BOX981 (508) 364-0894 DATED: JUNE '1941 �i EAST SANDWICH,MA02537 DATE CHECKED SHEET NO. B DEED PAGE 146 508-362-2922 06/27/08 DMM 1 Of 2 k ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) I = 52.07 --F.G .EL 50.5 FINISH GRADE= 48.5 F.G.EL: 49.95 F.G. EL::48.5 ` MAINTAIN 2%.MIN SLOPE OVER LEACHING AREA MAX. COVER OVER LEACHING = 3.0 FT. w COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT r W/IN 6" OF FINISH GRADE :. 6„ "... 4" SCH 40 PVC @S=2% 10 I ' 4" SCH 40 PVC 0 0 0 0 0 0 a 0 0 0 a a (MIN.) 14' :INVS=481703 (MIN.) S= 1% MIN TEE'S ARE TO BE 4" SCH 40 PVC INV.46.7 a a a 0 a a 0 0 0 0aa INV.46.5 EXIST. OUTLET BAFFLE AS PROPOSED DB-3 0 0 0 0 a 0 0 0 0 0 0 a • H-10 DISTRIBUTION BOX INV. 48.25 EXISTING 1 ,000 GALLON SEPTIC TANK INV. ELEV.= 45.75 GAS BAFFLE TO BE INSTALLED ON NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING OR21 A"oousa , s 1 9" MIN. OUTLET TEE AS MANUFACTURED BY PIPE INVERTS PRIOR TO CONSTRUCTION PER TI TLE 5 TUF-TITE, ZABEL, OR EQUAL 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT EL. = 46.25- GRADE ON A MECHANICALL COMPACTED SIX 1P1V ELEV.= 45.75 INCH CRUSHED STONE BASE, AS SPECIFIED,IN OF 310 CMR 15.221(2) DOUBLE w,isrrm' ri:sw 24'0 MAsf9�' 3) TANKREP�WITHCE X1500G 1,000 GALLON SEPTICBOTTOM EL.= 43.75 GALLON TANK IC lNl/ERT DAR N M. IF FAILED, DAMAGED, OR UNDERSIZED. IGI 4) INSTALL INLET & OUTLET TEES AS REQUIRED ---�48" 50 8" No. 1140 y SEPTIC SYSTEM PROFILE SEPARATION 5.50 FT. - 146'8 I N.T.S. ANIT00p� BOTTOM OF TH-1 EL: 38.25 SOIL ABSORPTION SYSTEM (SECTION) 0?- P : 12259 SOIL LOGS i DESIGN CRITERIA + NUMBER OF BEDROOMS: 2 BR ACTUAL/3 BR DESIGN (SYSTEM NOT IN ZONE II) DATE: JUNE 26, 2008 'r SOIL TEXTURAL CLASS: CLASS I. (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI DIN KI T DAILY FLOW: 110 G.P.O. DESIGN FLOW: 330 G.P.D. HEALTH AGENT GARBAGE GRINDER: NO not designed for TH-4 �` Bth ( g garbage grinder) Elev. TH-1 Depth Elev. TH-2 Depth Elev. TH-3 Oepth Elev. Depth SEPTIC TANK: 330 gpd x 2 = 660 gpd USE EXISTING 1,000 GALLON SEPTIC TANK 48.75 0" 48.25 0" 48.8 0" 48.4 A LOAMY SANG A LOAMY SAND A LOAMY SANG A LOAMY SANG 0" LI V. RM (330) = 445.94 S.F. 10YR 3/1 10YR 3/1 1OYR 3/1 10YR 3/1 I LEACHING AREA REQUIRED: 74 48.42 B 4" 47.92 B 4" 48.22 B 7" 47.73 g" LOAMY SAND LOAMY SAND B USE THREE (3) INFILTRATOR 3050 UNITS WITH 4 FT. STONE 10YR 6/8 10YR 6 8 LOAMY SAND LOAMY SAND ( , / 10YR 6/8 10YR 6/8 1 FIRST FLOOR ON THE SIDES & 1.3 FT. STONE ON ENDS: 25' L x 12.16 W x 2 D BOTTOM AREA: 25 x 12.16 = 304 SF 46.33 Cl 29" 45.75 Cl 30" 46.47 C1 28" 45.98 Y9" Ci .E SIDE AREA: (25 + 12.16) X 2 X 2 = 148.64 SF r E TOTAL SQUARE FEET PROVIDED = 452.6 vs. 445.94 REQ'D I& PERC 0 44.33 I BR JBR DESIGN FLOW PROVIDED: 0.74(452.6 S.F.) = 334.95 G.P.D. vs. 330 G.P.O. req'd BthMEDIUM MEDIUM MEDIUM MEDIUM SANG SAND SAND PERC 043.98 SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN � 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 I OPEN TO BELOW 100 KELLEY ROAD, HYANNIS, MA Prepared for: Mike Dedecko Engineering by: Surveying by: SCALE DRAWN JOB. NO. 38.75 120" 38.25 120" 38.8 120" 38.4 132" DARRENM.MEYER,R.S. N.T.S.PERC RATE <2 MIN/IN. ("C" HORIZON) SECOND FLOOR Bco-Tech �vlronmentel DMM Po BOX 981 NO GROUNDWATER OBSERVED PERC RATE <2 MIN WA ("C" HORIZON) �` EASTSANDWICH,MA02537 (508) 364-0894 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED 508-362-2922 06/27/08 DMM 2 Of 2