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0083 MEGAN ROAD - Health
83 Megan Road Hyannis P A - 292 252 I F Y Y f Ij t dommonwealth of Massachusetts a q a_ a� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is. Hyannis MA 02601 06/10/2021 required for every H_y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information ,Sys I9Lt(aT on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return key. Company Name 52 Rivers End Road _ rya Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 06/10/2021 _ Inspector's Signature a e.- The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 ti Commonwealth of Massachusetts 1n= Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� 9 p Y rY 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 _ page. CityTTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Please read the bottom of the first page of this report. This statement is from the Ma. DER This home was inspected under the Ma. DEP and The Town of Barnstable's guidelines. This 2 bedroom home has an H-10 1000 gallon with a D-Box feeding 3 infiltrators with stone. At the time of the inspection the leaching was dry and no visible failure criteria was found. Note the septic tank is under a deck but there is a trap door to access the inlet cover. The cover is raised to grade. The inspection port is at grade for the infiltrators. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �R - Title 5 Official Inspection Form �z _ �1n Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts gin) a Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts PD Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road 'J Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. Cityrrown State Zip Code Date of Inspection G. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or.privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 .� Commonwealth of Massachusetts Title 5 Official Inspection Form 1-1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road V Property Address Paul Collins Owner Owner's Name information is Hyannis MA 02601 06/10/2021 required for every y _ page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): G plus PD Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: In 2020 -44,880 gallons were used and in 2019 -44,132 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 _ page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ 'No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 4'\� Commonwealth of Massachusetts 1x Title 5 Official Inspection Form i r- I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2007 New Leaching Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 32"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. ii k t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form G II Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t� a � 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis annis MA 02601 06/10/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1000 gallon 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend the.new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the baffle was in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 83 Megan Road N wl�i Property Address Paul Collins Owner Owner's Name information is Hyannis MA 02601 06/10/2021 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 � Commonwealth of Massachusetts _,-A Title 5 Official Inspection Form ,1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road L Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc-rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road �V Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Y Title 5 Official Inspection Form l� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road V Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner's Name ;., i-;vannis MA 02601 06/10/2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system;including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters The building. Check one of the boxes below: 71 hand-sketch in the area below drawing attached separately I I I i 1 I I I g;ti018 Tide 5 Official Inspection Form:Subsurface -Sewage Disposal System Page 16 of 18 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Megan Road Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form aJ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments < � 83 Megan Road u Property Address Paul Collins Owner Owner's Name information is required for every Hyannis MA 02601 06/10/2021 — page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 oNo. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Th5po 6p.5tem QCongtruction Permit Application for a Permit to Construct O Repair Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 3 � �U Owner's Name,Address;and Tel.No. Assessor's Map/Parce Installer's Name,Address,and Tel.No.���` '� Designer's Name,Address and Tel.No.,D0�4 M y 26 -- 2 Type of Building: d� 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) 4/(2 CxPO gpd Design flow provided a gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Q�� Type of S.A.S. Description of Soil 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 Certificate of Compliance has been issued by this Board of Health. Signed `?/yy���G �1�/ /�S Date O Application Approved by // l��(Ji�-r Date Application Disapproved by: Date for the following reasons Permit No. aoo:9 ( Date Issued .1 0 ...r^� ,. •._...,,�—+,,.,..-....r.."�..-....... ...�ti•.•N��""'^<^ . ".n-f�+-+Jr-.-...r.r-'�.r.w"'i .�'ti. -I`,^� -^sn �,. ti-.e.••Y•- ,. � .�'' -' .. l; 9 1s r '' J �- o.' Fee N .. THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ PUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Ztppliration for �Bigo 6pgtem �Cottgtruction Permit f i Application fora Permit to Constru't O Repair Upgrade( ) Abandon O ❑Complete System ❑Individual Components ' Location Address or Lot No. �j 3 �r= /��U Owner's Name,Address;and Tel.No. Assessor's Map/Parce Installer's Name,Address,and Tel.No. —Designer's Name,Address and Tel.No. / mrayyzos 5a Ray C�/ f•�S%H�cf/.C7 Type of Building: d� A Dwelling No.of Bedrooms — Lot Size d sq. ft. Garbage Grinder ( ) I ti Other Type of Building � � No.of Persons Showers( ) Cafeteria( ) Other Fixtures j i Design Flow(min.required)_ / �gpd Design flow provided -3 8 gpd Plan Date Number of sheets rl Revision Date i Title i Size of septic4i.k � (� /OOy Type of S.A.S. //Rl.? P4M 3 01 v Description of Soil i I Nature of Repairs or Alterations(Answer when applicable) I i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 1 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed !//l�yl =� il��t/ Date / o-7- 1 Application Approved by rn�i ,17 Date 11Z ApprioatiomDisapproved by: Date for the following reasons Permit Nd. � ""�(/� Date Issued —— ————=——————— ————————————— ———.——————— -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS i Certificate of Compliance F , THIS•IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by e✓ at has been co•-n�structed in accordance with the provisions of Title 5 and the for Disposal System Constructionc- Permit No. 0^t � n dated i i Installer (�� / /W6 signer 1:,)A-1:Q1!iy )VIC-7 #bedrooms' �) Approved desigm�low gpd f The issuance of this permit shall not 'e const ed as a guarantee that the system w'4l Uons designed. ¢ Date 7 Inspector :.: , , � No. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wigogal �&pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( PI'Upgrade ( ) Abandon ( ) System located at � � 1(D i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Co stru tion must be completed within three years of the date of the p( a Date J Approved by I r r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Volunta ssessments 83 MEGAN RD 6 Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD 02632 _ Owner Owner's Name information is HYANNIS MA 02601 9/22/07 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. Important: A. General Information When filling out forms on the computer, use 1. Inspector: LLs 6111. only the tab key to move your MICHAEL DEDECKO cursor-do not Name of Inspector use the return key. COMPASS REALTY DEV CORP � 2q'i, 2SZ Company Name Q _P.O. BOX 2384 _ Company Address MASHPEE MA 02649 rew" Cityrrown State Zip Code 508-221-5003 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: z ❑ Passes ElConditionally Passes ® Fails _ t7"a I ❑ Needs Further Evaluation by the Local Approving Authority 1_,I cis iz .y: 9/22/07 Inspector's Signature -'----� Date The system inspector shall submit a copy of this inspection report to the App oving AuRhority(Board of Health or DEP)within 30 days of completing this inspection. If the system s 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. 83 MEGAN•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/22/07 required for 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. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 83 MEGAN•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 _ Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 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 • r ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt.marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑' The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 83 MEGAN•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 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City[Town 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 ® ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ l, ® 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 El ® 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. 83 MEGAN•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 MEGAN RD - Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/22/07 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than.100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection El 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. 83 MEGAN•08/06 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 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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? El ® 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)] 83 MEGAN-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. Cityrrown 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: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): N/A 9 ( Y 9 Sump pump? ❑ Yes ® No Last date of occupancy: N/A 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: Last date of occupancy/use: Date Other(describe): 83 MEGAN•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records;if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: N/A Were sewage odors detected when arriving at the site? ❑ Yes ® No i 83 MEGAN•08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 _ Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight, yes vented, no sign of leakage. Septic Tank (locate on site plan): Depth below grade: 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 ------------------------- -------- ------------7------------------------------------------------------------------------ Dimensions- 1000 GAL Sludge depth: 2-1 3211 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle ' 11" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? MEASURED 83 MEGAN-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): NO NEED TO PUMP,TEES INTACT,STRUCTUALLY SOUND,LIQUID EQUAL WITH OUTLET INVERT,NO LEAKAGE 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): 83 MEGAN-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 83 MEGAN-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 �I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection , D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1/6X6 ❑ leaching chambers number: ❑ 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.): ` SOIL SAND/GRAVEL,YES SIGNS HYDRAULIC FAILURE IN LEACH PIT , PONDING 2, NO DAMP SOIL,VEGETATION NORMAL. 83 MEGAN•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/22/07 required for 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 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.): 83 MEGAN•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 9/22/07 required for 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. ® ~ t a ( 2 33 S2- - 32- ' 83 MEGAN•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 MEGAN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 9/22/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® -Surface water ® Check cellar ❑ Shallow wells - Estimated depth to ground water: 52.96' 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: BARNSTABLE GIS -You must describe how you established the high ground water elevation: BARNSTABLE GIS 83 MEGAN•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 1 COI+ ONWEALTH OF N ASSACHUSETTS ExEcu TIVE OFFICE OF ENVIRONMENT-AL AFFAIRS • DEPARTMENT OF ENVIRONMENTAL PROTECTION w TITLE 5 u; _ > OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSES F NTS 3- T SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM � v PART A o aro QQ CERTIFICATION -i rn Property Address: O 3 mccialat, Pi � - Owner's Name: Owner's Addres*f. .j- - 32 Date of Inspection: �11 Name of Inspector: pl print) e tiTT '�'P ` Company Name: jC I�i �ta�S -ARCEL 5--: Mailing Address: Telephone Number: cS'0 38S7b 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 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 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority jj Fails Inspector's Signature: Date: 31,51 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IIISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: t T Date of Inspection- 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 descnbed in 3l 0 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evahrated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional P section need to be replaced or repaired.The system,upon completion of the replacement or repair,as roved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the f e following statements.If"not determined"please explain. The septic tank is metal and over 20 y ohd*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or on or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complyth tank as approved by the Board of Health. *A metal septic tank will pass inspecti if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than years old is available. ND explain: Observation of s e backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or du a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board o€ ealth): broken pipes)we zqAaced obstructiemislemoved distribution box is Fled or replaced ND expl The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will p inspection if(with approval of the Board of health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFIICATION(continued) Property Address dr p Owner: 111rero Bate of Inspection: 3�3 ` C. ]Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in or r 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 ith 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public alth,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 vege ed wetland or a salt marsh 2. System will fail unless the Board of Health d Public Water Supplier,if any)determines that the system is functioning in a manner that protec he public health,safety and environment: _ The system has a septic tank and soi sorption system(SAS)and the SAS is within 100 feet of a surface water supply or tnbutary to a ace water supply. _ The system has a septic tank an SAS and the SAS is within a Zone i of a public water supply. The system has a septic d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply welly*.Method used to determine distance "This system passes i e well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile panic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DOSAU SYSTEM INSPECTION FORM PART.A- CERTIFICATION(continued) Property Address: Owner: A`erO Date of Inspection: a� D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ail inspections_ Yes ' Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool t Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow o—( Required pumping more than 4 times in the last year NOT due to clogged or obstructed p4*s).Number of times pumped . _ Any portion of the SAS,cesspool or privy is Mow 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. 0( Any portion of a cesspool or privy is within a Zone I of a public well. 4 Any portion of a cesspool or privy is within 50 feet of a private water supply well. goT 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.IThis system passes if the well water..analysis, performed at a DEP certified Laboratory;for coNarm bacteria and volatile organic.comp�s indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equatto or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria 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 rva a facility with a design flow of 10,000 gpd to 15,000 YYoou must indicate either"yes"or`W to ofthe following: (The following criteria apply to large s ems in addition to the criteria above) yes no _ — the system is within 0 feet of a surface drinking water supply _ the system is . ' 200 feet of a tributary to a surface drinking water supply the syste is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone f a public water supply well If you have ered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Secti n D above the large system has failed.The owner or operator of any large system considered a significant t under Section E or failed under Section D shall upgrade the system in accordance with 310 C1v1R 15.304.The stem owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address• g� 4 O 0 Owner: AI-4� Date of Inspection: d — 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? Ii 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 o!f 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 imte_nance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example;a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMa 15.302(3)(b)] 5 Page 6 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 . Zoe,- M -� Owner: i e/`b __ Date of Inspection: 6�_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): e'2 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: I 10 gpd x#of bedrooms): p10� Number of current residents: 0 Does residence have a garbage grinder(yes or no): �Ib Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):Nb Water meter readings,if available(last 2 years usage(gpd)): 6 3 - ',("Wdn 9� Sump pump(yes or no):A70 t�6� Last date of occupancy: ZzQ; COMMERCIAL/iNDUSTRIAL Type of establishment: Design flow(based on 310 CMR I5.203): Qpd Basis of design flow(seats/persons/sgft,etc . Grease trap present(yes or no):_ Industrial waste holding tank Ares es or no):_ Non-sanitary waste discharged a Title 5 system(yes or no):_ Water meter readings,if avai le: Last date of occupancy/u OTHER(descri GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):Ld If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):AZ 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEX TS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ! f�w/lis Owner: %rd Date of Inspection: 443�0'S� BUILDING SEWER(locate on site plan) . Depth below grade: AY _ Materials of construction:_cast iron X40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:J' (locate on site plan) Depth below grade: 6N Material of construction:gconcrete_metal—fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no)!_(attach a copy of certificate) Dimensions: /060�F ai/ Sludge depth: e2 p Distance from top of sludge to bottom of outlet tee or baffle: 3a Scum thickness: o7 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottooutlet tee off baffle: How were dimensions determined: Pt/1�GY Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outle invert,evidence of leakaN,etc.) ."t o a,&$ S o v kb/a `t t fiPCS � fti t4 G L° cc�'/ i It VON GREASE TRAP:_(locate on site plan) Depth below grade:, Material of construction:_concre metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of sc to top of outlet tee or baffle: Distance from bottom scum to bottom of outlet tee or baffle: Date of last pump' Comments(on p ping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to o et invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Ni P� ' Date of Inspection: 6 TIGHT or HOLDING TANK: (tank must be pumped at time inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal glass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gall y Alarm present(yes or no): Alarm level: Alarm is g order(yes or no): Date of last pumping: Comments(condition of and float switches,etc.): DISTRIBUTION BOX: JV (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 2 Nc� 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.): 'I&.e box toad lead oed YXkf gy&K A-o A o'�rCQrt7 -J'W. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes o): Comments(note conditio pump chamber,condition of pumps and appurtenances,etc): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUAFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: /fli*$0 0 LS Date of Inspection: 3ZiLa(— SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number. f leaching chambers,number. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Yrf &1avvie ` s l ci-vo CESSPOOLS: (cesspool must be pumped as part of inspe ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater" ow(yes or no): Comments(note con dit" 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: 'Z Comments(note condition il,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: g� A S Owner. Date of Inspection: O 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. st4,r e row• �'o es,c� yo�-7 a �a �n 4 Page I l of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8.1 Q 0.M_ ea J�bjav_v�6 Owner i�¢ Date of Inspection: SITE EXAM Slope 0 Q Surface water 00 Check cellar 40 Shallow wells 00 Estimated depth to ground water JA feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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 establis d the high ground ater ele ation: or` o o yEX d D 11 3 _ f---- C.OMMOLkVA-TAL-T- -GF-MASSACHUSETTS ' - Eluc TFVE-OFFICE--Or-E-m-RaN.NtKNTA-L AFFAiRs tiO IYEPARTMENT OF ENVIRONMENTAL PROTEMOI7� D, I ti • ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 s TR>aY,C0\Et�E� Secre.an ARGEO PAUL CELLUCCI D'AVID B-STRUHS Governor_ _ _. Commissioner - . SURSURFACE_SEIKAGE-DLSPOSAL SXSTEWINSPECTION EORNL_.--_ _ PART A Z-q 7. t CFRTlE1CATION ,�` T %%G� 'roperty Address: meL�Rr1QcI }'tltijjftq.0201 Name of Owner d4fl&Tlx%#e C rX0VIMA rOS Address of Owner: iffli WtcTQe.jA )ace of Inspection: 12-- 14-99 Wea g '` �Q-glofl-3.00 Marne of tr�accor.t>Tease-Prtnt►-R-€-I-4-C-. g ' _ Lam a-DEP-approved_system.inspeetm.pursua•rt to-Section_-15_UO-of-Tdie-S-(310-CMR-�5.000I ompany-Nam: ELL IS BROTHFPS N,-T rn - Nafrng address: 2 3 ENTERPRISE- __Ya-A T H PORT , MA r - 9o- �-c--,--•_ :ERTIFICATION STATEMENT certify-that- d4posst- that the Information reportedbelow is true,-accurate _md complete as of the time of inspection. The inspection was p-ertormed-based on-my-training_ant-experience-in the_propet_functioa, nd naintenance of on-site sewage disposal systems. The system: 1 Passes _ CorrditionaltjrPass-�s - Evaluation By-the-Eoeat-Apptevi"thority - Fails - nspector s Sigrtagere:- _-`�� -_ Date:---w � he System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of ompleting_this_inspecii.on.--tf-theLsystem_is-a-shaced.systam-or-has_a_de&kjr tlosu_of 10 Q00-gpd.-or..gceaterr.thelnspector-and-the-system owner hall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the "tem owner and copies sent to.the buyer,.if.applicable-and_the-.appto_ving_e�uthority. IO-TES — 1 -ev'ised 9/2/98 page or A t-_jPnetednn RorydeA Parr__ 5, f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Ad lress-!8�3 >an RJ_ UlF, nfis�MA a a 6 01 Owner: fvb�+ r3#, Cq��Lttr►ATi+� INSPECTION SUMMARY: Check Aa B, C, or D: A. SYSTEM PASSES: 1 have not found any infoTrwtjon w ich indicates that any of the failure conditions describe 31;0CMR 15.303 exist. Any failure criteria n oed are cateolNow. COMMENTS:. i�I .7 ' 5. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Cond(onal s"section need to be replaced o►repaired. The system,upon completion oT the-replacement or repair, as approved-by theHealth,will pass. Indicaa' yes, n or-flet-determined-M-N,or NO)..-6eseribe-basis of --tf--"not-deterrnined' �xp(ain-why-not. _ The septic tanks-metal,-unless-the-awaer bt was.provide d--the-systerninspectm-with-&-copy-of-a-CerUficaw-of Compliance(attached)indicating that the tank we installed within twenty(20)years_prior to the date of the-inspection; or the septic tank, whether or not metal,is cracked, ructurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspecti if the existing septic tank is replaced with a complying septic tank as approved-by the-Boorrd-of-Health. Sewage.backup or breakout or high static water It el observed in the distribution box is due to broken or obstructed pipets) or due to a broken,settled or uneven distribution I ox. The system will pass inspection if(with approval of the Board of Health). --broken pipets-)-era replaced .-._. distribution bon-is.Jeacelled or The system required pumping more than four time a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health -broken pipets)are replaced obstruction-is-removed e TeV1Sed /-2/-9-8 Page2of11 SUBSURFACE-SEWAGE-DISPOSAL-SYS-TEM-INSPEC-TIOI�FORM PART A CERTIFICATION(continued) roperty Address:83 hv4tq 1, P,1, -1��atanlS}1MA�a401 'wrier: ( sfi r�e�C-}sxaLicwz�rs- .. ace of Inspection: 12 14- 49 FURTHER WAt"TION-IS REQUIRED BY--THE-BOARD OF-H64LFH---- Conditions exist which require further evaluation by the Board of Health i 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 ACCC RDANCE WITH 310 CMR 15.303(10)THAT THE SYSTEM M NOT-FUI*CfitONIf-M!-A-MANNER WHICH MLL PRt371`CT-7f4E- TitANBSA€ETif AND-TH€ CesspooLot.priWis within..50-feet_nLsuif Cesspool or privy--is-within 50 feet of a bordering vegetated wet nd or a salt marsh. 01 /,¢- 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH LAND PUB IC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE POBLIC H TH AND SAFETY AND THE ENVIRONMENT: The-system-ftes-a-septic-tank-and-soil absorption the--SAS-irwithin 100 feet of a-surface watersupRly or tributary-_to-a-susface-wate�supply_—._ _ _._ _ The-system has a septic tank and soil absorption syste and the SAS is within a Zone 1 of a.p-ublic-water supply well. _ The system has a septic tank and soil absorption systerr and the SAS is within 50 feet of a private water supply'well. The system has a septic tank and soil absorption systery and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis f ►coliform bacteria and volatile organic compounds indicates that the weft-is free trom potfutton-from thsrfecility and-thv- of-arntttonia--nitrogerrand Fate nitrogen-irequal-Ur-ortess - then 5-ppm—Method used to-determine-distanes--- - -- validt:- - - 31 OTHER evised 9/2/98 PW3-of11 SUMUN FACE SEWAGE DISPOSAL.SYSTEIM 11111SPECT101S ia01W IARTIt--- _ hgwtylwra,e: g$*evhvU_ rrhsw�-A�a�o1 - owner: i�fiae -- Owof bapectaorn: a 2-I W-g 9 'Yes'oa No'-m ON*of to = --- ._ thaw-deterrolead OM one atino of on_followlnSftllurro- gin !as desaibsd In 310 CUR 15.303. The basis for the detardrgAton Is idsntised below. The Board of Fedth should be to datKnilm what will bs neeasom to conact tM 1a8we. Yes No Bmkup,of sawspa ruts Ws".or sVstenr D of theSmotaudaaenereReat duo_to-an_avor oeded or.dogW SAS or Stalk gWm wed in the dsuibudon box show outlet due IA an ovsrloaded or doped SAS or cw+P�. Lk#W-dso*ln eesspoote h>:s l2-dw,9ow. Requkadpanpbq a+arafhwn�tlans In tM Imm Vest fue to nnnod �ipetsl. Any portion of the Sol Absorption System.cesspool or pd oy Is below due hbh proundwMW Devotion. Any portien orrcaapod-or Ary► pdvv In-+drip.toes I of ai AIIIFWGL - P*N,_ - Any portion of a cesspod or privy Is within SO feet of a p Was.water supply iiso. Anti portion of a eesepod or prey►a ess•tinan Too-11" per trap 50 fii�c*an a pfivsti water supply-well-with no - occepohle-woogwBty snolyair-H for E: LAROE SYS I FALLS: You nerst)indicate eltiar"Yes"a"No" to each of the following: Trw 0 ripply to NOW eVotonsin-ad Ndg tothe --__-- tea stgdron entbacouse- na_ormme of the_ .. - . sxkt: Yes No tie sysfenn witi the tm to system is located in a nitrogen sensitive was ILnI I NdImed Protection Ares-IWPA)or a napped Zone 0 of a pubk water supply wd) Trio-ownw or ops -tm-alwwouclraystem t6 -Plesso Commit do hmd.w4m revigp�-��4�-- .-- ---. • �4d.11.. FO W PANT B M�/S■ r.Adi.es:Cd3 Megan VU IAVI T%ntS)MA 0a4'a I o.a.r: GL,risf��,�1-�r�t,�+r,ATos DO*of berodoll.t2-ty-q9 Check If the falowbp hwe been done:You mast bdioate sides "Yee"or"No"as to each of to following: Y _ No _nlormatbn was dod by the owner.occup=vL or Beard of HNld • None of tlw system comrponusruts hew been pumped for-at isast two wedw arWHho sysarn has teswoocaivlgmarnatnlow eats during that period. Lwgs volume of water haw not bean Introduced Into the system recently or as part of this InaPectlem--- _-. As butt plans have been obtained and exonined. Nate N they ve not avalabb with WA. - The fadky or dwelling was inspected for sips of sewage back-up. - - Thrsystem flew. _ fo�slgns otbnelmd. Al system eomporantr.ramiudYrg the Sob Absorption System.have been located an due-tits. _ TWasptiu:-W*-itia*Wee wwo uncowret,"opt-wxU w-lntvriw oTtho-supliw2a rlrwerInapected-ft _. or tees,nwwdd of eanetruetion.dinuoneiors.depth of lquld.depth of sludge.depth of scum. - fha k*m&beeden-ot bas"on: --„ EulediuB_fnhonnodon.For example.-Plan at B.O.H. - Detamulred in tee fish pt eny of tho talwre auiterla related to Part C b at bees.approxMuadoru of dbtana b uesexuptebb) _.. . Swourfaee Disposal Systems. revised--9-/2./-9 8 SUBSURFACE SEWAGE 81PS #MSPE FORM -- PART--C--- SYSTM 9111 oiW1A ION "�prop.rty-,wares.:���^-►�iP►��e�--I•� ►-�►4A3�-'d�'�l(p o r -_ Owner: (�r1STi��E_.C-�f C.Qltrr�r�I l Deft olrb-pec Piro 12-14•q 9 F�seNoyraNs -- Resiuett>IAt.• - Tog4DES1ON-Aow- _ . Nunft. of bedtooi to New Nu�er_stcrtcarrt (, Garbage grinder(yes or no)�� Laundry toopersto systemr- t"s or not P_Wyos,separate Inspection required Laundry system inspected (yes or no) Seasonal Use_y�es_or_.no!'��J- ► �- �' saes ` Watat_mater readingazd_syslows(last two.year's useg*(gird)•_ Sump Pump(Yes or rw):�(/0 -----� .f - f-F; ft(� r3 t Last ' data of occupancy: Type of astaNshment• f K f w,- �TBasbdon Tb_zM__.. 0-istgn , Basis of design flow- -- 6reasa�aPpieseft--[ages oR ao#._.-_ k�natdaLWast�Koi�tankpnssM�.t�oLno1-__ Non•sanitery waste dischargod.to the Title 5 system:(Vas or no)_ Water meter readings.It available: Last date of occupancy: OTHER.-Moseri 0 - , Last - TION @VMPNG RECXXIDS and source of information: System-pumped --inspection-1ages If yes,_volume P--~•/Lbo gallon uon for pumping: TYPE T6N - r -Septic tank1disti bution boxisoll absorptlon-system Single cesspool Overflow cesspool Privy Shared system(yes_or no) Of Y-es„attach previous inspection records,K any) t/A Technology aft.Attach copy of up to date operation end mdntanancs contract Tight Tank Cagy of DEP Approval Other APPROMATE AGE of al components.date Met~of known)end source of information: � ollors detected when oniving at the-it*-(yes or_m�d "1 Pet- - SUBSURFACE FORM PART-C---- - r� SYSTBI NFORM rad)ATION(COndM AoQ v Addross: '6 3 Ty%!aAn YZL-N%�Ann�i,YY\A-o a 6O l Owner: L�nctsltifPAfl C�z104imr�To3 Da1s ei bepee6on: 12. MUMIG B (tamwsrn-�e ) -- Depth below graft: �� Matedfiof Construction.- Cast iron 46 Pa!& -other(*Main) Distance from Vivo"water supply well or wction line Diameter SEPTIC TAM:4-400 (ioeate on sits ) Depth below greds:�7`� Material of construction:15nerate_metal_Fiberglass _Polyethylene_ofhw(expldn) M tardris meld:-Eatags—= _Afas1Nol i J __ .� _s--r•- _ Sbrdge dam:_ - Distance'f vm top-of sludge to bottom of oNdleL-tee Distance from top of scum to top of_outlet tee or befM: 1� ;, Distance from bottom of scum to bottom of et tee or baffle: !J Now dimensions were daterminsd: Comments: (recomrnendadon for pumpin ,owdtk gf bdetpnd oirplat tees or bafNas.depth o liquidd I al I relation to ocjtlet invert,structural integrity, evidencrotisokap�. / J C��tsr QIIEASE TRAP: ` Qocafs on oftplan) Depth-bflow glade._ �Aotsdd of :.__Conc�-_metd__� -Pol _ne_ other(expidn) me Dinsions: Scan thickness: Distance horn top ofscum to top of-oudst ted a 6effri: - oud-t tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or ,depth of liquid level in relation to outlet invert.structural Integrity, evidence of leskaga,etc.) w rev-ised-V-2-/-9-8--__ e 7 of 11 SUBSURFACE NSIMMUIPEC KWFOM Nropwo Address: 8's rn cry% R alHY►r}I��iYl�l a a6rj) Dewaf Impeder:-t Z-14-9 9 TIBIfT-Qli- MWG-TAWL-, -.. .--.,ITTmk awst haourneed pdor_to.-w et ti of.inspection) poeste_on aite planL-_ Depth below grade:_ Material of construction:_conc*ete -_ _othertsuplain! sions- capeclty: geuons Design flow: gslions/day Alarm present Alarm level: Alone in working order:Yes._ No - Data otprevioas-pumphtg:- Comm~-- (condfttoit_ofWattes-condga otahwm.WuLffoat_switches..etC.i_ pocate-.on sib plan) .. DI1�1-B01D� Depth of liquid level above artist Invert: �:-- r , tnob.1f level and distribution is q_u_ ."dense of solids carry-ofveer..vAcIT"of joksge i_ _.or out of x,etc.) (locate-on WW plant-- Rumps-ht_wocking--order--(Ysa_ocHo1 _ Alarms In wotking_order(Yes.or No) _ Comments: (note condition of pump chamber,condition of pumps and appurtenance etc.). i reuised_912PO------- p�lr sof11 SUBSURFACE SEWAG€ SYSIKSPECTION,,FORM PART C SYSTEM INFORMATION kontinueM 'mP AdAr }w 4�1 h1f1}'k me o �D i Orrnsr:. D%ri s l%ne- C�erct�mA l o z Date of Inspection: 12.-14-q t1 SOd ABSORmou.sysTmiSASk (locate-on-site Dian it possible t_ ,not required--location_may be approximated lty_non4ntrusive_methods) W not-located explain: Types_ Wachina p►ts,-number: - leaching chambers,number:_ 1e8chingA14611eriea,number:_ leaching trenches,number,length: leaching-fields,number.dimensions-- overflow cesspool,number:_ Alternative system: Name of Technology: Comments:--_- , (note condition of soil,si s of hydraulic failure,Jevel of p noting,d mp soil,condition of ve etation, tc) CESSPOOLS:-- (locate on site plan) Number and-configuration:--- Dspth-tap-of-litpeid Jepth of scum layer_: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow lCesspool=mustbwpumped as-part ofinsp&CtionL- Comments: (note condition of soil,signs of hydraulic failure,level of ponding, co station of-vegetation,etc.) PRitllrr Iloeste ors site plank Materials of construction: Dimensions: Depth of solids Comments: (note condition of soil,signs offiydfaulic fa7u e,-tever-of-ponding,can Won of-vegetatiorrm,etc.) an M- AILSYITM 1W FORK PART C SYSTQII NFOIMATHM(condnuedl Naverty Address: let Av1 A�1 14nOWm nli_ Oaft of irspecdan. SKETCIiDE STD: include ties to at least two permanent reference landmarks or benchmarks locate all weds within 100'(locate where public water supply comes into house) vNI f t I 7 l_ revised 9/2./T9.8. pdgeioof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPWnON FORM SYSF (aos#reudl boapertyAddress:8-6morr', A�1Y)��l'111A oikbl'i Ourew' C1�r�sT;r,e.C1 t D�-i 1hf3To-s Date oPrnsp.ct�orr: 2 y_9A MRCS--_ Report name —--- _ Soil Type_ Typicel-death_to groundwater USGS Dab website visited Observatio -Wells-c"cked Groundwater depth: Shallow Moderate Deep SITE-EXAM--.- - Slop.--- Surface water /:4-� � vs.• Check Cellar Shallow woos EadmatW Depth_to-Groundwate at -thsnwdhods-,,s*d-to determine High Groundwater Elgvadon: .Optaned from Design Plane on record i � te_(Ab�_property.-observation hole,basement sump etc.) Dvtn*Sd'from local conditions Checked with local Board of health _-- _ eked pumping records . VCheckedlocal excavatorsl"UAers Used.USGS Data Describe how you established the Hgh Groundwater Elevation.(Must be completed) - et r • �` - i, 64 Town of Barnstable WE � Regulatory Services Thomas F. Geiler, Director • DAMMAM& MAC Public Health Division 1639. �Tiart°' Thomas McKean, Director - 200 Main Street,Hyannis,MA 02601 Office: 5087362-4644 Fax: 503-790-6304 Installer & Designer Certification Form r Date: Sewage Permit#J- M 3 Assessor's Map\Parce 5 Designe /z� Installer: kl/z,1_11�'( Address: 1400 de-X 4 SI Address: 12R-W_� 0 V�31- On O was issued a permit to install a (date) (installer) septic system at e Rn /0O 0:address) based on a desi;n drawn by �✓✓�� oNa ' %-✓ 9fdated (designer) l 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 a'n&or septic tank. I certify that the septic system referenced abode was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mgss9� o D AF" I� (Installer's Signature) " No. 1140 ZI� S1 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN TABLE PUBLIC HEALTH DIVISION. CERTIFICATE 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 3=26-4-doc • GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED LEGEND BOARD OF HEALTH AND THE DESIGN ENGINEER. O y 2. ALL WORK AND MATERIALS SHALL CONFORM,TO THE REQUIREMENTS 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION y s 41 (� OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE 12. THIS PLAN IS TO BE USED FOR SEPTIC„ SYSTEM PURPOSES ONLY +( � }--� PROPOSED CONTOUR `� LOCAL RULES AND REGULATIONS. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 1 ® PROPOSED SPOT GRADE 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 14. ALL PIPING TO BE 4" SCH 40 ® 1 8 FT UN —— 9S —— EXISTING CONTOUR DESIGN ENGINEER. �� (UNLESS SPECIFIED OTHERWISE) MARY ALI 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW �n • � 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I: + 96.52 EXISTING SPOT GRADE 9oG GE E � f FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN FOR THE USE OF A GARBAGE GRINDER ENGINEER BEFORE CONSTRUCTION CONTINUES. 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING III/— EXISTING WATER SERVICE R' co $Z 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 17. PROPERTY IS NOT LOCATED IN A ZONE OF CONTRIBUTION. o = 1311 y 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF TEST PIT ER a � THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C07 NTY S HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. C T 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. m ST P L ' coKA GUNK o0 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED y RD C TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. h 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY BENCH MARK tL CO�E g ER THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING [ CONSTRUCTION. LOCUS MAP N.T.S. ,F PAINT SPOT 01�I .STEP ELEVATION = 53. 68 ff BARNSTABLE CIS DATUM ---------------------------- --------------------- 2 2 8.3E f t 1 54 C ------ ---- --- ------------- ------ --------------- . 53 < - - -# - / I \\ I O DRIVEWAY --- GAS �� LINE I j T 2 � �/ GAS Exist. 1000G r� GATE4 �L I �- + _ . `! Sep tic Tank -w WATER L 89 Sf - V--- AREA. = 192 j I .\ \\ j EATER t h Pit 0 z I Existing Leaf z n O I \\ ` o i (See No ile 10) X XI r I I r 1 j G L J o to I z CO X II I 11 Li a ! i w w Li O O� 1 1 o ~W„• / I Q I < W i 1 1 I a N I oCDj 0 TH-4 TH-t'3 cn II �� ► o O ro Y i / j Li/� ----�r� / j II Lr CD / jQ 0 I \ TH-1 12.16' T j \ TH-2 L/NE - - - - - - - - - - - - - - - - ------------------------- - - --- - - - - - - - - - - --- - / --------- /L - - - - - -- - - - - - - - - --- - - - - ---i - - - 54 241.75 ft / / 53 52 of Mgss9� PROPOSED SEPTIC SYSTEMUPGRADE PLAN C � D E1 83 MEGAN ROAD, HYANNIS, MA N . 1140 Prepared for: Asevedo SURVEY REFERENCE: O MA 292 Engineering by: Surveying by: SCALE DRAWN JOB. NO. C/$TF P.LOT.•252 DARRENM.MEYER,R.S. Boo-Tech Ira vimnmenta! 1"_20' DMM PLAN OF LAND BY T.H.STEGMAIER, CE NITAR\p� DEED BOOK.# 19680 PO Box981 (508) 364-0894 DATED: DECEMBER 24, 1956 6 07 DEED PAGE.# 048 EAST SANDWICH,MA 02537 DATE: CHECKED SHEET NO. �•� 508-362-2922 11/06/07 DMM 1 of 2 ELEV. TOP 1 FOUNDATION (Existing) � FINISH GRADE= 51.10 , 54.20 F.G.EL- 53.25 F.G.EL• 53.5 F.G. EL: 53.5' A f MAINTAIN 2% MIN SLOPE OVER LEACHING AREA . COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT L _ 35 W/IN 6" OF FINISH GRADE s" 4" SCH 40 PVC t _ L - 5' .. 10nl. ® S 1% (MIN.) " 6 0 0 0 0 0 0 0 0 0 0 0 0 LLL(MIN.) TEE'S ARE TO BE 14 © S= 1 0 (MIN.) ------------------ :: 4„ SCH 40 PVC I NV.51 .0 " o 0 0 0 0 0 0 0 0 0 0 0 INV.51 .62 INV.50.80 0: EXISTING OUTLET GAS PROPOSED DB-3 O O O O O O O O �O O '0 0 BAFFLE I.H7-10 DISTRIBUTION BOX INV. 51 .87 EXISTING 1000 GALLON SEPTIC TANK NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR To CONSTRUCTION Fs roe r 9" AWN. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO PER TITLE 5 GRADE ON A MECHANICALL COMPACTED SIX OF INCH CRUSHED STONE BASE, AS SPECIFIED IN BREAKOUT EL. = 51.10 310 CMR 15.221(2) , INV. ELEV.=50.60 DA 3) REPLACE EXISTING 1.000 GALLON SEPTIC M R TANK WITH 1500 GALLON SEPTIC TANK 24" j I No. 1140 " IF FAILED, DAMAGED, OR UNDERSIZED. WA-WED INV/ER r 30.5" V o SEPTIC SYSTEM PROFILE 4) INSTALL INLET OUTLET TEES AS REQUIRED BOTTOM EL.= 48.60 'PEClS(E �--48 50 8 SgNITAR�a� (J I 146" O/ SEPARATION 5.10 FT. �O BOTTOM OF TH-1 EL: 43.10 SOIL ABSORPTION SYSTEM (SECTION) SOIL , LOGS P#: 11991 DESIGN CRITERIA. i NUMBER OF BEDROOMS: 2 BEDROOM ACTUAL/ 3 BEDROOOM DESIGN (not in zone II) DATE: NOVEMBER 2, 2007 SOIL TEXTURAL CLASS: CLASS I (0.74 GPO/SF) SOIL EVALUATOR: DARREN MEYER,1 R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNS. BOH DAILY FLOW: 110 G.P.D. DESIGN FLOW: 330 G.P.D. Elev. TH- 1 Depth Elev. TH-2 Depth Elev. TH-3 Depth Elegy. TH-4 Depth GARBAGE GRINDER: NO (not designed for garbage grinder) 53.6 A 0" 53.8 A 0" 53.6 0" 53.8 0 SEPTIC TANK: 330 gpd x 2 660 9Pd USE EXIST. 1,000 GALLON SEPTIC TANK LOAMY SAND LOAMY SAND A LOAMY SAND ; A LOAMY SAND 1OYR 4/1 10YR 4/1 - 10YR 4/1 10YR 4/1 LEACHING AREA REQUIRED: (330) = 445.94 S.F. 53.10 6" 53.3 6" 53.10 6" 53.3 6" .74 LOAMY SAND B LOAMY SAND B LOAMY SAND B LOAMY SAND USE THREE (3) INFILTRATOR 3050 UNITS WITH 4 FT. STONE 10YR 6/4 10YR 6/4 10YR 6/4 i 10YR 6/4 ON THE SIDES & 1.3 FT. STONE ON ENDS: 25' L x 12.16' W x 2'D 50.93 32" 51.13 32" 50.93 32" 51.13 32" BOTTOM AREA: 25 x 12.16 = 304 SF Ci Cl C1 C1 MEDIUM SAND MEDIUM SAND MEDIUM SAND MEDIUM SAND SIDE AREA: (25 + 12.16) X 2 X 2 = 148.64 SF 2.5 Y 6/4 2.5 Y 6/4 2.5 Y 6/4 2.5 Y 6/4 TOTAL SQUARE FEET PROVIDED = 452.6 vs. 445.94 REQ'D PERC ®49.10 PERC ®49.09 DESIGN FLOW PROVIDED: 0.74(452.6 S.F.) = 334.95 G.P.D. vs. 330 G.P.D. req'd 47.6 72" 47.8 72" 47.6 72" 47.8 72" PROPOSED SEPTIC SYSTEM UPGRADE PLAN MEDIUM MEDIUM MEDIUM MEDIUM SAND SAND SAND SAND 83 M EGAN ROAD', HYAN N IS, MA 2.5 Y 7/4 2.5 Y 7/4 2.5 Y 7/4 P 2.5 Y 7/4 Prepared .for: Asevedo. 43.10 126" '43.3 126" 43.10 126" 43.3 126" Engineering by: Surveying by: SCALE DRAWN JOB. NO. PERC RATE <5 MIN/IN. .("C1" HORIZON) DARRENM.MEYER,R.S. lsroo-Tech Environmentai N.T.S. DMM NO GROUNDWATER.OBSERVED PERC RATE <5 MIN/IN. ("C1�' HORIZON) Po BOX981 (5.08) 364-0894 NO GROUNDWATER OBSERVED EAST SANDWICH,MA02537 DATE CHECKED SHEET No. 50e-352z922 11/06/07 DMM 2 of 2