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0039 MAINSAIL LANE - Health
ri 3,. 77-1 . Mains'le Lane Hyannis _ - A = 288-- 186 I� 1 �1aas Town of Barnstable PC Department of Regulatory Services BARRUABrA Public Health Division ` >Hwaq Date i te7lti �+ 100 Main Street,Hyannis MA 02601 • �EIJ MA A Date ScheduledI Time I U/�M Fee Pd._ Soil Suitability Assessment for Sew e D sposal Performed By:,MtCHae--T1"cf4rra1. EIT C5E Witnessed By: �„' Q r LOCATIOU& GENERAL INFORMATION �C J Location Address 2 t MAt�.5AIL✓ HVAM'01S' Owner's Name -fl4d A5 -5HC--P_ OC •J (MAIHSILC-) Address 39 1%4At45'e..0 LIV WAOIJIS / r- SG C-t•1C�lI.1L'�3'CII�JGr Zt.7 Assessor's Map/Parcel: �� J { `P Engineer's Name�AKWIDC-: C-0TErY1QAsES u-C NEW CONSTRUCTION. REPAIR X TG C-PlSitlee�Id19 T 22elephone# SOg-L�-17-�i-l'1 Sri g-27 3-O 3 7 7 Slopes Land Use 1zES%PEMTtAr. . �o i- J p ( ) Surface Stones Distances from: Open Water Body tso R Possible Wet Area Drinking Water Well t5s ft DWhage Way t0 ft Property Line >t q ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands an proximity to holes) Parent material(geolo(geologic) OvrwA3M Vr A 3 o . � $W18. Ss -hDepth to Bedrock >Depth to Groundwater•. Standing Water in Hole: >I L( " 4L5 Weeping from Pit Face ' 12te" z3GS Estimated Seasonal High Oroundwater > t2V S(,,S DETERMINATION FOR SEASONAL.HIGH WATER TABLE Method Used: VOZWr GgSCdvArrow Depth Observed standing in obs.hole: I.Ity • lu. Depth to soli mottles: y t2c. Dept tir to weeping from side of obs:)role: Index Well# — _ Itt. Groundwater Adjustment N j 1 . tt• Reading Date: Index Well leYol _ AcU,pactor A Q.Groundwater Level Observa don PERCOLATION TEST ]bate �I� 5 Thub 939 Hole# t Time at 9" ,••_„_� '� Depth of Perc i•2- Time at 6" start Pro-soak Time @ Q1:53 AM i Time(9"6") - End Pre-soak 1 O:oo q nna 1 Rate Min./Inch Site Suitability Assessment: Site Passed t/ Site Failed: Additional Testing Needed(YIN) Al Ye-S Original: Public Health Division Observation Hole Data To-Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify tbe. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EP"1TC\PERCFORM.DOC _ VS DEEP-OBSERVATION HOLE LOG Hole# I ¢Z Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. onsi_ stency,%Gravel) O.IZ'• — Pry . IZ(P.- . L+ F DEEP OBSERVATION HOLE LOG 'Hole# Depth from Sall Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,Y2 Oa DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. y Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes . _ Within 500 year boundary No �!� Yes Within 100 year flood boundary No,� YEs Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material's -- •- Certification I certify that on. 10^Z7 9l (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 training,expertiseZandperience described in 10 CUR 15.017. Signature Date -/0 Q;\SEVnC\PERCFORM.DOC No. ✓ ` ® 70L Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pliLation for MispoSaf .6pstem Construction permit Application for a Permit to Construct( ) Repair()� Upgrade( ) Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. 39 W 41 5A(4. L-0,J Owner's Name,Address,and Tel.No. 0w^,St• loocu! S�R�< iV, Assessor'sMap/Parcel $ R �� -NJ s� NE A i(/fS' Installer's Name,Address,and Tel.No. 570!9-47Z-9Q7 7 Designer's Name,Address,and Tel.No.S �-973_0 377 CADC-L--JtV =VTW0Js&-T t c,c- p -43C Ojer(th'i0-tVcarr-C ZrN C_ Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1 3 sq.ft. Garbage Grinder( ) Other Type of Building $Yp f( o No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3 3 r S gpd Plan Date 2 10"a01 ,5 Number of sheets t I Revision Date Title 39 M C SAIL 4,406 )AIJlUl5 Size of Septic Tank , 0 o® Type of S.A.S. (A) 00 CatU.00 d4*U1AtT4 Description of Soil M(:']1 i' CQ9946 6AX�b 60 1 a" 6 Ct— P LAK Nature of Repairs or Alterations(Answer when applicable) U_Sj& QWS-C(P6c 1 O0C� C—,4U_4-ffl_) 1 CC_ 41(T — paq pe ak Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea Signed Date G— r Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �� S��-� Q� Date Issued /o No. :�ao/v � �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISIO TOWN OF BARNSTABLE, MASSACHUSETTS ftpYicatiou for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. 39 M AI A l L 1.tJ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a$ $ I 39 M N L- 621E r1 VA N Kl 6 Installer's Name,Address,and Tel.No. 50$-47*7"92'17 Designer's Name,Address,and Tel.No.SdR-;k73-6 377 DC--k1 c V& tF*JT&ZP#0J-5&T I.C,C. i�j c_ *NC (: JoW Pik & Type of Building: Dwelling No.of Bedrooms Lot Size (t'aJ SQ sq.ft. Garbage Grinder( ) Other Type of Building lS ItJ ta.J T f AL. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3 3♦'► 5 gpd Plan Date �-"(y_Q 0 Number of sheets r Revision Date Title 399 M!Q1J;5A/L LAlUg HYAtjk)1 S Size of Septic Tank {, Q oo Type of S.A.S.(e;L) S�CGD E34U.D&) d 14otu ems Description of Soil�-� coy93� � � t.-1r 5 Cr-- e�{4 Nature of Repairs orAlterations(Answer when applicable) VS�- �X1 11N6c lt(a0C7 C_54t ,t71U 5e'ztc. _T&LVn!. 7b fie, _) H-Ao p-fox -tn l a� Sc� G- ,u CWAAk s X3 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 Certificate of Compliance has been issued by this Board of Hea f. Signed Date p4r- I( — Application Approved by Date y Application Disapproved by Date for the following reasons Permit No. D06 2):w? " Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) 'Upgraded( ) Abandoned( )by- at „N has been constructed in a�ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No.. - S �✓?)dated Installer idNGW(O6 �� 9Q 5�5 [.L(2 Designer V L 'r-&J6j(A b L p�JGC -�j�JG #bedrooms 3 Approved design flow 33 d gpd The issuance of thisa er it shallt be construed as a guarantee that the system w' fu trory as design . '.y Date 7/ / � Inspector , ,w --------- ----------- - ------------------ ------------------- ------------- - - No. ® ''�� Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTHPIVISION -BARNSTABLE,MASSACHUSETTS Disposal ,bpstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at� � Mk/�rSAI C.Aus e a_ 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 corn eted within three years of the date of this permit. Date �) I Approved by i 8/27/2015 16:32 5082730367 td4219 P. 001/001 Town of Barnstable Regulatory Services Thomas F. Geiler,Director B, ,MAS& Public Health Division A6S. o;, •� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-802-4644 Fax: 508-790-6304 Date: 2 8' 5 Sewage Permit#a®l 5-X1]. Assessor's Map/Parcel Installer& Designer Certification Form Designer: SC En�tnee0-AC.., T 0 G Installer: GAC)eu.;Ct= C-viterect'se.S, LZ-C. Address: 2,k5y C(cnbg{(_V littIhw�/ Address: l53 Co.,v►meru'al 5�(-ee+ East wcreham M/} b2:3b H401fee-, 1NA 6764/ 7 On $ l I ^;tDi Caee.+..:tde_ Entere(t seS was issued a permit to install a (date) (installer) septic system at H4?vlsai I 1-avie. based on a design drawn by (address) TinC. dated (�uoosk Ion ze15 (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 of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 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 eertitied as-built by designer to follow. Stripout(if re q nspected and the soils were found satisfactory. �NeP JOr!fv L. CMURC!+I;L D f� - " JR. �bj* ( nstaller`s Sig tore) No a 17 esigner s Signatur (Affix esi e s Omp Here) PLEASE RETURN_ O BAI2NSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM A" AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ! ronn.duc Town of Barnstable Barnstable Regulatory Services Department • '"� Public Health Division I I- s6J9. 1e ' " 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4923 July 20, 2015 Thomas W. Sherlock 39 Mains'le Lane Hyannis Port, MA 02647 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 39 Mains'le Lane, Hyannis Port, MA was last inspected on 6/19/2015 by James D Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1) 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 THE BOARD OF HEALTH • .Thomas McKean, R.S. CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Ev1\39 Mains'le Ln Hy Pt Jul 2015.doc it f 7d7/2015 Parcel Detail GQ (HIE SAANSTABI rk A. �.fl- } 6.�41 „s .� 44 � Logged In As: Pa rCe Detail� Friday, .July 17 2015 Parcel Lo0kU01 Parcel Info Parcel ID 288-186 Developer Lot'LOT 4 Location 39 MAINSAIL LANE Pri Frontage Sec Road Sec Frontage a village HYANNIS Fire District HYANNIS Town sewer exists at this address No �� Road Index`0957 -_a Asbuilt Septic Scan: ' Interactive Map.� ' N,, 288186_1 I It Owner Info owner.SHERLOCK, THOMAS 1/V O Co- - wner Streetl 39 MAINS'LE LN�Streetz r cityHYANNIS State MA ^�zip P 02601 Country I Land Info Acres 0.26 use j'Single Fam MDL-01 zoning ;RB Nghbd!0106 Topography Level 1 �� Road .`Paved utilities Public Water,Gas,Septic Location i �. Y ••rt.. Construction Info Building 1 of Year 1985 I Roof Gable/Hi Ext Wood Shingle Built Struct p Wall g Living 1288 Roof Asph/IF Gls/Cmp AC None Area Cover Type style iRanch Int wall Drywall Rooms 3 Bed Bedrooms in Bath Model'Residential Floor Carpet _ Rooms 2 Full Half Grade Average Type HOt Watery Rooms 'otal 6 Rooms Heat Found- ' Stories }1 Story Fuel Gas ation'Poured Conc. Gross 3060 v..- - A rea Permit History Issue Date Purpose Permit# Amount insp Date Comments 8/1/1985 Dwelling B28360 $60,000 1/15/1986 12:00:00 AM HP 1 STOR Visit History http:/fi ssq l2/intranet/propdata/Parcei Detail.aspx*?ID=21965 1/3 Town of Barnstable i + IARNSCABLE, A b q �`. Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862A644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE_CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) eaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Jul06 15 10:30p G�60 p,18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane - Property Address Thomas Sherlock — �y Owner Owners Name ` information is {I nnisport MA 02601 6-19-°15 : required for every —� page. City/Town State Zip Code Date of Inspection , Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms j ���'' NnOF,M,4�'t.i�i on the computer, '/ ``� ��........,.Sd'EY use only the tab 1. Inspector. key to move your i�: JAMES u' cursor-do not James D.Sears use the return Name of Inspector =`� `E key. . ? *� . CapewideEnterprises,LLC : A*-.o o s Company Name ��' F 5•f N SPE- sole 153 Commercial Street ���JF,........ Company Address c MA 02649 Cityrrown state Zip Code 508-477-8877 S 1623 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 15.0001.The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-6-15 ;n,pectors 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. , s V I t5ins-3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 1 of 17 i i i i i Jul 06 15 10:31 p p,197 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information required for every � p H nnis oft MA 02601 6-19-15 page. Cityrrown 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: [] 1 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. a t Comments: Failed system -leaching. The system is a 1000 Gal. tank D Box and pit. 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", "non 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 ❑ NO(Explain below): i I I 15ins-3A3 Title 5 096691 Inspection Fonn Subsurface Sewage Disposal System-Page 2&17 1 I i Jul 06 15 10:31 p p.20 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is required for every Hyafinisport MA 02601 6-19-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 El 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 GMR 16.303(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 i r i ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i t5ins-3113 7i1le 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I t i f Jul 06 1510:32p p.21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is MA 02601 6-19-15 required for every Hyannisport page. City/Town 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. j ElThe 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 Tess 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: I t 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 0 ® 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®ei is less than 6" below invert or available volume is less than Y2 day flow p'e T t5ins•3113 TRIO 5 otNciel Inspection Form:Suosurtace Jewage UIspmal System•Page 4 or 17 Jul06 1510:33p p.22 Commonwealth of Massachusetts - . Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information a l-lyannisport MA 02601 6-19-15 required for every - page. CityrTown Stale 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. ❑ 0 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 ppmr provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this forma ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 0 ❑ 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 foitowing, 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 11 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 i i t5ins•3M 3 Tills 5 01recial Irwpection Form:Subsurface Sewage Disposal System•Page 5 or 17 ' I[I Jul 06 15 10:34p p.23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is required for every Hyannisport MA 02601 6-19-15 page. Cityfrown 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? i ® ❑ 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 NIA) ® [] 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 sae and location of the Soil Absorption System(SAS) on the site has I been determined based on: j ® ❑ Existing information. For example, a plan at the Board of Health. r ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of 1.distance is unacceptable)[310 CMR 15.302(5)] Q. System Information Residential Flow Conditions: I 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 i i t5ins•W13 Title 5 Official M136aion Form:SuDsurrace Sewage Disposal Symsm•Page 6 of IT `1 I I r E Ju!06 15 10:34p p.24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is required for every Hannrsport MA 02601 6-19-15 page- City[Town state Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Na Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2013-47,200Gals g ( y g (gPd))' 2014-54,000GaI s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date ccu Date Commercial/Industrial Flow Conditions: i Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): f Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? _ ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No f i. Water meter readings, if available: it i 15ins-3113 -nU*5 OtOUeI Impacgon Form:Subaurrace G—go,Dtapo 1 date--Page 7 of 17 f z i IiI Jul 06 15 10:34p p.25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -- y 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is H annis ort MA 02601 6-19-15 required for every y p page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): 4 i i General Information Pumping Records: Source of information: NA 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): I r I 15ins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I i _ i JuJ 06 1510:35p p.26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Main Sail Lane Property Aaaress Thomas Sherlock Owner owner's Name information is N nrlfsgort MA 02601 6-19-15 required for every page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1985 Permit # 85 -817. Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): 30" Depth below grade: reef 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.): Pioeing is 4" PVC SCH 40 & SCH 20. Pipeing to and from D Box 4' PVC SCH 20. Septic Tank(locate on site plan): igrr Dopth bolquu rgrprtro root Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1000 Gal. Precast H-10 Dimensions: 41 Sludge depth: t5ins-3113 Title 5 OrSdal Inspection Farm:Subsurface Sewage Disposal Systom•Page 9 of 17 it , i Ju106 1.5 10:35p p.27 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane _ Property Address Thomas Sherlock Owner Owner's Name information is MA 02601 6-19-15 required for every Hyannis port page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cunt.) 26" Distance from top of sludge to bottom of outlet tee or baffle 6 Scum thickness Distance from top of scum to top of outlet tee or baffle 12 Distance from bottom of scum to bottom of outlet tee or baffle 22' How were dimensions determined? Asbuiit-Plan-Tape Sludge Judge Comments(on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank and cover's at 18" in &outlet baffle. No sign of leakage or over loading Tank need to be pumped Tank to be pumped after inspection. Pumping to be done 6-22-15. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 - - - i Date of last pumping: Date tsine.3n3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal system Page 10 of W i i i Jul 06 15 10:36p p.28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 39 Main Sail Lane —_ Property Address Thomas Sherlock Owner Owners Name information is H nnisport AAA 02601 6-19-15 required for every page- Cityfrown State Zip Code Date of Inspection, D. System Information (cost.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): I I 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: 9 gallons per day Alarm present: ❑ Yes ❑ No Alarm level.- Alarm in working order: ❑ Yes ❑ No Date of last pumping: date J Comments (condition of alarm and float switches, etc.): i i i I Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i t5ins 3�13 Title 5 Omcial trrspecBon Form:sutnudece sewage Disposal System•page 11 of 17 I� i Jul06 15 10:36p p.29 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Fonm-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is required for every Hyannisport MA 02601 6-19-15 page. cityfrown 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 - -- 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 16 V-30"below grade wlone line out.Wall's are gone on box. Need to replace D Box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: i - i5ins•3f13 Title 5 Mid Inspectlon Form.SWsurfeoe Sewage Disposal System•Page 12 d 17 i I Ju106 15 10:36p p.30 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments — 4 39 Main Sail Lane Property Address Thomas Sherlock Owner Owners Name information is tiyannisport MA 02601 6-19-15 required for every -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: i ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: t ❑ 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.): Leaching is a 1000 Gal. precast pit w/2'stone. Pit and cover at 4'below grade. pit is full, level at 4" below inlet line Need to replace leaching. i 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 i t5ins•3113 Title 5 official Inspection Form:SubsWace Sewage Disposal Sysem•Pape 13 of 17 i i Jul06 15 10:37p p.31 Commonwealth of Massachusetts Title 5 official Inspection Form -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is H nnis ort _MA_ 02601 6-19-15 required for every �a p _ 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.): i — i I i I 'I t5irs•3/13 Title 5 Official Inspection Form:Subsurface Sewage Oisposa!System•Page 14 Cd t7 i . t I Jul06 15 10:37p p.32 Commonwealth of Massachusetts Title 5 Official i Inspection Form p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is rtrris ort AAA 02601 6-19-15 ' required for every P Zip Code Date of Inspection page. CityrTown state 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 A o � o �. fi -3= 33 — y 3 4 arY j3-3 2 ,/-S i I f5ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal system•Pape 15 of V L. I �I Jul06 1510:37p p.33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock Owner Owner's Name information is H annis ort MA 02601 6-19-15 required for every p page Cityrrown State Zip Code Date of Irspedion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Na 12' Estimated depth t high ground water- feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1982 Date ❑ Observed site (abutting propertylobservation 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: j T.H. on file 1982. No G.W. at 12'. Bottom of pit at 10' below grade. Bottom of pit at 2' above T.H. Depth. a i i I 'Before filing this inspection Report,please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 16 of V I i i L I Jul 06 1510:38p p.34 Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Main Sail Lane Property Address Thomas Sherlock _ Owner Owners Name information a aninis ort MA 02601 6-19-15 required for every y P page. City/Town 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 i ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t i i I ' III I i i 9 l5ins-3/13 Title 5 Oflidel Inspection Farm Subsurface Sewage Disposal System•Page 17 cT 17 j f i <: VEO AUC 8 1999 �' I@WNOFSggIV41 COMMONWEALTH OF SAM EXECUTIVE OFFICE OF ONMENT AIRS John Graci DEPARTMENT OF ENVIRO N DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108 = 2 51 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 39 MARI &-tE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Name of Owner MRS.ROBILLARD Address of Owner: BOX 693 HYANNISPORT MA.02647 Date of Inspection: 8/9199 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: nla Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: . X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Ev u on By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:9/10199 The System Inspector sh#s�ubmita copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 0 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n(a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa 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 Wa 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nia_ (approximation not valid). 3) OTHER nta revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes .No X Backup of sewage into facility or system component due to an overloaded,or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day Flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:819/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9199 FLOW CONDITIONS RESIDENTIAL: Design flow:-Q g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):I Total DESIGN flow: IV Number of current residents:2 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):,M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: nla gpd(Based on 15.2103) Basis of design flow: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: n& OTHER: (Describe) Wa Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source o: information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa_ gallons Reason for pumping: nta TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes..ii,.;h previous inspection records,if any) 1/A Technology etc.Attach copy o: ip to date operation and maintenance contract Tight Tank Copy of DEP Appi oval Other: Wa APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 13 YEARS OLD. Sewage odors detected when airk a iy at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:819199 BUILDING SEWER: (Locate on site plan) Depth below grade: 1 Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: Wa Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: 1 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MQ nLa Dimensions: L 8'6"H 6'7"W 4'M Sludge depth: 1_" Distance from top of sludge to bottom of outlet tee or baffle: 3E Scum thickness:1 Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17"" How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EMERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metall_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: n& Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:.a& Distance from bottom of scum to bottom of outlet tee or baffle nLa Date of last pumping: Wa 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.) n& t revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Wa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) WA Dimensions: Wa Capacity: nLa gallons Design flow: nLa gallons/day Alarm present: NQ Alarm level:jiLa- Alarm in working order:Yes_No_: NQ Date of previous pumping: Wa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:1 MUM LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND,SYSTEM IS FUNCTIONING PROPERLY PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): N_Q Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:819199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: ONE LEACH PIT leaching chambers,number: _nLa leaching galleries,number: _a& leaching trenches,number,length: nla leaching fields,number,dimensions: nla overflow cesspool,number: n& Alternative system: n& Name of Technology: -n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT APPEARS TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert:.n& Depth of solids layer: n& Depth of scum layer. n& Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla PRIVY: _ (locate on site plan) Materials of construction:Wa Dimensions:nla Depth of solids: D& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/A revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a pC AA III hB 51 AC 53 b F4 c l revised 9/2/98 Page 10 of 11 J ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 MAIN'S LE LANE HYANNISPORT MAP 288 PAR 186 LOT 4 Owner: MRS.ROBILLARD Date of Inspection:8/9/99 NRCS Report name: n& Soil Type: n& Typical depth to groundwater: nLa USGS Date website visited: nLa Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2198 Page 11 of 11 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF rHEALTH ....... ................OF... ------..-----....--------.-_..----..-.--.-.---.----.-.----- Appliration for DWpo al Mirks Tonstrnrthin "ami# Application is hereby made for a Permit to Construct (� ) or Repair ( ) an Individual Sewage Disposal System at ....._.. . ..--••••to .•-•._a,A r.. -....................... ..... `n! l��r�r` ...�h1 ..................................................... -ocation-Address or Lot o. -s.......- .1 .5 s_......... ---------------------------- . .�:�.:. srF--- �r.� a ..._!C e �..... ...._ .0...... . ......... Installer Address d ype of Building Size Lot....11 3�.........Sq. feet U Dwelling—No. of Bedrooms..............._.:._............_.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............... No. of ersons.....__..._................. Showers — Cafeteria a YP g ----------•-- P ( ) ( ) G� Other fixtures .-------•----------------------•--- --•-----•-------------------------------------------------------------------•------------ ----- W Design Flow.............../f:Q......................gallons per I= per day. Total daily flow.........3..30_........................gallons. W Septic Tank—Liquid capacity.lU`ikV..gallons Length.$...G.of..... Width..y.'_.!P_.".... Diameter________________ Depth.X..!Y..._it -. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------------_ Diameter..1,00.__...... Depth below inlet....�.G...�..... Total leaching area..d.VILZ---sq. ft. Z Other Distribution box Dosing tank ~' Percolation Test Results Performed by..... O.,m....)._u ......................................... Date.... fi.-I.el--............ ,aa Test Pit No. 1... . -.._.minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Wt ------------------------------ 0 Description of Soil ®^!��' �.¢9 , S �iscz•�.� I_.k .►• -•-------------------•-•-•--- W VNature of Repairs or Alterations—Answer when applicable..............................................................:_-............................._.. --------•-------------------------•-•--.....-------------•-•------------.-------------._.........-•-----•------------••-----------•...-•-•-----------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pr ous of iITI. 5 of the State Sanitary Code—.The undersigned further agrees not o place the system in op ration nti ert to of plian has been 'sued by the b and of health. teat J��a�e PPlication Approved BY ... 1 (�^� Date Application Disapproved for the following reasons:................................................................................. ........................... ---------------------------------------------------------•-------•--•--•--••••--------•----•---------•------------------------------------- Permit No.......... ........................ -.. Issued. .Date Date ------------------- .... ...�s.��............................., THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `"�"" ► :................OF... a.r.w. ......------......-..-...---*....... ._................... Appliratinn for Disposal Works Tons rur#inn Frruti# "Application is hereby made for a Permit to Construct O or Repair ( ) an Individual:Sewage Disposal System at: ..... _ ....... a►r to..:�r't ?a ... a ....................... ---•r= v►*t 5 tlt�r ...i t°' ..................................................... ocation Address t t� s E ..... ----------------------------- . . °a. ...>1� �=�r► o r I ner a►" ...._ .... ,... .._... ............... ... ark Address Installer Address ype of Building Size Lot.../1 ..Sq. feet ......._ .... �. Dwelling—No. of Bedrooms................ .................._...Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building .... No. of persons............................ Showers —Type g ..._._...:...--•----•--- p ( ) — Cafeteria ( ) d Other fixtures .........................:......... ----------- ----------------•-•--•-----------•-------------- ------.... �< rpn'i� W Design Flow...............ft.0 .:_..__.........._.__gallons per per day. Total daily��low..........�-._'_�........................gallons. WSeptic Tank—Liquid capacity./ -gallons Length : _.!!_..-.. Width.t/ 0 . Diameter..._... ...Depth. �...... Disposal Trench—No..................... Width................_.. Total Length......... Total leaching area...................sq. ft. x ►t � ;; Seepage Pit No..................... Diameter /.0#.0...... Depth below inlet---�t_--.C.)....... Total leaching areaOlt.2.,.,sq. ft. } Z Other Distribution box O Dosing and a Percolation Test Results Performed by.: i'. ._ .....t--�`6--" ...................................... Date._. ' ..._...... Test Pit No. I...A.Aft..minutes per inch Depth of Test Pit.................... Depth to ground water.,....................... LL, Test Pit No. 2..........:.....minutes per inch. Depth of Test Pit.............:,.::.. Depth to ground water........................ ---------------•-•...... ....... O Description of Soil---A'J� owrv� t ....5a►.. .............................................................� - / 1�j sr�d..� -_a_ -►; ..... ...--- ...... V ---------------•------------------------.---... ............................................. .........._._..._.. : ,.... -----------------------------•--•---•-----•........• •• --.. ....... --•• ----- .............................................................. UNature of Repairs or Alterations—Answer when applicable...................... ...................... .............................................. .............................................................--...---......•-------------._.............-------•----•---..._.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the pr ons of'III 5 of the State Sanitary Code—.The undersigned further a�regsnot o place the system in op ation nti ert' to of plian has been s ed by the b and of health. t.l"�t ly �ac�� .S i� ......................... . j.� -..__.... PPlication Approved B ...... ` F . PP y....• ----•-_.. .•-----•--••----•-----------•--......... _ . ----- ��Da Date Application Disapproved for the following reasons:......................•---•--------•--------............-------------------•----•-•-•-------------•--------- .........................•------•----•------......-•----•--•--.........---------••-------...--------...................--•---.......---••-----------•-•----•--•--•---•--..........---.............------ Date PermitNo........... -�--.................� ......._.... IssuecL.:.................................--.................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Titrfifirate of Tontlilittnrr TH( .TO CE TIFY, That the Individual Sewage Disposal System constructed (->e) or Repaired ( ) ..,.. r ( Installer at......... - 1.....- : - --- ---- ---------------- ---------------------------------------------- has been installed in accordance with the provisions of TALE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-'-''�,'�-.�........�.... 7....... dated...... �,.�''ft' ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ ® :.. .g. ............................... - Inspector............ ............ -----.. ...... ..... .................... THE COMMONWEALTH OF MASSACHUSETTS �h BOARD- OF HEALTH .............................OF....... F .... ....................................................... F ........ Disposal Works Tuns#rur#ion rrrutft Permissionis hereby granted.....------=Sjj,kr......... .(.................................. ............................................... to Construct ( ) or Repair (� ) a�fliviidual Sewage Disposal System T at No.........1 �` - -- a'" "! Lcn.N:.-- Street T as shown on the application for Disposal Works Construction Permit:. o..` .... Dated...... .. ^1... _ ......... Y �'+ -- Board of Health �r DATE......... . � ' �.. .............:. FORM .1255 A. M. SULKIN, INC., BOSTON - A -x•• '> ., r _ _, .<. -. U.raw. �,;,, _wx:za ,.. x r. .. s .a, c ,. Jn ... .,.... .. sa ..a ._ .. r..a .. 2 }� ^., X .... .,:w... 41,, .. .+ M ,:.,.. _. ... .., < .. >r_.. .�:,_ r ._t__ _ _,. _ .,. ..k_- x �. tr .. , __ ^.rk ",> ::Y. ate. .. ..»x.:.. ..>.. _ r. _ -R. .. cx .. X. '.'V-?i tie•✓. -A ''�'4i-'.. ., - .. ,�.. I- ..t — r , <-. s��-s� xz T..T , ..i , ,. .. ._ .. r .. ..�., ., ,. + u ...r ,.:0, 1. ,:.f3-. .r' •F � .-� i ,_ ._. ..... .... ._ ,. ..a .. .A..' ., ... + .,4 C:� .rr� •_ .. . . . ... .. J � •.•:..» ,< fp _�.. £fir. V. +�§ w 11 I -L ,�.:.- ,.._ : ,i _ :^'+- .L .�. v,......a} r��x a.. .f°:'�W v u: a. yk .. :.5 1``rs4 Mi'. t _e ., _... ._. _.. _. _'!;vr`F1. ,. �t{S�F,1.VL :.t .. �.T,= a.,, w'E•:F..« 'nl..�n a::±f�R _ _Ow a ... .. ._ _. .. .! - .: ._ .. ...<-. -sue... 'A....... ..__- - _ �S� ...8`. R 1 C: , WI , - _. __ , 5 RT AT ,� �� x F N E_ ._ AT O S . f> r r _t _ ' 4-1 _ 8 , . ._ ..mac_ -..r. ,. y. f. x t.... .r,. ....r,.,.. �, _... lw a a.. _ . _ .,. ET. __ _T, . RC®L I 1w i .A _ _.PE ON R:AT '____a, ,- >.a __ > ..,.z rir �:VF ... . y� v T tO L E I Ri t ,, . L :,._� . e � n. i• t3E _ ,_., .. : y u. r sF_. ,__, ,. _ . T,_ S .f� 0 t+. . _ . _ ,.:. 11AT 7 _ _. ATION. 8 ALE 1�3N. . .... r,- _ r ELE,V q _. ... ,. ., .. .>, ... `" `z.. ... ,. _ . . . __ ,. ..t _. 3r Nth_ lT _ ail E L.EA . .,, . ,: � ,.wfT - , 1. __ . . _ _._. . z: 'f'T: 1 t: ., _ _ _ n r . ., < T._. ti,,-,..s... .. .a a: u.. .,,�. ..-..., - _.. .. 4.. e'er`.: +may. QY�C _ - x a 7 ,. gym- � .,, . _ ,,. h ` -... s -. ... -. Y ._.. .- .:: .. _ -_ _...- .. .,.. .u. -._. _ _ ,r_, __ ... __ _.._I .: _. ,._ r.... _ �_..,. .:._ n,.. .m, , .. ... .. _.. u G /- .. _. .. -n... - .. .. ,�. .r,.. . .. _ ... _._. , .. ,.DES' ,._ - ,.il ' .i. C. ,.,r .. ., r. .. :. f .. x. , - , _ . . _ , z -.� .q,.a. .. . .. .-.- ... r.... • ... ,s u'K..a - Xwt i ,. a:. _- r x .n ,.8. .. v ...:.., .,.n ,.,, �.......w ,... .... .1 .. - , _ GARB GE . _ _v ., �., . ..,r �- !d i +F� _ -_. _ ,. .. _ "I ,.._- � -., F �..�GAL./t3R. .QAY x .;BR GAL /DA1F 2' ,�Ai✓ M _ _.. TOTAL. :ESTIMATEQ. L011Y •( l ) �A ,_, .�_ a. .. n .. .. .. ... r. x ...ii L - _ y�. r.. - GAS:' : .. _ .> , i. .. 3 n n.. x,_r 4 .. w w . - W GAL: CT AL :...SIZE.. PT1C 7`14N1 T4 a3E INSTA .1Eb t_ _. a >, t _, L „. P ,:k .. ..k ..r,.,...... .. ..r. }.i, _ ,�,1,_ ,. - r.. --,. r ACHtNG AREA RE�3UJ: EMENTS' _ ._ , Y.._ _:. : LE - : , -. , me;µ, .. ' y . . . �. . w, _ . ,,,.__ - � _ ol. ,SIDE..--11YAL1r_,.,_ �IR-R•�A=�_ `�•13.F.;�.�,�� _ ,. � _ ��` BOTTQM ARE"A `GALA/5 F. V I8.- I ` , . . :',, _- _+ - :�- �NS`J:,.:78 .GAL._, 1., A HING ,..:CAPA,CITY BOTTOM-- .•SlQE.WALL , , , >.. _,.. rv . ;. 1 t .. 11" 11 "_' - ..COT. /P,�fJ. ... .- - -> . .>. mz. _ -_, > �. . .,_ _:_. . _ .,_ .. Y -,:�,� � -�.,. I ,GA �;:: _ .x , . 1.1. _�. :• �� x. _ .;. _.. E RV EACHiNG CAPACITY... . , y , - , g _ . Zo .,� . R SE E L _A, . .TOP OFI. 1. _ FOUND. ' t ELEV. /0J�"./ CONCRETE 4,� ;SCH. 4.0 ,CLEAN `SAND OOa COrVERS PVC PhPE . 1. s-t, ,L CONCRETE-,;, 1. _, - MI' PITCH- :: w�. _ :. \ - 1. ..1. - . 1. N� - < ��� I18, PER FT. I. :,' COVER. _ , 2% MfN. .PITCH R{CHARp ,;; 12 MAX. �� .. , a _. =:- v to _ - N ? 2" LAYER'0F 1/:9 l/'2 It q r FLOW .LINE,., Fc1s _ _ :' - '1NA' D ,. S`TON'f M �' _ ' y jj o — 3/4 'I`1/2 11 .,:, ;.., 4 --CAST ,IRON r,r : .!_ g ., . - -, r S � a _, C i,' a W P MI PIT H ,', .' ,. PI. E _ N. ,.,. n-. -,t .,, .. , 'x,... . x. � �_ .r _ u , . . : r. X . . , Y. ,.. a O. _ t . . _ . .-,.„ .y ! 4., PER FT. , - ��ST < — P#�ECAST•,.:LEACNIN - H .. v _ G „ _:,. , Q.YY m ► U W n c •• p a ;� 'BASLN OR< ' E�U'lV . ._ •, ,- n. _ . _. Q .y. , ::. , ei m -. 1. O .�/�/L ,.++�� W ;p;: r 'r v Y . ,_4 D(o i �.r fe rZ 1.111_11 GAL ,,�, ,�sj , ,rs - MASS. , a G.o a. s EPT IC µ ; -,_ , . S :�I _ . ,,• TANK /„ " fi R J ©, 1�aR'N,.t1 ±t C , ` ,. S,.FRS .T,_ - a 13 4 8 ROUTS 13 4: ._ I. ,.:_.: ., . _,. . X 4 -, -. - , ;: .1. .. ...,. - ,. ..K .,._. ._ -,... a- .. - ,_. . z, N4S, MASS A- T DELI E S . h ,- . PROFILE. OF 1 GROUND W�A.T.ER:_;- TABLE =:7G ,9 !,. _ y _ _ ",''1. CLUENT s a' " . : $ :; sr.• �.A.. 1. JOE NO$Z'��9w.�.as,�y ;'_ T M sc� .. 50,E T for 2 P L sYS E., s. E.AGE Dis 0sA , I. , y'<,. ter,. s . T. (.ALE _ .,; h .� y NOT O S rT x.. = j DATE SHEETOF w, 4t p, � t ter•_ W. _ r� ..,fir ''i �+ a� r.� �'`�t��'i,,- ^�P d t I .. r I.twA^5 sw � '��. �'� �,F�� � ..vJ7 � 'Y � +xe y;'w,'14+. ,y t•''. l�kar'rla.�. k a °L. '�fli'krn �, i f a2'':.a , •i 4 t} Irk.:�.l} r S 3S'# '%,a 5t 3 S > y"Nyl ' Y? F_.- } ( `F , , "4fi a f<a,r�r �, r!F:;' i f;.•' r` q4' � K ,� •�n � i "� s A .t t ,'� r 'm vh¢ at '.,✓ t F y w, J 1 u r ,w3 ryR��' �+�4 �y".„ re 1.� .� a ' � ��;�v lfd '� t't' a7 ,.t �m�'�i>•'SSJY du,' SI r"j.,y'k r .s; )r s e,+, lttr .. y , 4r � } 1,t�q.�7 �Kx�fr ?;� t a D It1.Gr t a /®C' w ,C.lj tF a -t r 3 � � �0, i + t { R "•1 r �iw+ 3 't irn ! ��t.v ka 1 rr I: _0 r �� ! } x— �s.f �-R �}ate._ �• t1� �� �¢ aMi a`-'G�.. .. +rs-fk ,, S t t , �: .•"�tt its *;. + ) i f ?,fi !� `sf ' .n �� ,� i ai�� ;� SS 4 ( i'�ts'��✓� I ee r 4 ' t °P r ' t x" 3! } SEPT/CN W 1 TDWiy' D BOX,. TANK Lai � 'L`a 7 � i :.t } I i i• yy, t '�! _ 3� f � R A� byr3F. i Aj -�� Fkit 20 et r R J � i Y'. } e � f 4��� II�� t Pt F `r � 4�� 7 `�f ' a' t �- € > •$�ry r � t , f i t � :`S ,g N +� � �L �'" c fin. t, f Rfi 7• y�rt : CEAGHIIVG -00 i '� � 1 (• � ' `' '� #u C- C a tr��*a�3 i�6g y' �Y„7 F + •i 1 a r,r ..I L at rf'r }` C t�� l 7�i '� 3Y.�•t`� 'E't�i�"r - o a S Y r1 v+ rt dS ,a q iL r R r. z, 'a _+ 3�f :, r A Y s; ;.� f 3 s ft t 7 i �'ftj »�;i✓- - t 'w z. c f y t r e � r a' d �, .'� aa ...�4 r1 t 3 i •,eFa r�3�J� {t 4ys r; 5 '�0�� +a r� }Pk �a t t �f 1 f i• i i1 e jN F J'j S ' t,� ro 4 rd 'i. ! 7 �, fil >`f75� A�t4s-�r J iY'.!b i.'YvIT�}Tt�'4:a���� Y r1 {'• f 3 i r .E t e a x ;c r' �7. �,.{ Y EXISTING a`'FINAL, GRADES ..SHALL,'" tt Y-REMAIN ESSENTIALLY THE;SAME., �O.r//i✓G eio.. /l[/gMGA� 7ZJ , /'Y /Si(/G,Q/�✓G�.��'S/ r r i ;t' :'N { Y `�t y, � rid,+��,�� f'" �, � i t C i !j (f .3s •fi3. i,Jy, 5 , ' f 1. f p J--. ,�Y'�Y. i XISfi'>I'IN� SFOT ELE'.VATIONS O;A s KM dEXISTING CONTOUR �, n F{NISHEQ ;SPOT; ELl .VAT IO:N0 ' 'fNISHEIY' CONTOUR 0, PROPOSED PLGI' h�` APRR ' FD=% 80ARD OF HEALTH �� � y 4 BARNSTABLE ;M ►SS.' r: -0 f: LOT. Al N S' aGE ✓. 1/'HEAllri''N, � n , s1348.` ROUTE 134 o JAMEs { EAST DENN_fS, MASS u, RI_CHAD.,; c O'HEAltN 3 E: 8 / ./82 DAT `- ` JOB N 0 . Ifi79 CL{ENT= K ' •`` ``` `} ...R`SU�v-�` OF DR , ,� y� TOWN N OF BARNSTABLE LOCATION 39 /n�.o CAA l i �b1VG SEWAGE# (L®QC" X7a VILLAGE 1-1`1rg Q tJ( S ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. e�KFU31 er c(S'68) V;?7-8877 SEPTIC TANK CAPACITY oo a//��>67 a t5, LEACHING FACILITY:(type) a k T40 C/t"be--'S (size) NO.OF BEDROOMS t OWNER ✓�ca 6t J e r 10 r-SC PERMIT DATE: f5 ' o1C3 ( COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on PIA site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachms facility) _ Feet FURNISHED— cAJ' of I� CC f (JvP) ' 11 (a ti o v r � t/v OD � F TOWN OF BARNSTAXBLE yr LOCA' ION� SEWAGE # J` ( SSESSOR'S MAP VII.,LAGE &&'0T *kv L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00 LEACHING FACILITY: (type) > (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: ' Separation Distance Between the: {y 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) C�CQ < Feet Furnished by `l � 1� CY n -7r" -� Q h 4 i l� � A T 10N MAjjQGAIL S E W A G E PE R M I T NO. VILLAGE 1w I N S T A LLER'S NA E i ADDRESS c% s er � d UI L D�� OR OW ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� �. •� ,� ��N N N � � �, P� \ _ ..,;�` ,�, 1 ✓� rN .�-"� s S - :� r� ; . � ti T.O.F. EL.= 283± FINISH GRADE OVER D-BOX= 26.9'± FINISH GRADE OVER CHAMBERS= 26.3' - 27.1 GENERAL NOT E REMOVABLE WATER-TIGHT COVER OVER f PROVIDE H.D.P.E. RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO DOUBLE WASHED w/COVER TO WITHIN 6" STONNEE T TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OF F.G. (TYP OF 2) RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 27•5 FINISH GRADE '± F.G. OVER TANK EL. = 28•0'± 5DIA OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC MIN SLOPE 1% BOX TO F.G. (SEE NOTE#21) 2"OF 1/8"TO 1/2"DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. . - _--__ - _-_._. -- ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 20"MIN.ACCESS i _ + DESIGN ENGINEER. COVER(TYP.OF 3) I TOP OF SAS- 25.00' PLACE RISERS ON ALL EXISTING 4" � _PROPOSED 4" 9" MIN. 9"MIN. CHAMBERS WITH 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 36 MAX. 24.00' 36"MAX. BREAKOUT EL= 24.50' INLET PIPES TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. FINISHED GRADE 6" 3" 3" DROP MAX L=71'+ J 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 9 MIN.SLOPE @1% [J�PROVIDE WATERTIGHT ELEVATION =24.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4"PVC IN FROM JOINTS (TYP.) � 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" ( ` � *2 •�'-} SEPTIC TANK 4"PVC OUT TO 0 0 0 O 0 0 0 0 0 O D O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY o0 00 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. R R Oo OUTLET TEE** 24•30� MIN. 6 24.13' T oo 00 0 0 0 o0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR 48 CONTRACTOR SHALL 0 0 0 � 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SHALL VERIFY AND CONDITIONIZE VERIFY OF EXISTING OTEES ION OF GAS BAFFLE 6"CRUSHED STONE o 0 0 0 0 0 0 0 0 0 0 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM 1S OVER MECHANICALLY o _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXISTING SEPTIC AND REPLACE AS COMPACTED BASE AND DESIGN ENGINEER. TANK NECESSARY 4 0� 8.5' (TYP) 4'0� .585' .585' 5 OUTLET DISTRIBUTION BOX (NP) 8. ELEVATIONS ARE BASED ON APPROXIMATE M.S.L. DATUM. ELEVATION OF 30.00, TO BE INSTALLED ON A LEVEL STABLE 25.0' A ESTABLISHED ON THE TOP OF A NAIL SET IN A PINE TREE, AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 22•00, GROUND WATER ELEV= < 16.40' 12 0' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 - 500 GALLON H-20 CHAMBERS 5'MIN. CHAMBER END VIEW CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. SEPTIC TANK PROFILE ** H-20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR TEES TO BE CENTERED 0 ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE DIRECTLY UNDER RISER NOT TO SCALE NOT TO SCALE WATERTIGHT. TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING PERC NO. 14770 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM MAP 288 I r INSPECTOR: David W. Stanton, IRSAPPROPRIATE AUTHORITY. PARCEL 53 '� EVALUATOR: Michael Pimentel, EIT, CSE 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS MAP 288 C.S.E.APPROVAL DATE: Oct. 1999 LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE PARCEL 49 t� THEY SHALL WITHSTAND H-20 LOADING. �" July 28,2015 r DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. PROPOSED H-20 ' TEST PIT#: 1 DISTRIBUTION BOX ROPOSED 2-500 GALLON H-20 LEACHING ELEV TOP= 26.90' 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE CHAMBERS WITH AGGREGATE ZONE 2 I MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. m N ELEV WATER= < 16.40 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, l� \ ' II FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ROPOSED INSPECTION O PERC RATE _ <2 min./inch FENCE(�'P) PORT WITH ACCESS BOX �, * G 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN / S81 * OU DEPTH OF PERC= 12"-30" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 0 08 40"E \ a SHED I 100. - _ • TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: 38. + ASSESSOR'S MAP 288 PARCEL 186 �i __ _ m / 5 (2) SHRUBS o -~ • 0" 26.90 OWNER OF RECORD: THOMAS W.SHERLOCK AND JUDITH A. SHERLOCK a Benchmark _ Fill Nail in Pine Tree / / �-- TP 1. (3) / I • 12" 25.90' ADDRESS: 39 MAINS'LE LANE Elev. =30.00 >, 26x9 \ Perc HYANNIS, MA 02601 Approx. M.S.L. 30" 24.40' FEMA FLOOD ZONE X >500 o LOCUS COMMUNITY PANEL# 250010568J (1) N TP 2 , 1 17. DEED REFERENCE: BOOK 12632, PAGE 45 '29 �. ' r„;,;� 26x9' 25.0, I '' 18. PLAN REFERENCE: PLAN BOOK 273, PG. 14 GC-1 \ (4) 36.51 I Med.-Coarse Sand 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. J _ r 18" PIN % SHRUBS \ s I s r `!• C 2.5Y 6/6 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY x -PAVED DRI�,i E- `" Q1 Q FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY l \ I LL •" FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. CONC. PAD N MAP 288 GC-2 IN ACCORDANCE WITH 310 CMR 15.401 - 15.405 THE FOLLOWING LOCAL UPGRADE x � N� -- 21. PARCEL 54 / GARAGE Q I APPROVAL IS REQUESTED FROM 310 CMR 15.211: / SALB = 27.6'± a \ I 3 , 1.) A 2.5'VARIANCE (10.0'-7.5')FOR THE SETBACK FROM THE SAS TO THE GARAGE. x t o _ , LOCUS PLAN FU ❑ SCALE: 1"= 1000' 126„ 16.40' �J DECK BASE uu I MENT) No Mottling, Standing or Weeping Observed 101, PIL -- - SAS _ �qS 3 I DESIGN DATA TEST PIT DATA LEGEND ' CO �Gq = , PERC NO. 14770 X Z INSPECTOR: David W.Stanton, IRS NUMBER OF BEDROOMS (EXISTING) 3 - - X 1 ' LLJ NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, EIT, CSE - 50 - - - EXISTING CONTOUR C.S.E. APPROVAL DATE: Oct. 1999 r PROPOSED CONTOUR _ Q Q DESIGN FLOW 110 GAUDAY/BEDROOM x {2) 10" OAKS ` #39 / 2015 1 -� DATE: July 28, 1 t` EXISTING APPR X. 1 CO ATW w = I _j p TOTAL DESIGN FLOW 330 GAUDAY TEST PIT#: 1 -- ❑/H/W EXISTING OVERHEAD UTILITIES 3-BEDROOM � ❑\ I+1 � Q � DESIGN FLOW x 200 % = 660 GAUDAY j DWELLING (� ELEV TOP= 26.90' GAS -- EXISTING GAS LINE 28.3 TOF = '± Z i _29 -_ '� ' U USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV WATER= < 16.40' W W EXISTING WATER LINE co J 3 a INSTALL 2 - 500 GALLON H-20 CHAMBERS PERC RATE _ TEST PIT LOCATION Q \ 1 �Zg / 1Z SIDEWALL CAPACITY DEPTH OF PERC= O Q EXISTING 1,000 GALLON SEPTIC TANK N _ w _ TEXTURAL CLASS: 1 I M w (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAUDAY MAP 288 w ' Q (25.0'+ 12.0')(2 ) (2') (0.74 GPD/S.F.) = 109.5GAUDAY I -- - EXISTING LEACHING PIT u LP o 0- „ PARCEL 55 / ' 3 o BOTTOM CAPACITY 0 Fill 26 90' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE LP i`27 I = I8L, (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 12" 25.90' I ,o (25.0'x 12.0') (0.74 GPD/S.F.) = 222.0 GAUDAY 13 PROPOSED H-20 DISTRIBUTION BOX z I w I QO PROPOSED H-20 500 GALLON LEACHING CHAMBER -27 - -p- - MAP 288 TOTALS: y% PARCEL 186 3 TOTAL NUMBER OF CHAMBERS 2 { XISTING 1,000 GALLON SEPTIC TANK 11,350 S.F.± = I TOTAL LEACHING AREA 448.0 SQ.FT. REV. DATE BY APP'D. DESCRIPTION ��- TO BE UTILIZED IN THIS DESIGN TOTAL LEACHING CAPACITY\ \ - __ '___❑ 331.5� I GAL./DAY r---.. PROPOSED SEPTIC SYSTEM UPGRADE APPROXIMATE LOCATION OF EXISTING LEACHING ma Med.-Coarse Sand ���`H of M,asr PIT TO BEPUMPED, FILLED WITH CLEAN, COARSE y% I C 2.5Y 6/6 0'� 9�y PREPARED FOR: SAND, AND ABANDONED (TYP OF 2) �\ CHU OHN L JR. CAPEWIDE ENTERPRISES I3 C IL � -o 418 A 8100.0,0 N 0,E ��y/ ? I �� LOCATED AT F c ° -.__26- I I 39 MAINSAIL LANE HYANNIS, MA 02601 SWING-TIES R , SCALE: 1 INCH = 10 FT. DATE: AUGUST 10, 2015 1 MAP 288 NOTES: PARCEL 185 DESCRIPTION GC-1 GC-2 No Mottling, Standing or Weeping Observed o 5 10 20 4o FEET 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. CHAMBER CORNER(1) 8.4' 31.1' PREPARED BY: RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING CHAMBER CORNER(2) 19.9' 36.0' 2854 CRANBERRY HIGHWAY FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO CHAMBER CORNER(3) 28.7' 20.3' ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 SITE PLAN CHAMBER CORNER(4) 22.4' 9.2' _ 508.273.0377 3.) ENTIRE PROPERTY IS NOT LOCATED WITHIN A DEP APPROVED ZONE 2. SCALE: 1" = 10' Drawn By: BSM Designed By:BSM Checked By:JLC JOB No.3183