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Home My WebLink About0310 MITCHELL'S WAY - Health 1 ;. 310 MITCHELLS WAY F ; Hyannis A = 291 - 303 4 I uec ci Zu'l/ u12t) HP Fax page 1 ' � • • a9/-363 Commonwealth of Massachusetts Title 5 Official Ins {- pection For r a Subsurface Sewage Disposal System Form -Not for Voluntary As essments3 310 Mitchell5 Wa Property Address Deisy Soto 'e Owner O wner's Name j information is required for every Hyannis .� MA 02601 12-20-17 `r page. Clty/Town State ZIP Code Date of Inspection Inspection results must be submitted on this form. inspection fo ms may not be altered in any way. Please see completeness checklist at the end of the form. Important;When A. General Information filling out fops /' on the computer, `"1��11tlI1 jt�j OF 4tgt use only the tab 1. Inspector: �a`� key to move your cursor-do not James D.Sears :' JAMES G use the return key, Name of Inspector Ca y Name Enterprises ':* rag Company Name _ 153 Commercial Street 1NS G`\`�`�� Company Address 11011111111100� ^� Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time.of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority 1 12-20-17 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. 15ins.dac-rev.6116 Title 6 Ofticial Inspection F :Subsurface Sewage Disposal System•Page f of 17 /p y ld Vs ,7 Dec 21 2017 0125 HP Fax page 2 c"\ Commonwealth of Massachusetts p Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary As essments 310 Mitchells Way Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 12-20-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any oft the failure criteria described in 310 CMR 15,303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and pit. B) System Conditionally Passes: ❑ One or more system components as described in the"Condit onal 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&e 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 lank 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): t51ns.doc•rev.e116 Title 5 official Inspedion orm:Subsurface Sewage Disposal System•Page 2 of 17 ueC cl [u1/ U12b HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Forrn Subsurface Sewage Disposal System Form -Not for Voluntary As essments "v 310 Mitchelis Way Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 12-20-17 State Zip Code Date of Inspection B. Certification (cons) ❑ Pump Chamber pumps/alarms not operational. System will Pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or.high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or Lineven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ ❑ NO(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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board cf 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 Nhich will protect public health safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ina.doc-rev.6/16 Title 5 official Inspection For :Subsurface Sewage Disposal System-Page 3 of 17 Dec 21 2017 01:25 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 310 Mitchells Way Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 12-20-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Suppiler, 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 w thin a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is w thin 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less tl ian 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 idrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or ce spool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in IMEW is less than 6" below invert or available volume is less than 1/day flow p,r t5ins.doc•ray.6/16 TUIe s omrAsl Inspection orm:Subsurface Sewage Disposal System-Page 4 of 17 uec Cl eul( Ul:e!) HH Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Forin Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 310 Mitchells Way Property Address Deisy Soto Owner Owners Name information is required for every Hyannis MA 02601 page. City/Town 12-20-17 State Zip Code Date of Inspection B. Certification (cost.) Yes No ® Required pumping more than 4 times in the ast year NOT due to clogged or obstructed pipe(s). Number of times pumpe : ❑ ® Any portion of the SAS, cesspool or privy is elow high ground water elevation. ❑ ® Any portion of cesspool or privy is within 10C feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less thar 100 feet but greater than 50 feet from a private water supply well with no acce table 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 s equal to or less than 5 ppm, provided that no other failure criteria are It liggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ The system is a cesspool serving a facility wi h a design flow of 2000gpd- 10,000gpd. ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.30 ,'therefore the system fails. The system owner should contact the Board of H alth 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 a ea(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner sh uld contact the appropriate regional office of the Department. 15ins.doc-rev.a/w Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 Uec 21 Z01/ 01:25 HP Fax page 6 Commonwealth of Massachusetts P Title 5 Official Inspection Foril Subsurface Sewage Disposal System Form -Not for Voluntary As essments 310 Mitchells Wa Property Address Deisy Soto owner Owner's Name information Is required for every Hyannis MA 02601 12-20-17 page. Cityrrown 51ate 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 ow er, occupant, or Board of Health ❑ ® Were any of the system components pumpec out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introducec to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained ar d 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,S, located an site? ® ❑ Were the septic tank manholes uncovered, open ed, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions depth of liq uid, depth P q p of sludge a d 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 crit ria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15,302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x 4 of bedrooms): 330 tsins.doc.rev.6116 Title 5 0triciat Inspection For ;Subsurlace Sewege Olsposel system•Page 6 of 17 Dec 21 2017 0126 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection For in Subsurface Sewage Disposal System Form-Not for Voluntary As essments 310 Mitchells Way Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA D2601 12-20-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and it. Number of current residents: 0 Does residence e ce have a garbage grinder? Yes No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallor is per day(gpd) Basis of design flow(seatslpersonslsq.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: i5ins.doc-rev.6116 Title 6 Otfidal Inspection F :Subsurface Sewage Disposal System-Page 7 of 17 Dec 21 2017 01:26 HP Fax page 8 Commonwealth of Massachusetts p Title 5 Official Inspection Forin ulv�z� Subsurface Sewage Disposal System Form - Not for Voluntary As essments 310 Mitchells Way Property Address -Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 12-20-17 -- Pap. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) if yes, attach previous inspection records, if any) ❑ InnovativelAlternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from systern owner) and a copy of latest inspection of the I/A system by system operator tinder contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5lns.doc-rev.6116 Title 5 Official Inspection orm;Subsurlace Sewage Disposal System-Page 6 of 17 Uec 21 2017 0127 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Forin Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 310 Mitchells Way Property Address Deisy Soto Owner Owners Name information is required for every _Hyannis MA 02601 12-20-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1985 Permit #84-555. 12 -2017 -New D Box&outlet Tee. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 0" Te at Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: fe et Comments(on condition of joints, venting, evidence of leakage, We.): Pi ein is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: At Grade 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 ofcertificate) ❑ Yes ❑ No Dimensions: 1000 Gal, Precast H-10 Sludge depth: 2" 15ins.doc•rev.6/16 Title 5 official Inspection For :Subsurface sewage oisposal System-Page 9 of 17 Dec 21 2017 01:27 HP Fax page 10 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 310 Mitchells Way ,p`i - Property Address Deisy Soto Owner Owner's Name Information is required for every Hyannis MA 02601 12-20-17 page. City/Town State Zip Code Date of Inspection D. System lnformatidn (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum.thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18'r How were dimensions determined? Asbuilt-Plan -Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage. etc.) Tank at working level, Tank at grade,inlet and outlet tee's. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass 7 polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6I1 6 Title 5 official Inspection Form:Subsurfooe Sewage Disposal system•page 1 o of 17 uec el cu i i u'l:Z i H' Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary As essments 310 Mitchells Wa Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA. 02601 12-20-17 page. CIty7own State Zip Code pate of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspecti n) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain). Dimensions: Capacity: gallons . Design Flow: gallons per day Alarm present: ❑ Yes No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No tSIm.coc-rev 6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Dec 21 2017 0127 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary A sessments r 310 Mitchells Way Property Address ..Deisy Soto Owner Owner's Name Information is required for every Hyannis MA 02601 12-20-17 page, CItyrrown Stale Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site pla ): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"A' below grade w/one line out. Box is new 12 2017. 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 conditio ial pass. Soil Absorption System (SAS) (locate on site plan, excavation n t required): If SAS not located, explain why: t5ins.doc•rev.&16 Tale 5 Official Inspection Fo :Subsurface Sewage Disposal System•Page 12 of 17 i uec n eUl f u1,C6 HP 1-ax page 13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal system Form-Not for Voluntary A sessments I=M®r 310 Mitchells Wa Property Address Daisy Soto Owner Owners Name information is required for every Hyannis MA 02601 12-20-17 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool numbe ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a 4' precast pit w/3'stone. Pit at 4"below grade. Pit is dry w/clean wall's. No sign of over loading or high stain line. 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 15ins.doc•rev.6116 Title 5 Official Inspection For :Subsurface Sewage Disposal System•page 13 of 17 Dec 21 2017 0128 HP Fax page 14 Commonwealth of Massachusetts ul; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 310 Mitchells Way Property Address Deisy Soto Owner Owners Name Information is required for every Hyannis MA 02601 12-20-17 page. citylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc..): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6118 Titl95 Official Inspeclion arm:Subsurface Sewage Disposal System-Page 14 of 1T Dec 21 2017 0128 HP Fax page 15 Commonwealth of Massachusetts Title 5 • = official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary As essments 310 Mitchells Wa Property Address Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 12-20-17 page. City/Town State Zi Code D Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewag9 disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately P Y o � n-�- rr7 , 13•-3 = a" 15ins.00c•rev.6118 Title 5 Official Insoect.an Form Subsurface Sewage olsposat system•Page 15 of 17 Dec 21 2017 0129 HP Fax page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary A sessments 310 Mitchel Is Way Property Address -Deisy Soto Owner Owner's Name information is required for every Hyannis MA 02601 12-20-17 page. CltylTown State ZipCode Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to! ground water: 10, feet Please indicate all methods used to det ermine the ground high g g d ter elevation.- Obtained from system design plans on record If checked, date of design plan reviewed: 4-11 5 Date ❑ Observed site(abutting propertylobservation hole within 150,feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators installers- (attach documentation)tatlon) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 4-11-85 G.W.at 10'. Auger T.H. 4' below bottom of pit dry. Auger T,H. at 8' below grade d . Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15lns.doc•rev.6116 Tire 5 official Inspection Farm:Subsurface Sewage Disposal systerr-page 16 of 17 Dec 21 2017 01:29 HP. Fax page 17 Commonwealth of Massachusetts - -, Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary As essments l5 310 Mitchel Is Way u Property Address Deisy Soto Owner Owner's Name information is Hyannis required for every - MA 02601 12-20-17 page. C1tyfTown Slate Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 151ns.doc•rev.6118 Tide 5 Official Inspection For :Subsurface Sewage Disposal System-Page 17 of 17 76 No. 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Npfication for Disposal *pstrm Construttion 3perrnit Application for a Permit to Construct( ) Repair(k} Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 310 /`'1'i TCj+C-4 . S WAY Owner's Name,Address and Tel.No. f(YA ,&RUIs F4MAJIC al ai'l OAiS1l 1�fv�E�J17CzZ- Assessor's Map/Parcel a9 l 3 O 0/o !k['mi4g Z, s W t Installer's Name,Address,and Tel.No. 5 UJ&>q7Z—$9 17 Designer's Name,Address,and Tel.No. Type.of Building: Dwelling No.of Bedrooms N Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) A*= gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) SNSTI(C.C—N04J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He. h. igne Date r Z.'l —®ipf`/ Application Approved by Date Z / I� Application Disapproved b}� Date for the following reasons!' Permit No. ®(7 / Date Issued 2 -a��F, r"Efc�r'h'��'**,.7.,.�+.xkr'+�`'�y';�{�` >�*tT•jjmK7�.;S!"�.�dA'"•�;;+v,:*.,Ikr'°i„�F'..'::y"^�,,,"t.^aft.,S+.��,�.i`s,�r'4Sr,..rr'-r'.t't�"'^`�ti+^'"K P,--r.. -- 'd^,,+e',,.,, ."'�C. x',, r ` '' No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLLIC ;HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 'YZipplitatlon for Construction Vertu Application for a Permit to°Construct( ) Repair Ml Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 3/O M(rcft EGC is Gt AY Owner's Name Address and Tel.No. i{yA&wis FAtAne PlA5 /64mv �a-ta,4A DeL Assessor's Map/Parcel a9( 303 0/() ki-r4liczL rs 1i ..fq f'/•yAit, V1_<, Intstajler's Name,Address,and Tel.No. S b$-477-gig ?7 Designer's Name,Address,and Tel.No. 153 0 vu�'�CG/4E_ 'S7T d` ASc4 p6G_ Type of Building: Dwelling . No.of Bedrooms '"' a Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min:required) gpd Design flow provided A)I% gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) N -IV& 10 0-80X 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. Date I ;L` !4 Application Approved by i��""�< i Date /2 /L//- 1'7 Application Disapprove Date for the following reasons Permit No. �Q� % Date Issued t / a/�..C�1'7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compfiance d Ov"ri-�THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) x>Z64lSE� R Abandoned( )by A45Le>tb6 ` - - at--• 3`o -,(q-i c4E��S wA-y 14 y has been constructed in accordance - with the provisions of Title 5 and the for Disposal System Construction Permit N'O�b �i q6 dated (, i Installer (24PCk>t Ocs BtJ7 QIS',g Designer 6V #bedrooms Approved design flow gpd The issuance of this perm+it sha11 nlot be construed as a guarantee that the system willl19ct o as es Date ( { t Inspector - - _ ----_-------_------- ------------------------------------------- ------ - 'No. � '7► 1 P-'BOX f 0 t Cr(-� 7- Fee��• THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal i�pstent Construction Vermit Permission is hereby granted toConstruct( ) Repair(x) Upgrade( ) Abandon( ) System located at Jio m`T�:aEz.4,,�5 w,4y C /y4o-)!S and as-described in the above Application for Disposal System Construction Permit. The applicant recognized his/.her_ uty to comply with Title 5 and the following local provisions or special conditions. Provided:Co true on must be completed within three years of the date of this permi. . Date / I ! 2 01Approved by �� LOCATION 9/ SWAGE PERMIT NO. 31® VILLAGE INSTALLEWS NAME&ADDRESS alu-t BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED w t �r CT� Y 1k THE COMMONWEALTH OF MASSACHUSETTS :r BOAR® 9� )tf ALTH OF.... �9"...iv .'U.1... ;�:Vo6fion for Disps al Works Tonstrurtinn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at �. on.Addr s or Lot No. ....... / r 170 ��L ..ner ............ d(�1 I�y� > Installer Address / / s t' Type of Building Size Lot�G.lt_G- .�._Sq. feet . '� Dwelling-No. of Bedrooms:___.._...............................Expansion Attic (� Garbage Grinder ( ) aOther—Type of Building ............ No. of persons_... 1.4.......... Showers ( ) — Cafeteria ( ) Other, fixtures ... ---------------•-------•--•-•--•----•--•------•--•--------=--------------•-----------------------•••-....----------....-------•-- WDesign Flow.:........_3...t..........__(__. .____gallons per person er y. Total ily flow.._......J.3__Q_____________________gallons..n G4 Septic Tarik-Liquid capacit ,P14-t?gallons Length Diameter Width"Y—"14 ._ Diameter._~ A._. De th---�_----- -- Disposal Trench—No.__�'/t!!-___-_ Width_''' A._.._..__ Total Length__!" ____.__Total leaching area~ !►_,_ sq. ft. .... Seepage Pit"No..................... Diameter..................... Depth below inlet.,................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing a ( ) Percolation Test Results Performed by__ " ,/i.G1 _ ...._ /v / �/a. � ..---�---•--------- -- DatY,�_:,t._ft�----•%-........minutes per inch Depth of Test Pit.................... Dep�o groer-----------__-__-_-____. Test Pit No. 1..... 44 Test Pit No. '2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --•-•• ............... •--•-................................................ 0 Description of Soil------P.. �..... A�J'-------- .AC iA •----- 1 a.r. ........................................................... Ws ....... ll� - -------•------•-•-----------•-•------------•-•-- .................................. x ----- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... =------------------------------•--------------------------•------------••-•-••----------••-•---.......---•---•--•-------•----------•-•••.•---------------•-••-••---••-•••-•-•••••---•--•-•------ Agree t: e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the ro isiol - f TI'r of the State Sanitary Code—The undersigned further agrees not to place the system in era ' n r of Compliance hareniby the bo of health. tgned ...Ap ion Approved By--••• ------- l ...........................•-----•------ l Date Date p ieation Disapproved for the following reasons:................................................................................................................ Date S,y* PermitNo--------------------------------------------- ------••-•• Issued........................................-----: Sl tyiroG f06"nJ�2 MuS ��pn(—Sr '�---""--Date�.............fix ; d a_t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----........._........................O F...................................... Appliration for Disposal lgjarkii Tonutrurtion Frrmit` - Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: ........ - .......•---.......... - -•---.....-------- •--- Location-Address or Lot No. ......................—.......................................................................... ..---•-----.._....------........_.._..................---......---..............__............•-•- W Owner Address a •-•---------••------------------••••••••--•----•----••------..._.._.............._._......••--•.._ .._...-----••---•------.._..•----•---•----• -....._..•-----------.....----------••--•--•-•--••--- Installer Address UType of Building Size Lot............................Sq. feet 1—i Dwelling—No. of Bedrooms............................................Expansion Attic ( ) - Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth............... x Disposal Trench—No_____________________ Width.............._..... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No------------_-------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by................................................. Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_................. P4 ----•-----•----------------- -------------------•-•--------•--.................. ......................................................... 0 Description of Soil....................................................................................................................................................................... --------------------------------------------------------------------•---------------------------....--------- ---------•-- - •-•------••-----•--•-----• - ----------•-- U Nature of Repairs or Alterations—Answer when applicable________________________________________________ _ ..........,.................................. Agreement: /The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t e p sions o TI 5 the State Sanitary Code— The undersigned further agrees not to place the system in op io un • a fi f Compliance has been issued by the board of health. Signed----•-----•--•-----•-------------------••---.....-----•-••------••-----•--••---------• ..........................Date p i ion Approved By--•-••-•-•-----• -1 �' (---- = �..---- -----•--•-----------------••---------•-•-- --.:�1 L ............. Date plication Disapproved for the following reasons:......................................................................................... ---==---------------- .....................................•------------------------•----•-----------..--------...-----_.._..•'--••--•-----------•-••--••---••---------••-•---•---••--•----•---•-•-•---•--•-•-•----•--•------- Date PermitNo......................................................... Issued-....................................................... s 1 Date —��1� ��7iV j✓t,)� L=N�i+ c P.J•!_ e �r.t `_1 f- (r.,t F�J;-- 1I Vie— F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... _ 011rrtifirtttr of Tomplianr THIS I O :,BjRTIfLiS jkat the Individual Sewage Disposal`'System constructed ( ) or Repaired ( ) b1_..•--•........-•-•-------•-----•-•-................. •....-------•.......----- �, (1 T Vj `r t Install 1 '- at............................................................................ ri has been installed in accordance with the provisions of T I �Fr�-jfk .State Sanitary ,f o/fdescribed in the application for Disposal Works Construction Permit No.......................................... dated---------- ........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® _ G8J ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4 • r r ry DATE.--•• q t ...................................... Inspector ---- ..................... V(�r w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.. ................................O F._......-----...._._._.._.___...___..........._._.__•_.. No......................... FEE........................ Permissionis hereby granted...................-- _ dZ_l'......�-`-'- .................................................................................... to Constru t ( 1 () ) � Indlvi4 1r-Sewage Disposal System atNo..................................................................................................................... Street > ...r.y a :J /,I -'�-•--------------•-•--•-- as shown on the application for Disposal Works Construction Permit No -ct � ............................... r r/ ....................................... ----- -------------------•-----••------•------. t . DATE_ l 3- '�5 ��L } /j, !t �tBoard of Health ................................................ FORM 1.2$5 A. M.' ULKIN, INC., BOSTON 1 ! !/1 _,. ., , . ', i a .. - \: - - - tot. `'e l-., l e,1,`4.l p. Y ° .�° ,t 5 - r• t l' Kr MV ki fi t '•1 r SY 1..iv \ �R yf 4r I l `� > yr { i S I ,� I %IA• .. k 1 5 / l 1 1 V 1 r 1 1• F .1 y i ` 7 ' J ;�y"�N ham ' ^z x 1 G.. .; " o. 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() � ' h ;I � `� xw, r j1L \.. / /d p L k'Ui ' ( { „s' IS4 x ac,, 4 rt}sa;, i*sfr`etrll(r �} ,+u"�-: ' .�,__, :+ �t + '� 3 ' epr4 ? r�. L1'j r ' 'w 1 �/ /' :I l/1'tv°I1/ Vt/'/+/ *\ �� :�Glk/ I f 9T� ul ,`If f, �%!4'% 41� �. `,: ` Mt ray v�1+i � r`I r . LEGEND I %. a s ,,Y ,, .�'•{ PL N„,has, . EX08TINA 9:POT - ELEVATION 0x0 CERTIFIED 17T PLA ! '"i. { EXIIIaTIPI0 ,CON.TOUR -- 0 — , '", f NtSHEO 9POT: ELEYATI.ON LU:7 f► �1E7:cr� w.4y ,��I`°�x' V ' ' � 'INI�HED: C.0N.TOUR 0 � .`' c �, { �, a,a { r .=f NOTE :The locatl'on Of ,.any %xis ing Uil( BT'Qi'OUild S'PWercl e, I� A, r ` `w"e115, or' other Ut11*p .- S}lOWn on tF.iS plan is approx- . ? , att�ate only as det,eimined from records:"and/,or verbal. , xr ; �A a 1 5-TA-0`Ajtip t�►� , ` > I� tn£ormation The;iontractor is responszble:..for.the a 1 t „ at DATE / �/a— ,u verafic;at�on;. of tfie exist"ing locations in the 1£ield $GALE / > ' 4 3� ' ' r It 4QREDGE ENG/NEER/NWCa ING� CLIENT.Nz��LN'' I CERTIFY THAT THE PROP08ED",. rx, 5 vSfs , BUILDING $MOWN ON THl$ PLAN n' f ,, ,, Et it FM REOIJTERED JOB N09 , j ,, �LCI.VIt� r LAND ,, �; ONFORMS TO THE, �ZONINtd LiA4�IR�' �, a,��; dt DR BY ..�:____� M A 3 S � �, E 0 R RV R OF BARNS'TABLE r a:, 7; `MAIN STREET i ` �_'a.. , , f %sV MYANNIS, MASS. SHEET.�.- OF ATE RE(3 LAND SURVE R' ;` c i r Jf11 i�'3t " s; LE/gCf/I�VG_P/T A tE lyDRLs TN^N !rt ,dELO.w � - _ SRAtOE,� P �lI1M ETER ,CQiyCRF7-E. �D - /O FT /r?1K SJ/ArCL BF BROUGHT TO GRAhE=�i4N. .EXTRA " r , 4•P } 1/Pl PJPZ ' >F FgYy C^ S Z' /h'ON C O✓ER Sh/A L L COYER.S r !N DR Ew�4 y • CQntCR�TE = Y d7CAGE ,. . COYER C:LEAM.'SANO i /J QA"CXF/L L L/ tlt0 LEYEL 40 Q "PIA _ z LAYFR i 4 SGHE8 v14 40. •` DcrD G/l L. •. • e� 1 • • • • • r.•.r a '•' W.A 5 HED S7*✓l'E �j Yr'JIN.P/TG/I iR D/ST. ' • • + • . • • s + , � •". ,' S€PT1C TANK �R max , • p, , rIV— ,ti• DEPTX �5,I Z a PRECAS T SEEAt1GE _ .... i x �. _ t 3 • s. .. • 4 9 D GAL O� s. ►• •. + • •r • e o !l�(rG'/CT CLEY�IT/4NS ni.r CA PA.c.r-'y/NYERT AT Ot//LD/NG I v 5s FT. 3 /2 FT GlA/r1_ C CAE 7A'BUL�4TtaN> l os, 3_cr INLET •SEPTIC TANX 7 - E 1�ls:W fr. N �X, P ' Ol/74ET SEPTIC TANX I.o4.9:FT GROUND ytl�TF� T/tDLE z INLET D/3TRt6UT/ON. BO?r SEG'T/B/4' L.' t : ouTtET-DISTR/'Bvr/oN JOX FT .SgyVAGE OISf�O�SA L SYSTE!►9 TASULATIDAI INLET LEACHING P/T I o4:5 fT LEACXlNG:. PIT OIMEKJ/ON A 3 FT SCALE D/jlErYS/aN a ` 4 • " DESIS/v CR/TER/A D/MENSlON C AWN-SER OF AED,ROOMS 3 tAM& GED/SPOSAL uNir Nv�r� ,SOIL LOG SO/L TE3T TOTAL E?7lI►iAT'EG FLOytl014, TEST.AE! SOIL.7l�ST I E[E✓ 16 3,9 ELEY. VATS OF SOIL TEST , /1fUMaER OW LfACMIM4 P/TS f" , _ - M ,"._Co NL:v i"r 3/06-44ACNI NG PER P/T J 5 t SQ �T o-.Z F /�IESULTS M//T/VESSED dY t 3 E LoE'w► ,4 PiERGGC^T/Olti� M/I1,S/INCN 407'-TOM Lfo•iCN/IVG oS R P/T S4• F?' S✓ ,3 v, satGOL/4T/ON 4MA7AF 2 'r'r`�//„1/p�y�VGN TOTi1L LEACH//VG AREA SQ :iT RESERYEL$4C'h'!N�AREA i V u SQ FT t 1> _ !o L.D7 LOT."/a Af/ FIC ERT ., y - 1 R T -; �' �_ `U, 7ErL, L�RrtrD6EEJl�4GlNI6Z�RlIJA►G 7t2 M/�/N .ST.y }IY�NN , - - E�! - _ - �- --'-_ _:, .._ -:;..,: ..�...::.rs ,-:.:._,.. ..::s.... �.� .:_: .,::_�",_,..,. _'p2.:4s....�.•,. .k...__.. .n, __...- �_. ...x..i:__. __,.,,_...,.,....�,..,i__. ,..._. .. -_____.._:.._ 3..,._�._...a--. ..,,J..��„2..�...,3`�.-..:i,+...,.o;.�yat-,e�X-.,��--.,aw.r��&.t .�_,e i.'�^1�_:�< a...... _ _..- • President: .,a, Member of: ROBERT BRUCE ELnREOGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS EL,DREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS - ALBERT A.MORSE,P.E.,R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG,P.E.,R.L.S. SURVEYING AND MAPPING Q / - �J / AMERICAN SOCIETY FOR CREC�.CS('EZEd C-Rr 9istvted TESTING AND MATERIALS Lana c's eivif 712 MAIN STREET 3 �+ csuave yo¢s CnC�1.nE841 HYANNIS,MASS.02601 TEL.(617)775-2244 j September 11, 1985 Board of Health Town Office 267 Main Street Hyannis, MA 02601 Re: Lot A, Mitchels Way, Hyannis, MA (Barnstable Holding Job # 85058)—. Gentlemen, A final inspection was made on September 9, 1985. The leaching pit is located on the ground in accordance with our design plans dated April 30, 1985, and the sewerage system insert elevations were measured as follows: DESIGN AS BUILT Inv, at foundation Elev. 105.5 105.8�,. Inv, at .Septic Tank Inlet 105.3 105.4 Inv, at Septic Tank Outlet . 105.1 104.9 Inv, at Dist. Box Inlet 104.9 104.7 .Inv• at Dist. Box Outlet 104.7 104.5 Inv, at Leaching Pit 104.5 104.3 Bottom of Leaching Pit 100.5 100.7 The system appears to have been installed substanitally in conformance to' the minimum design standards specified in our sewerage plan, Sincerely, Robert B. 'Eldredge, R.L.S. ELDREDGE ENGINEERING CO. INC. cc: Barnstable Holding AsBuilt Page 1 of 2 LOCATION � H 3�O y EWAGE PERMIT NO. VILLAGE INSTALLER'S NAME&ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED -DATE COMPLIANCE ISSUED http://issgl2/intra,net/propdata/prebuilt.aspx?lbappar=291303&seq=1 11/14/2017 .