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HomeMy WebLinkAbout0250 LONGVIEW DRIVE - Health Hyannis F/R A = 251 140 r Town of Barnstable �Z"E�y- Regulatory Servir - — _'Y� . Richard V.Scali,Direct pL,,_ 1 ,260:376 12-17-2014 10:39 BARNFrABI$ MAftBuilding Di'v1si0 BARNSTABLE LAND COURT REGISTRY Tom Perry,CBO,Building Con......,.,.,,.... 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I, the undersigned,being the owner of property situated at 250 Longview Drive,Hyannis,MA holding title under a deed recorded with the Barnstable County District Registry of the Land Court as Document No. C198574,being shown on Assessors' Map 251 as Parcel 140,hereby agree,certify,warrant and represent to the Town of Barnstable that the accessory attached apartment, which contains living quartets, is intended for use as a family apartment,for year-round occupancy. - , This unit shall be used for a"Family Aparunenf'(as defined in Zoning Ordinances)which would require compliance with the Family Apartment Rules and Regulations. The family apartment unit must be occupied only by the property owner or a member(s)of the property owner's family as accessory to an owner-occupied single-family residence. Occupant of Main Residence: Monica Barros C� -5 Relationship to Owner. Owner Resident of Family Apartment Cathie Louise Silva �n t Relationship to Owner: Mother-in-law This unit shall not be rented as an apartment or as a single room,or in any fashion,which rental would be a violation of the Town of Barnstable's rules, regulations,and zoning ordinances. Prior to occupancy of this unit, affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. ¢ This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. z� The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. WITNESS our hands and seals this f(' day of 2 o .- 20_,- TOWN OFBARNSTABLE: OWNER: y. Monica Barros IVaf5a-s Perry,CBO Building Commissioner THE COMMONWEALTH OF MASSACHUSETT BARNSTABLE COUNTY,SS Date Z Then personally appeared the 'above-named (owner), aS and made oath as to the truth of the foregoing instrument,before m Notary Public LSON My Commission Expires: UNDAEY Notary Public gsamplc $ARNSSASLE REGISTRY OF DEEDS- Commonweafth of Massachusetts John F. Meade, Register Omy Commission Expires March 24,2017 TOWN OF BARNSTABLE LOCATION SEWAGE #'4 VII,LAGE ASSE OR'S MAP & LOT�� /7� INSTALLER'S NAME&PHONE N . � r -��9, SEPTIC TANK CAPACrlVAV—Qd/,0X LEACHING FACILITY: (type) NO. OF BEDROOMS. .002 BUILDER O' 0�.' PERMITDATE: l COMPLIANCE DATE: l� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �` ��. � O _ � . �_ � � a� c� � ., a �' _ f f No. 90 0 —A 1i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fppYication for 10is-posal *pstrm (construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NoR Sb A047 v P!<V oil Owner's Name,Address,and Tel.No. Assessor's Map/Parcel A&R4 �,1T-4 r Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Imp as! Rwco-1 /yp C�qiv � 5ZF5 -- r�-r-d7 fK Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided -/ 6. 56 gpd Plan Date,by /�¢ z4y yL Number of sheets l Revision Date Title Size of Septic Tank --6s,4i,,;Z AlnA. Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,C g , A/b�s S/�.S• /I Date last inspected: Agreement: The undersigned agrees to ensure the cons ruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En ironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boarde th. Signed Date rz 6 z4lr Application Approved by c Date 7_6_C l Application Disapproved by Date for the following reasons Permit No. �® ! Date Issued -7—6— (t y_ .).»r�.,...-,y,.�.,i.,. r Oro No. �_ � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation for Nsposal *p. ° stem �D�teIIBtrUttloYC Permit .lS Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components jLocation Address or,Lot NoR S-d- ®I. Ow er's Name,Addres ,q/ p a and Tel.No. ae,e 2 Assessor's Map/Parcel t Installer's Name,Address,and Tel.No. Designer's Name, ,an d Tel.No. p /Li�� asl P�.l iyo Type of Building: ie p Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r�' L Design Flow(min.required) 3 c�,C/J gpd Design flow provided gpd Plan Date/,by /6 1 ?-w t` Number of sheet� / Revision Date Title Size of Septic Tank.E-r/,S14�n,7 141 Type of S.A.S. /1''� ��1/� --Z,,X—,l W.1&cs Description of Soil Nature of Repairs or Alterations(Answer when applicable)4me,%, 'J" 4, �', /�,5�• A PI�D�Pri2 !�C¢.V��i6rt, Date last inspected: Agreement: The undersigned agrees to ensure thjHeth. ruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of tonme 1 Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board j Signed '' Date 7f61u�� Application Approved by ` Date Application Disapproved by Date for the following reasons Permit No. ao f} Date Issued 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 77wo A Z 4,4. at o?Q) k17 (N 9:>"L;Y,-- has been constructed in acco dance with the prop .sions of Title 5 the for Disposal System Construction Permit No. 'Z6F I— .1r4 dated r _q Installer ��'���iti '' �`. Designer #bedrooms Approved design flow U gpd The issuance of this permit sh 11 t 6co strued as a guarantee that the system,will fit * as e 'gned. Date �� InspeSr ------------------ No. l 1 �( L Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 9ppstem ConstCULtion hermit Permission is hereby granteCons tru ( ) Rqpair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co leted within three years of the date of this permie-7-- Date �~ Ci�� Approved by Epp THE Tp� Town of Barnstable '' ` Barnstable Regulatory Services Department 1MASS Iei RARNS TABLE. 639. Public Health Division m i63q. ATED MA�a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.GeilerLeach pit is only3f mndwagter,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5361 June 14, 200d Mr Robert Cataldo 250 Longview Drive Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic-system located at 250 Longview Drive,Hyannis, MA. Was last inspected on 5/19/2011 by P. Scott Campbell, a.certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System should be pumped. •- .Inlet and outlet tees in place; there are no tight seals on inlet or outlet pipes, • Tank is leaking at-both ends of septic tank; evidence of leakage out of tank. - - The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action ER OF THE BOAR�OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc l r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis : Ma. 02601 5/19/2011 every page. City/Town State Zip Code Date of Inspection 3 Inspection iesults 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: A. General Information When filling out 314 �� forms on the computer,use 1. Inspector: 9 only the tab key to move your P,-Scott-Campbell cursor-do not Name of Inspector use the return key. Cardinal Company Name.: 32 Ridgetop Rd. Company Address Cotuit Ma 02635 City/Town State Zip Code 508-420-1295 S1388 Telephone Number License Number B. Certification 1 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 ori�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: ° rV r n ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-19-2011 Inspect6ris Signatu a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. I 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Dispos System•Page 1 of 17 T Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 250 Longview Drive Property Address Robert C'ataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Cityrrown 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 F1 N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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 t5ins.11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I I ' Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 250 Longview Drive Property Address Robert Cataldo Owner Owners Name information is required for Hyannis Ma. 02601 5/19/2011 every page. City(rown 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to.the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El El than depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 . Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Cityrrown 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 ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every 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? ® ❑ 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 isigns of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? . ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): . Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11110 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 M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name inforation e uired forts 4 Hyannis Ma. 02601 5/19/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and, maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•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 M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 11/19/2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 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: l Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Y H annis Ma. 02601 5/19/2011 every page. Cityf town 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 4 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): system should be pumped. Inlet and outlet tees in place. There is not a tight seal on inlet and outlet pipes, tank is leaking at both ends of septic tank.evidence of leakage out of tank. 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Cityrrown 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.): 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Citylrown 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): d-box is 10" higher than outlet side of septic tank. Water does not get to d-box due to improper pitch. 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: S.A.S. unused Dry at time of inspection due to improper pitch from septic tank to d-box t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ 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.).- dry soil, no signs of hydraulic failure, no ponding, normal vegetation. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins+146 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 250 Longview Drive Property Address Robert Cataldo Owner Owners Name information is required for Hyannis Ma. 02601 5/19/2011 every 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.): M t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts fz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is required for Hyannis Ma. 02601 5/19/2011 every page. City/Town State Zip Code Date of Inspection D. 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 t r 12 g 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 M 250 Longview Drive Property Address Robert Cataldo Owner Owners Name information is required for Hyannis Ma. 02601 5/19/2011 every page. Cityrrown 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: 12+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS information Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 250 Longview Drive Property Address Robert Cataldo Owner Owner's Name information is Hyannis Ma. 02601 5/19/2011 required for y every 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 Commonwealth of Massachusetts c Title 5 Official Inspection Forms Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive ' V)l V ) 0-t' Property Address \Nivia Ferreira Owner Owners Name information is Hyannis, MA 02601 12/11/07 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information '- When filling out y, yam. forms on the computer,use only the tab key 1. Inspector: to move your Michael Kellett cursor-do not Name of Inspector : use the return n key. Aardvark Environmental Inspections Company Name P.O. Box 896 Company Address East Dennis MA 02641 Cityrrown State Zip Code 508-385-7608 S13742 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes 0 Fails ❑ Needs Further Evaluation by the Local Approving Authority - 12/12/07 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts _ Title 5 official Inspection Fort Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. Citylrown 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: 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 z 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 t5insp•08/06 Title 5 Official Inspection Forth: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 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis annis MA 02601 12/11/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 fall 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. t5insp•08/06 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 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is Hyannis MA 02601 12/11/07 required for y every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 ® Backup of sewage into facility or system component due to overloaded or El clogged SAS or cesspool El ® 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 %day flow Required pumping more than 4 times in the last year NOT due to clogged or El ® . Number of times pumped: obstructed plpe(s) P P ® 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 16 t5insp•08/06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 250 Longview Drive - — Property Address Nivia Ferreira Owner Owner's Name information is Hyannis MA 02601 12/11/07 required for y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No El ® 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 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. t5insp,OB106 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 e y 250 Longview Drive Property Address , Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. CitylTown 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? ® ❑ 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 approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp•08f06 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 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 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 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. Citylrown 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) EJ 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: 11/19/04 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp-08/0 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page a of 15 " Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is Hyannis MA 02601 12/11/07 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 5.0 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting; evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 4.2 feet Material of construction: El 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: 1000 gal Sludge depth: 4 Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured t5insp-08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. Cityrrown 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.): The tank was sound and tight with tees in place and liquid at outlet invert. r 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): t5insp-08/06 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 .'� 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. CitylTown 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 even 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.): The box was level and tight Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•08106 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 Voluntar y ry Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is Hyannis required for MA 02601 12/11/07 every page. C4 Town State Zip Code Date of inspection- D. System Information (coot.) 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: ® leaching chambers number: 5 ❑ 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.): This system has 5 flow chambers surrounded 3 feet of stone. There was no sign of ponding or failure. t5insp•08/06 Title 6 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 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. Cityrrown 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 b 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.): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 "r1\- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 ' �L\ Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 250 Longview Drive Property Address Nivia Ferreira Owner Owner's Name information is required for Hyannis MA 02601 12/11/07 every page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local'Board of Health-explain: Checked with local excavators, installers-(attach documentation) ® Accessed'USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20 feet t5insp-08106 Title 5 Official tnspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF THE Tp� Regulatory Services STAB Thomas F. Geiler,Director BAMNMASS. 9`b 039. •�� Public Health .Division 'DTFn Mn�" 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 s and interpretations contained within this report. 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 Regulatory Services } Thous F.Geiler,Director ' IAITNSFABLE, • Public Health Division $,p i639• e04i Thomas McKean,Director 20O.Main Street,Hyannis,MA 02601. Office:.508-862-4644. « , Fax: 508-790-6304 Installer &Designer Certification Form Date: / c2N Designer: '"mot Iistaller: � rJ` Address: . Address:on 1 was issued a permit to install a (date) (installer) . r septic system atZ�O G.tl r based on a design drawn LIy (address) W 0'7 ►� ''ram' l�:l �;r4,Q.�LHE,;j �.�.,�,. t4 16 ,�©�':�,=►�lOw :certify that the septic system referenced above was installed substan11a11 according'to he design,_which may include minor.approved changes such as late x=as,relocaticin ®f the distribution box and/or septic tank. .. I ce _;th t the septic to referenc , ' rtifj� ep sys rx►._ ed above was installed with.•.ptalor:changes U,e• greater the 10' lateral reloealibi of the SAS or.-any vertical relooatibn of any comport t of the.septildls-stem)but in accordance with State&Local°Regulations. Plan revis oxk of certified as-t;Yljfby designer to`follow. ,OF,k bAVID: Inst e Signature) O IN iID66 s TP ` gNITAFi1.P� . er s Signature) ( x e er',s Stain p Here) PLEASE RETURN TO JBARI�TSTABLE I'UBLIC#HEALTR.DIVISION. CERTIF C t.TE 4F CQnPLIANCE. WILE ®SI'_B =N SSUED BOTH!:3�S tFORM ,A - BUILT 4CA 3 ARE RECENT D!ETHE:BAR r STARLEDIVISIE)I� TRANK YOU. , A } i Q: PtealthLSeptic,Designer Certificafiop Fore, c 7 � G� b � 4 IZ I I TOWN OF BARNSTABLE ; hf 4 flre-� SEWAGE #5;� -` GL LOCATION `�Y o VII,LAGE ASSESSOR'S MAP& LOT l INSTALLER'S NAME&PHONE N0 rsr S SEPTIC TANK CAPACITY' L LEACHING FACILITY: (type) �� (size) 2 NO,OF BEDROOMS ®Al F BUILDER OR OWNS PERMITDATE: U L COMPLIANCE DATE; 0 I, Separation Distance Between the: � Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility. (If any wells exist Feet on site or within 200 feet of leaching facility) Edge'of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by � Pe TOWN OF BARNSTABLE ,?-,JCATION Dr6f--) SEWAGE # 311I.LAG ASSESSOR'S MAP& LOT ' INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) O_S� �/�°I w (size) o263caY Y 1D'1 NO. OF BEDROOMS 11®A( 'BUILDER OR OWNER PERMITDATE: / O t, COMPLIANCE DATE: IIZZ ') ,0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) Feet Furnished by .I — e (� O No. 1 Fee�= THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miopooal *potent Cbnotruction Permit Application for a Permit to Construct( )Repair bpgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Z:;? ��i�1�, �� Owner's Name,Address and Tel.No. Assessor's Map/ParcelC�n� 2511 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 V) J�a Type of Building: Dwelling No.of Bedrooms Lot Size�q.ft. Garbage Grinder( A. Other Type of Building — MCS1\0_ No.of Persons 1 Showers( ;,<Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow -gallons. Plan Date_� Number of sheets ( Revision Date Title Size of Septic Tank r) Type o S.A.S. Description of Soil t 5 . Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees t ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisi ns of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued by this Board Vj7h,,j,—SignedDate �L Application Approved by . . Date I / J Application Disapproved for a following reasons Permit No. 20-b 2 Date Issued �`� No �1 'Fee • '- "` F e Entered in computer: E-GOiMMONWEALTH OF MASSACHUSETTS Yes PUBLIC-HEALTH DIVISION,-TOWN OFBARNSTABLE,, MASSACHUSETTS' A `1 01ppYication for, gpogat *pgtem Cbn truction Permit Application for a Permit to'Constivcf(+J)Repair Upgrade( )Abandon( ) ❑Complete Systeml Individual Components i Location Address or Lot No-I .L dn�V ew e- Owner's N-atm-�e,Address and Tel.No:' ' Assessor'sMap/Parcel:.; Installer's Name,,Address,and Tel.No. ^ Designer's Name,Address and Tel.No. C p 0415 5 3 Ace �3�i i�0 ! Type of Building: i Dwelling No.of Bedrooms Lot Size _=sq.ft. Garbage Grinder(N�� i3Other Tl pe of Building Cam_ No.of Persons ( Showers( ✓Cafeteria „7> Other Fixtures LxC,7) )_ kl-Ect'rrt GWNV:' ! 1. Design.Flow gallons per day. Calculated daily flow gallons. _r Plan Date / Number of sheets r� Revision Date ,Title /� tR� a�p Size°of-9eptic Tank?_ke 14,5 1(300 C ca�_c .� Type of S.A.S. �.`7 lei Description of Soil t Nature of Repairs.or Alterations(Answer when applicable) �"�-� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thhis Board f He' th / Signed /�1�! % Dat f j i Application Approved by�— ,�V . . 2 Date Application Disapproved for a following reasons . Z Permit No. 2 y` Date Issued U —_ ----- �- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiffcate of Compliance 3 kjro,,s a,� THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( )Upgraded ) Abandoned( )b rRM12 L _t-i/ 4__ at 1Li � 1 P Fr.' L Al 1P &n 17..{ .S has been constru ted in ccordance with the provisions of Title:.and the�forr�Disposal System Construction Permit No. t ""�✓�' dated 1 / U Installer_. - I Z A �dl fit E� - Designer ., The issuance of this•pernut shall not be construed as a guarantee that the system 'll function as Oesigned. Date ' / M 1 0 4 Inspector � I ---- ------------------------------- . . . -- . . No.? f)UY` 42 Fee 1W 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS ` Df5pogal *pgtem Congtructfon Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at ., _ 1 (J 7 G& b(I f,,6.j and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pet. Date:_ t i `A7— Approved by V Ui� . i MAY-1.9-2011 09:32 Fr•om:BARNST HEALTH 150679OE304 To;5291108 P.1.1 A8BUIi1 — --- •— -- Page 1 of 0V'W OF BARNSTABLE .t,OCAT70N ! Lo ��,! 1E� SEWAGE 0;1�w 4-6(-, a+II,.I.AGE = ASSUSOR'S MAP&LOT-2-EL t INSTALLER'S NAME&PHONE NO)�1- SFP'IYC TASK CAPACITYa 5 Q U?3 L! i y LEACI-ONG FACIUW* (ty z a Y^NC3.OF BEDROOMS b A ' BUILDER OR.Q PERMITDA'!>o: 1 C3 C.MPLLANCE DATE: I U Separation Dist;uce Between she: MaXiMum Adjusted Groundwater Table►ci the Bottom of Leaching Facility Fe Priv®te Water Supply Well and Leaching F4oWty (Lr any wells cxist on site or Within 200 feet of leaching facility) F - Edge of Wetland and LAaching Facility(If any Wst)ands exist within 300 feet of leaebirs facility} Fe Furnished by t*p;"is;�i2/ir1irttnet/j�rc�}�cl�ttalpr�bitill.��,sp ?.��u l� r-�5114(1 C• eq—1 ,(�� j\ 5/19/201 i V- Town of Barnstable oF114e, o Regulatory Services .s, Thomas F. Geiler, Director eattrtszes[ �q ;39 ��� Public Health Division Arf01"°�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer.& Designer Certification Form Date: O Designer: � \ Installer: S Address: 7�C) Address: On '( WS- was issued a permit to install a (d te) (installer) septic system at LQ•����ress) ��6)S; based on a design drawn by d dated - 1 esigner) /N�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 of the distribution box and/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 any 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. (N`DF �—� I a er s Signature) 'CARMEN' 6F AY in No. 1181 'gner's Signature) (Affix De ��, . . ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFI'CATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form G 430' B3 TOWN OF BAMSTABLE LOCATION (��. .,� SEWAGE # �� u-'"'°"� VILLAGE ASSESSOR'S MAP & LOT Q INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �� S LEACHING FACILITY: (type) '� �'+ (size)NO. OF BEDROOMS yv�' BUILDER OR OWNER PERMIT DATE: 7_]7"9 COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) s Furnished by TOWN OF'BARNSTABLE LQCATION � �C �tnx�leJ" SEWAGE # Yt13`C,LAGE �. ASSESSOR'S MAP& LOT IV 0 - CJ - — INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY _T j O S. T LEACHING FACILITY: (type) Ar _ (size) 81�.�!T° , NO.OF BEDROOMS BUILDER OR'OWNER L- tom PERMITDATE: 7—I - 9 COMPLIANCE DATE: -7 —ao Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility a 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 I Furnished by i a � a w` � _. 1� t� r� � W N �. W�O. � 1 _,. n W F �. No. 496 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: :L11_1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppY cation for Migoml *p5tem Con,5truction Permit Application for a Permit to Construct( )Repair( )Upgrade)C)Abandon( ) Womplete System O Individual Components Location Address or Lot No." �j� Lot-rTUC<X_)Z Oi�� Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel �.V qD Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e%\C 77�OCR Type of Building:Dwelling No.of Bedrooms ,� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �2 y gallons per day. Calculated daily flow 387 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I SO-0 QD Type of S.A.S. 4 Description of Soil h A o Nature of Repairs cor Alterations(Answer when applicable) t h c -T vim.. C ¢aAbl, c: Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance h e o Healt Signed Date �17 Application Approved by Date�' /T- ?$ Application Disapproved for the follow' g reasons Permit No. / Date Issued No. r 6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcation.for Zi-quar 6potem Construction Permit ' Application for a Permit to Construct( ( )Repair( )Upgradej,( )Abandon( ) KComplete System ❑Individual Components Location Address or Lot No. L,.QN-co- i--2 Owner's Name,Address and Tel.No. Assessor's Map/Parcel d 7 f_ ,4 O '"r n �eA_ �V.--- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons ' Showers( ) Cafeteria( ) Other Fixtures d DesignFlow G� ,.. f' gallons per day. Calculated daily flow€ g p y y �7 gallons. Plan Date .Numlier of sheets Revision Date Title Size of Septic Tank "I S o `�t/� Type of S.A.S. , ,- Description of'Soff M"Ocgta✓,, .rts.r Nature of Repairs or Alterations(A''nswer when/applicable) out, be Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme Ptal Code and not to place the system in operation until a Certifi- cate of Compliance hhs b�ecrr�sue-d`by o Healt Signed . ... ._ - Date Application Approved by Date `z—(?- $ i4 Application Disapproved for the follo i g reasons Permit No. / Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded`"� Abandoned( )by �, --C. n at c..) i c.^.Y.- 5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._'?K— '16/ dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �7 Inspector No. ,&/ Fee ^�J THE COMMONWEALTH OF MASSACHUSETTS -PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miootar *pg;tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(1 Abandon( ) System located at ' ±"(3 4,.._1, �v t tA - and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to PP g Y comply with Title 5 and the following local provisions or special conditions. Provided:Construction must becompleted within three years of the date of this permit. Date: 7 - 7 Approved by �4 - 10/9197 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at C SO vtt`� "��6` meets all of the following criteria: V. There are no wetlands located within 100 feet of the proposed leaching facility (/. There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed /There are no variances requested or needed. . If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: G} A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) `/ B)Observed Groundwater Table Elevation(according to Health Division well map) F"- SIGNED: /l DATE: LICENSED SEP IC SYSTEM INS R IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert • `� �� �� � Vim, -� I -S �J �� ` s� j IV y E I 'nr rs 1s r I � ! LIZ', . fff I Q ! r z � -It---�-- Y� Ar +- T c 9 ' l E 4j- � II 1 4;J i _ ! LN VN I { nt . • SECTION A -A 10' min, from 'NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ALL OUTLET PM FROM THE Existing Foundation [house to septic.tank VENT PIPE (0 Least 24 inches tall) PROFILE VIEW OF LEACHING SYSTEM SET N R A LEAST BE 12• CONCRETE COVER SET LEVEL N B AT LEAST 2 FT. TOP OF FOUNDATION ELEV. 100.00 (Assumed) Septic tank coven meet be Schedule 40 PVC WICharcool Odor Filter ," r ` � t within 6 In. of ffnished grade Not to Scale -;i_•.- .r- :: ,'•� t_,- 2 Grade over Septic Tank - 96.00 Gr ade over p-Box- 9B.00 t--Grvde SAS - 98.00 - �� 3 -S'OUTLET C ,r of /a /t• _ over KNOCKOUTS4l ¢ fi�.'pi j /t• to I f/t ' lashed ChuAod Store �\ 5.5 OUTLET -� f 12' MIET ,t frf `o+A' W 3 } S � 0.02 +• 3 HOLE H-10 �, ` �- "• ? EXIST. DIST. e0x ,� �•c..'" . { ' EXIST. PIPE 18 1,000 GAL. s-o.Ot or Greater 3' Maximum over Top FEED-Elev-93.50 r "` 2 w r g o ' 6• 6 rq ( `"t � 1:250 Len 'dew Di �', •+ �! 5' 0.01• K foot t.75' FROM EXIST. FOUNDATION / w SEPTIC TANK 15' p ' t5s'~ 4• - SCH. 40 Te / 04 H-10 to ° PLAN SECTION CROSS-SECTION N-� 0 M ro'j ' Effective Depth ; ;h'j t� 24' Effective /S it ►! lip CONCRETE FULL FiwNOAT10 o _ > m rn i€ %r" Sldewnll /y� o� ', 1 ; " to t V,C • 6 �7 ' f' �-. � '. li e.hl ♦i / / 0 5 units a 6.25' = 31.25 3 HOLE H-10 DISTRIBUTION BOX •t SYSTEM PROFILE 6 In.of 3 4•-, , r .' 0 ' P1r r ti e, 5 > >o 4' 3 4 3.5' 31.25' 3.5' NOT TO SCALE �, . r! 7 jr r i compacted stone iSoT , n: Not to Scale - o rn escspee� ac�reeyExo+Nm , ( I 38' i c - 11 In.of 3/4•-•1 1/2' Effective Vldth Effective Length GENERAL NOTES compacted atone > o SOIL ABSORPTION SYSTEM (SAS) NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE - 1. Contractor is responsible for Digsafe notification No Groundwater Observed obeyvea 014400 m INFILTRATOR MODEL 3050 (H-20 LOADING)/ SUMNER & DUNBAR and protection of all underground utilities and pipes. (OR EQUIVALENT) 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2" stone. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30' /EFFECTIVE HEIGHT IS 24• 3. Backfill should be Clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved plan and Local Regulations. Dote of Percolation Test: NOV. 15, 2004 N/F AfARIT LARKIN 6. If, during installation the contractor encounters any Test Performed By. CARMEN E. SHAY, R.S., C.S.E. soil conditions or site conditions that are different from those shown on the soil log or in our design Results Witnessed By (. WAIVER per Barnstable B.O.H.) Failed installation must halt & immediate notification be EXCAVATOR. UNKNOWN Leach Trench made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 MPI 0 42" 7. No vehicle or heavy machinery shall drive over the PL septic system unless noted as H-20 septic components. 100.00' 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole 10. All solid piping, tees & fittings shall be 4" diameter NO. 1 Schedule 40 NSF PVC pipes with water tight joints. Z� • 12' DEPTH SOILS ELEV. 11. Municipal Water is Connected to ALL OF The Residence and Abutting _� fi - ----- ---1 P 9 0 98.00 '•'• • `i••f• Aboveground Properties Within 150 Feet. Loamy 2 Sand '_ Ii, Pool I THE PROPERTY LINES ARE APPROXIMATE AND 10 Y 4/2 • ""? - - - ----------- -J COMPILED FROM THE SURVEY PLAN GENERATED BY 0'-6' A 97.50 EDWARD KELLOG, CIVIL ENGINEERS OF BARNSTABLE, MA ENTITLED SUBDIVISION PLAN OF LAND IN BARNSTABLE, MA Cam TEST HOLE #1 -9$ LC PLAN # 28749-B SHEET 2, DATED DECEMBER 1958 10 1R 5/6 ELEV.= 98.00 ;' �1 z O Sept c Ta 00 gal. -- i - AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 6-- 42- B' 94.50 J "It IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Med. LOT #46 M 1 O ��'��' O THE SEPTIC SYSTEM INSTALLATION. Sand ko ------------ --- Deck CO 2.5 Y 3/6 0� EXISTING LEACH TRENCH TO BE PUMPED OUT AND '4�2144• c, es•oo REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION 40 Mil Liner To Extend EXISTING NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE LOT #50 FROM THE EXISTING LEACH TRENCHT TO BE DISPOSED From Elev. 94.50 to 92.50 3 BEDROOM OF AS PER BOARD OF HEALTH SPECIFICATIONS. and 10 feet be,Ond foundction ^r'ISTI":C HOUSE yGARAGE �� NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY I #250 �� ASSESSORS MAP 251, PARCEL 140 LEGEND Perc 1 PROJECT BENCH MARK I I Depth to Perc: 42" to 60" TOP OF FOUNDATION I i 11 DENOTES PROPOSED Perc Rate= Less Than 2 MPI ELEV. = 100.00 (Assumed) _ 1 I I SPOT GRADE Groundwater Not Observed I I i UV DENOTES EXISTING No Observed ESHWT I I ADJUSTED H2O Elev. = None - --- ; \�LJI\� ( X 104.46 SPOT GRADE / ------- --}--� I 1PL PROPERTY LINE W I I ASPHALT I of 96P - PROPOSED CONTOUR I LOT #49 i DRIVEWAY 13,000 Square Feet 0 �r \� - - - - - -97 EXISTING CONTOUR g� 00' I DEEP TEST HOLE & 2-18• DIAM. ACCESS MANHOLES 9 100. I PERCOLATION TEST LOCATION I fr •.,:.4 .f�g.=:- ; - 6 FOOT STOCKADE FENCE ..�` o ----I-' ���----- INLET ` OUT ET E= PLOT k THE ACCESS COVERS FOR THE SEPTIC TANK. L 1 G VIE O V ' TIY -0.RIVE' �� P LAN DISTRIBUTION BOX AND LEACHING COMPONENT (40 FOOT RIGHT OF WAY) OF PROPOSED SEPTIC SYSTEM UPGRADE _ '«., .•. :r»:,^�i.-• ,• SET DEEPER THAN 6 INIC ES emow FINISHED GRADE SHALL 8E RAISED TO VATHIN 6. OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE' PREPARED FOR PLAN VIEW INSTALL 1�-nTE CAS eAFFLES OR EQUALS r��W���� - ��,,�, M R . R A N D A L L D 0 Y L E 3-24• REMOVABLE COVERS L L Q LOCAL UPGRADE VARIANCES REQUESTED: b� �V,. e AT • • - _ 4• - 1. Request a varaionce to reduce the distance from the SAS to the t-Jc< Nd�r_e`L #250 . LO N GV I EW DRIVE •- 3• min,deorance 13' , Foundation from 20 feet to 17.0 feet for Maxlrpum Feasible Compliance. S INLET R•tnin.-F 2• min. Inlet to outlet to•IIm -FJ �"1_dT-F-1r T" OUTLET A 40 Mil Rubber Liner to Be installed as Shown`. pd�i�y HYAN N I S, MA 5' -7- --Jt L '5• -r Design Calculations Yf% Es a I �b�M 6r �� ASH OFMgS REPARED BY: y (440 Gal./Day Min. per Title V) ,,� LeachiGarbage Capaci y P P /D y ( ) o� A M y�, CARffE E. SHA Y Leachin Ca acit Pro osed: 440 Gal. a Minimum Min. Per Title V ' 'fV'- ' Septic Tank : - 2 x 440 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. N 8_0- 4'-10• • 0 20 40 50 S . VIRONMENTAL SERVICES, INC. CROSS SECTION END-SECTION SOIL ABSORPTION.AREA: Using percolation rate of <2 min.�nch Bottom Area: 0.74 gal/sq. ft. x 444 sq. ft. s 328.56 gallons I -P 1 P.O. BOX 627' Sidewall Area: 0.74 gal./sq. ft. x 200 sq. ft. = 148 gallons EAST FALMOUTH MA 02536 TYPICAL 1000' GALLON SEPTIC TANK Providing: 476.56 gallons `-- 4A1ITA0' ' NOT TO SCALE Use: (5) HIGH CAPACITY INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, SCALE: 1"=20' TEL/FAX : 508-543-0796 (3' W x 6.25' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND SCALE: 1„=20' DRAWN BY: CES DATE: NOV. 16, 2004 3.75' of WASHED STONE ON THE ENDS. PROJECT#SD658 FILENAME: SD658PP.DWG SHEET 1 OF 1