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HomeMy WebLinkAbout0034 MOUNT VERNON AVENUE - Health 34 Mount Vernon -- Hyannis A= 287 = 114 7 1 Commonwealth of Massachusetts t1� = M Title 5 Official' inspectionr —_ yl5. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. � 34 MOUNT VERNON AVENUE Property Address ---- -- ------------------ --- .: MARK &ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 Owner owner's Name —_--- -.--___--- -- ---- - - — information is required for every HYA_NNIS MA _ 02601 5/24/2021 ; 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 P'A. Inspector Information , on the computer, use only the tab Trevor Kellett_ key to move your Name of Inspector - -- —"- cursor-do not Ca e Cod Se tic Services use the return — ----� key. Company Name -- --- -- -- --___—_ _ 350_Main St. t rab Company Address ------- — W Yarmouth MA 02673 City/Town --- -- - -- -- State ---- Zip Code 508-775-2825_ _ SI-13744 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); I 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 1 ' - 5/27/2021 Inspector's Signature Date The system inspector shall submit a.copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l;y� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments to � 34 MOUNT VERNON AVENUE Property Address MARK &ALISO_NGARRETT - PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name----------- `-- —� information is required for every HYANNIS ^_ MA_ _02601 5/24/2021 _ page. City/Town 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304'exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 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 (whet her metal or not) is structurally ucturally 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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form T I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y _ 34 MOUNT VERNON AVENUE Property Address --------- —"— MARK &_ALISON_G_ARRETT - PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name --- — information is required for every HYANNIS MA _ 02601_, _5/24/2021 page. City/Town 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 f ,tip Commonwealth of Massachusetts —;.rs �Itle ��iclal Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Property Address — — --- MARK &ALISON_GARRETT - PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name — information is HYANNIS _ required for every MA 02601 5/24/2021 _ 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 asses system if the well water analysis,Y pperformed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen its 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: s 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 Title 5 Official Inspection Form - ` t'1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r y 34 MOUNT VERNON AVENUE Property Address --- MARK & ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name - ------ information is HYANNIS required for every ------------------ ---------- --- ---_. ..........-. MA__ 02601 --- 5/24/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) a 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 'h 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. ❑ ® 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 t5nsp doc•rev.7/26/2018 - Title 5 Official Inspection Fonw Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection For — — 1) Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Property Address — -- MARK_&ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name --- }— --- information is HYANNIS _ required for every H — _ _MA 02601 _5/24/2021 page. City/Town State Zip Code Date of Inspection Ca 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? ® [l 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)] 15insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts ,y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments " ; �;✓� 34 MOUNT VERNON AVENUE _ Property Address M_A_RK_& ALISON GARRETT- PO BOX 1274 TIBU_RON, CA 94920 Owner Owner's Name — information is HYANNIS required for every ----_.------._......---------_...- --------.-._-_ _MA_ 02601 _ 5_/24/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4--- Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 _ Description: R — — Number of current residents: SEASONAL 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 El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d '19 - 319 GPD t 9 ( Y 9 (9p ))� '19 - 379 GPD .Detail: — Sump pump? ® Yes ❑ No Last date of occupancy:. SEASONAL Date 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 7 of 16 Commonwealth of Massachusetts -;N Title 5 Official Inspection For !Tt`1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Property Address — MARK &ALISON GARRETT - PO BOX 1274 TIBURON, CA 94920 Owner — ------- -------------------------...----- ----- — Owner's Name- information — is HYANNIS required for every -- ,_ _ _ MA _ 02601___ 5/24/2021 _ page, City/Town 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: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: How was quantity pumped determined? ----- ---- -- -- — Reason for pumping: - — —--- --.. t51nsp.doc•'rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 16 , Commonwealth of Massachusetts Title 5 Official Inspection ®r 1s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V. ,< 34 MOUNT VERNON AVENUE _ Property Address — — — — MARK &ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name------— --- ---t -- - information is HYANNIS required for every ----.---------------------._-...__------------- MA -- _02601 5/24/2021 page. City/Town 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: 2009 PER ASBUILT CARD ON FILE AT BOH Were sewage odors-detected when arriving at the site? ❑ Yes ® No 5. Building Sewer (locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ❑ 40 PVC -- -- ❑ other(explain): Distance from private water supply well or suction line: 1^0±--- feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED 15insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNONAVENUE Property Address — MARK &ALISON GARRETT - PO BOX 1274 TIBURON,_CA 94920 Owner Owner's Name -------- ------ -- --------- information is required for every HYANNIS .____ ----- _ _ MA _ 02601 5/24/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 5"feet — Material of construction: I ® 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: 1500 GALLON Sludge depth: 5"- --- _. Distance from top of sludge to bottom of outlet tee or baffle -- - 1 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 --- — --- - How were dimensions determined? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON TANK IN GOOD CONDITION. PVC TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. COVERS 5" BELOW GRADE ;51nsp.00c•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .A 1.- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �lr 34 MOUNT VERNON AVENUE Property Address ----- ------------- ---------- �� MARK &ALISON_G_A_RRETT- PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name information is HYANNIS required for every _ MA 02601 _ 5/24/2021 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 El 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, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 34 MOUNT VERNON AVENUE Property Address - -- MARK &ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 OwnerOwner's Name -- information is HYANNIS required for every -_ MA—_ 02601 5/24/2021 page. City/Town 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). I-s copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth.of liquid level above outlet invert EVEN --- __ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LEVEL AND WATERTIGHT --------------- t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 12 of 18 < ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 34 MOUNT VERNON AVENUE__ _ Property Address — — MARK &ALISON GARRETT - PO BOX 1274 TIBURON. CA 94920 Owner --.._..--- ------ --- Owner's Name - information is required for every MA 02601 5/24/2021 HYANNIS 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: . i Type: ❑ leaching pits number: - ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 10'X60'X6' _ ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: ------------- ----- — __._ :5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts �,p Title 5 Official Inspection Form `—' l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4.1 34 MOUNT VERNON AVENUE Property Address ----- MARK_&_ALISON GARRETT - PO BOX 1274 TIBURON, CA 94920 Owner Owner's Name ---- -- --- - - --- --------- ---- -- information is - - - St required for every HYANNIS _ —--- - _ MA 02601_ 5/24/2021 _ page. City/Town ate 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.): 10'X60'X6' LEACH FIELD FOUND DRY DURING INSPECTION. 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.): f 15insp doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts D- -=Y Title 5 f ici o Inspection or I — ! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Property Address--------- —_-- —� ---� -- MARK &ALISONG_A_RRETT PO BOX 1274 TIBU_RON, CA 94920 Owner Owner's Name ---- - ---- information is required for every H.YANNIS. -_--... _ MA - 02601 - 5/24/2021 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.): t51nsp doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official I ���j�/4t�eefl o Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Prope rty__-...rt __.._._..._..._...----.._._.-- -........ ---_._..........--..... ._......--- -- y A A ddress --_—.----..._._...._.___----------------_.-----------._._. MARK & ALISON GARRETT - PO BOX 1274 TIBURON -CA 94920 Owner ---.. ------..._—.---._._.,. --- _ — -------' — Owner's Name ----------..._---------_._..._.._.—.----------------....__. information is required for every HYAN_NIS_ - _ _� MA____ 02601 5/24/2021_ page. City/Town State Zip Code Date of Inspection ---__ D. System Information --- 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: ® hand-sketch in the area below ❑ drawing attached separately i t � \r .t,l,.t-- - i A16 V- lc�;� �u11 Ito - `r3o 3�4 � cl X a i t5insp dOc•rev 712612IJ18 Title 5 Official Inspection Form:subswioce Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts 7 F Title 5 Official Inspection Form -_ - i} Subsurface Sewage Disposal System Form - Not for Volu ntary Assessments 34 MOUNT VERNON AVENUE _ Property Address -- --- -- - MARK &ALISON GARRETT - PO BOX 1274 TIBURON, CA 94920 Owne; — --.— -- — --------------------_— —_— —..------Owner's Name information is required for every HYANNIS_ — — __ _ MA__ . 02601 5/24/2021 page. City/Town 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: +10' — 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: pate - ® 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: TEST HOLE DATA PER PLAN ON FILE AT BOH. --------------- ---- --- -- -- ----- _ ------ ---------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.712612018 Title 5 Official Inspection Forst Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title Official l Inspection r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 MOUNT VERNON AVENUE Property Address ----- — ---- -- —-- MARK & ALISON GARRETT- PO BOX 1274 TIBURON, CA 94920 Owner _ _._.'..--------._-----------------_..._----------- Owners Name - ------- information is required for every HYANNIS. __------ ------.- -------------.__ MA---- 02601 -- 5/24/2021 -- ------page. _City/Town State Zip -- Code Date--—Inspection of 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 Forrn,Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of-Massachusef IN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .3 34 Mount Vernon Ave. Property Address 0 Garrett Owner information Owner's Name < : is required for every page. Hyannisport MA 02601 12/7/18 Citylrown State Zip Code Date of Inspection �a 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. A. General Information S—/*E /35S t 1. ,inspector. Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown Z State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification 4. 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 a Title 5(310 CMR 15.000).The system: Passes Conditionally Passes ❑ Fails ❑ Needs Further.Evaluation by the Local Approving Authority 12/7/18 Inspecto nature Date Tfe 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 used . at that time.This inspection does not address how the system will perform in the future under -.the same or different conditions of use. t5ins.coc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 17- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): e t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °a 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ • obstruction is removed ❑ Y ❑ N ❑ 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): 1 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. HY P annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water, supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: ' o D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No E ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ E Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet. from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a.large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate,either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ , the system is within 200 feet of a tributary to a surface drinking water supply ❑ El Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in'Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.-The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection C. Checklist - Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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: Z ❑ Existing information. For example, a plan at the Board of Health. El ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M � 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 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)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR-15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq°ft°, etc.):• Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the:Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Y p H annis ort MA 02601 12/7/18 Cityrrown 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: No recent pumping Was system pumped as part of the inspection? ❑ Yes ® 'No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t . Type of System: ® .Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool - ❑ Privy ❑ -Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A.system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/7/18 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: 2009 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments(on condition of joints, venting, evidence of leakage, etc.): b r I Septic Tank(locate on site plan): 6, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound { If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: trace t5ins.doc•rev.6/16 ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection F rm O0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) - Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2 >219 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float'switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. y P H annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert of, 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.): top of D-box is,10" below grade, no adverse conditions Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/7/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® ' leaching fields number, dimensions: 10x60 ❑ 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.): Perf pipe leach field was video inspected and is dry at this time, pipe is 2' below grade, no indication of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to'inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins:doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. , Property Address Garrett Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) . Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils are compact and dry 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 � �.� t5ins.doc-rev.6/16 F Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. HY p annis ort MA 02601 12/7/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high.ground water: 105"with GW adj 6.85' below grade 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. 2009 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2009 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, Site is at 17'msl contour and nearby wetlands is at 6'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Mount Vernon Ave. Property Address Garrett Owner information Owner's Name is required for every page. Hy P annis ort MA 02601 12/7/18 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 X 16.78 X X 13.04 X 2 12 X #35 ._ x 8.67 287113 SS #51 287114 #34 8.36 287118 #15 287 #.100 N 2 .:5 X X � X X 18 1 � X 8.2 NOTE:PARCEL LINES MAY NOT BE ACCURATE. The DISCLAIMER:This map is for planning purposes only. It parcel lines on this map are only graphic representations of may not be adequate for legal boundary determination or 0 70 20 40 Feet Assessor's tax parcels. They are not true property regulatory interpretation. This map does not represent an boundaries and do not represent accurate relationships to on-the-ground survey. physical objects on the map such as building locations. X 1 inch equals 40 feet 1 4 USGS Home Contact USGS SearchS National Water Information System: Web Interface Data Category: Geographic,area: USGS Water resources Ground Wa� �United States �G©: News: Recent changes Ground-water levels ®r t e tion Search Results -- 1 sites found Search Criteria Agency code = usgs , site no list = 413525070291904 Minimum number of levels = 1 Save file of selected sites to local disk for future upload USGS -413525070291904 MA-MIW 29 MASHPEE, MA Barnstable County, Massachusetts Latitude 4103525", Longitude 70°29'19 NAD27 Land-surface elevation 15.78 feet above sea level NGVD29 Output formats �l The depth of the well is 40.0 feet-below land - surface. : Table of data The depth of:the hole is 449 feet below .land Tab-separated data surface. Graph of data This well is completed in theSand and gravel aquifers (glaciated regions) Reselect period (N100GLCIAL) national aquifer. . : This well is completed in the STRATIFIED DEPOSITS, UNDIFFERENTIATED.,(112SRFD) local aquifer.. . Water Water level, level, Date Time feet - Date Time feet below Status below Status land land surface surface 1976-02-104 7.29 Q 1995-09-22 9.81 Q 1976-02-05 0 7.2910 1995-10-20 9.90 0 1976-02-24 0 7.32101 1995-11-20 0 8.95 0 1976-03-23 01 7.38101 1996-01-221 1 8.58 0 1976-04-27 01 7.841Q1, 1996- 1 8.17 Q 4 1992-05-221 1 7.94 L I1 • 2006-01-20� 7.60 1992-06-24 8.53 Q1 -2006-63-301 1 7.78 0 1992-07-22 01 8.8410 2006-04-261 1 8.18 0 1992-08-26 8.38101 2006-05-261 1 7.53 0 1992-09-24 0 8.81 2006-06-27 6.02 0 1992- 1 9.010 2006-07-20 0 6.42 0 1992-11-24 1 8.98101 2006-08-24 1 7.32 0 1992-12-210 7.62]01 2006-09-28 8.06 0 1993-01-210 7.47 1 2006-10-30 8.65 1 1993-02-24 0 7.4101 2006-11-30 01 8.50 0 1993-03-25 0 7.01 2006-12-28 8.73 0 1993- 6.68101 2007- 1 8.30 0 1993-05-250 6.900 2007-02-28 8.580 1993-06-24 7.53 0 2007-03-28 1 7.810 1993- 1 8.20101 2007-04-25 01 6.99 0 1993- 1 8.99 0 2007 1 6.99 Q 1993-09- 1 9.35 0 2007-06-2101 7.42 0 1993-10-20 0 9.610 2007-07-26 8.16 Q 1993-11-24 9.66101 2007-08-30 12:00 9.00 0 1993-12-20 857 2007-10-01 12:00 9.48 Q 1994-01-28 0 8.06 01 2007-10-26 12:00 9.68 0 1994-02-28 0 8.06 0 2007-11-29 12:001 9.71 1994-03-23 7.02 Q 2007-12-2101 9.40 0 1994-04-20 0 6.70101 2008-01-31 12:001 9.53 0 1994- 1 7.02 0-1 2008-02-26 12:00 8.610 1994=06-22 0 7.571 1 2008-03-27 12:001 7.73 0 1994-07-22 0 8.24101 2008- 1 7.72 Q 1 1994-08-25 01 8.80101 2008-05-22 12:00 7.79 0 1994-09-26 0 9.24 0 2008-06-20 12;28 8.17 1994-10-26 0 9.55 - - 7 1994-11-22 9.77 2008-08-27 12:00 9.01 1994-12- 1 9.7 11 Q1 2008-09-30 12:00 8.66 Q 1995`701-24 0 9.10 01 2008-10-29 01 •8.98 0 1995-02-22 9.071Q1 2008-11-26 12:00 8.96:Q 1995-03-22 0 8.96 1 2008-12-29 14:00 8.02 ' 1995- 1 9.02 Q1 2009-01-23 10:001 7.71 Q 1995-05-22 01 9.05 1 2009-02-25 10:001 7.82 0 1995-06-22 8.85101 2009-03-25 10:00 7.75 0 1995-07-20 =1 9.1701 2009-04-23 10:00 7.310 down cape engineering, Inc. SIEVE SOILS ANALYSIS_34 MT VERNON HYANNISPORT.xlsx DATE OF REPORT: 7125/08 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 34 MT VERNON HYANNISPORT LOCATION: DAVID B. MASON TESTHOLE SIEVE ANALYSIS Weight Sample(Grams): 674.6 SIZE :WEIGHT RETAINED € % RETAINED % PASSED (sum ) 1/211 10.0: 0.0%y€ 100.00 ..................................................... __ ______�----_-____ . 3/8" 0.0€ 0.0% 100.0% ------------ ..........................................:...........---------------o-------------- o 0.0: 0.0 : 100.0/o ..................................................... ___---__- __ __y..................................... 10 22.1 3.3% 96.7% ------------ .................................................._.�--------------o�.......... . ..............._o.. 0 16.6: 2.5 : 97.5/0 --__--------y.....................................................q--------------- y.................................... 0 185.81 27.5/o: 72.5/o ------------ ........................................ ..........------------------ ............... 0 311.7 46.2% 53.8% __0---------...............................................:.....++_________________.y..................... ................ 0 518.0 76.8% 23.2% -------------.......................:................. ...........---------------------------- ......................... 100 -576.6' 85.5% 14.5% 00 661.4' 98.0%: 2.0% PAN: 674.E:: 100.0%: 0.0% -------------r-------------------------- ------------------------------------- SAMPLE: 674.6' NOTE: TEST ON PASSING#4 ONLY, 15.3%RETAINED ON#4<45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b(GRANULAR, SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS : #4 100% (TEST ONLY MATERIAL PASSING#4) #5010%-100% #100 0%-20% #200 0%-5% REQUIREMENT FOR"FILL" IN TITLE 5. <5%PASSING#200 SIEVE RESULTS: PERMEABLE MATERIAL-CLASS I<5 MINAN. MATERIAL a �S�A OF bt�ss�c� NONCOMPACTED �° DANIELA. �N SOIL DESCRIPTION: FINE SAND,TRACE SILT, GRAVEL OJALA CIVIL c No.46502 NkL -7`jt s1oS t . Permit Number: Date: Corfipleted t y: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 1 �"'n� V ���� Lot No. Owner: (����,#`� Address: 3 'Mo,,� Ue0'/47:n hiLgimgl;r Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. ................:............................................................. .Date a2 7 mont /day/ ear STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well..................................................... _ Water-level range zone ..................................................... ✓� .STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to _ water level for index well ........................... • m nth,year STEP .4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .......................................................................................... s r STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water Y level at site (STEP 1) 17'� 0 3 �� Table L Potential water level rise,in feet,for use with index Table 1. Potential water-level rise,in feet,for use with index well Barnstable AIW=0 well Barnstable Al W--230-Continued. WATER ZONE A ZONE B ZONE C ZONE D ZONE E WATER ZONE A ZONE B ZONE C ZONE D ZONF,. E LEVEL LEVEL 20'.5 0.0 0.0 0.0 0.0 0.0 26.0 2.8 3.7 5.5 7.3 8.3 .20•.6 0.1 0.1 0.1 0.1 0.2 26.1 2.8 3.7 5.6 7.5 8.4 20.7 0.1 0.1 0.2 0.3 0.3 26.2 2.9 3.8 5.7 7.6 8.6 20.8 0.2 . 0.2 0.3 0.4 0.5 26.3 . 2.9 3.9 5.8 7.7 8.7 20.9 0.2 0.3 0.4 0.5 0.6 26.4 3.0 3.9 5.9 7.9 8.9 21.0 0.3 0.3 0.5 0.7 0.8 26.5 3.0 4.0 6.0 8.0 9.0 21.1 0.3 0.4 0.6 0.8 0.9 26.6 ' 3.1 4.1 6.1 8.1 9.2 21.2 '0.4 0.5 0.7 0.9 1.1 26.7 3.1 4.1 6.2 8 A 9.3 21.3 0.4 0.5 0.8 1.1 1.2 26.8 3.2 4.2 6.3 8.4 9.5 21.4 .0.5 0.6 0.9 1.2 1.4 26.9 3.2 4.3 6.4 8:5 9.6 21.5 0.5 0.1 1.0 1.3 1.5 27.0 3.3 4.3 6.5 8.7 9.•8 21.6 0.6 0.7 1.1 1.5 1.7 27.1 3.3 4.4 6.6 8.8 9.9 21.7 0.6 0.8 1.2 1.6 1.8 27.2 3.4 , 4.5 6.7 8.9 10.1 21.8 0.7 0.9 1.3 1.7 2.0 27.3 3.4 4.5 6.8 9.1 10.2 21.9 0.7 -0.9 1.4 1.9 2.1 27,4 3.5 4.6 6.9 9.2 . 10.4 22.0 0.8 1.0 1.5 2.0 2.3 27.5 3.5 4.7 7.0 9.3 10.5 22.1 0.8 1.1 1.6 2.1 2.4 27.6 3.6 4.7 7.1 9.5 10.7 22.2 0.9 1.1 1.7 2.3 2.6 27.7 3.6 _ 4.8 7.2 9.6 10.8 22.3 0.9 1.2• 1.8 2.4 2:7 27.8 3.7 4.9 7.3 9.7 11.0 22.4 1.0 1.3 1.9 2.5 2.9 27.9 3.7 4.9 7.4 9.9 11.1 22.5 1.0 1.3 2.0 2.7 3.0 28.0 3.8 5.0 7.5 10.0 11.3 22.6 1.1 1.4• 2.1 2.8 3.2 28.1 3.8 5.1 7.6 10.1 11.4 22.7 1.1 1.5 2.2 2.9, 3.3 28.2 3.9 5.1 7.7 10.3 11.6 22.8 1.2 1.5 2.3 3.1 3.5 28.3 '3.9 5:.2 7.8 10.4 11.7 22.9 1.2 1.6 2.4 3.2 3.6 28.4 4.0 5.3 7.9 10.5 11.9 23.0 1.3 1..7 2.5 3.3 3.8 28.5 4.0 5.3 8.0 10.7 12.0 23.1 1.3 1.7 2.6 3.5 3.9 28.6 4.1 5.4 8.1 10.8 12.2 23.2 1.4 1.8 2.7 3.6 4.1 28.7 4.1 5.5 8.2 10.9 12.3 23.3 1.4 1.9 2.8 3.7 4.2 28.8 4.2 5.5 8.3 11.1 12.5 23.4 1.5 1.9 2.9 3.9 4.4 28.9 4.2 5.6 8.4 11.2 12.6 23.5 1.5 2.0 3.0 4.0 4.5 29.0 4.3 5.7 8.5 11.3 12.8 23.6 1.6 2.1 3.1 4.1 4.7 29.1 4.3 5.7 8.6 11.5 12.9 23.7 1.6 2.1 3.2 4.3 4.8 29.2 4.4 5.8 8.7 11.6 13.1 23.8 1.7 2.2 3.3 4.4 5.0 29.3 4..4 5.9 8.8 11.7' 13.2 23.9 1.7 2.3 3.4 4.5 5.1 29.4 4.5 5.9 8.9 11.9 13.4 24.0 1.8 2.3 3.5 4.7 5.3 29.5 4.5 6.0 9.0 12.0 13.5 24.1 1.8 2.4 3.6 4.8 5.4 29.6 4.6 6.1 9.1 12.1 13.7 24.2 1.9 2.5 3.7 4.9 5.6 29.7 4.6 6.1 9.2 12.3 13.8 24.3 1.9 2.5 3.8 5.1 5.7 29.8 4.7 6.2 9.3 12.4 14.0 24.4 2.0 2.6 3.9 5.2 5.9 29.9 4.7 6.3 9.4 12.5 14.1 24.5 2.0 2.7 4.0 5.3 _ 6.0 30.0 4.8 6.3 9.5 12.7 14.3 24.6 2.1 2.7 4.1 5.5• 6.2 30 A 4.8 6.4 9.6 12.8 14.4 24.7 2.1 2.8 4.2 5.6 6.3 30.2 4.9 6.5 9.7 12.9 14.6 24.8 2.2 2.9 4.3 5.7 6.5 30.3 4.9 6.5 9.8 13.1 14.7 24.9 2.2 2.9 4.4 5.9 6.6 30.4 5.0 6.6 9.9 13.2 14.9 25.0 2.3 3.0 4.5 6.0 6.8 30.5 5.0 6.7 10.0 13.3 15.0 25.1 2.3 3.1 4.6 6.1 6.9 30.6 5.1 6.7 10.1 13.5 15.2 25.2 2.4 3.1 4.7 6.3 7.1 30.7 5.1 6.8 10.2 13.6 15.3 25.3 2.4 3.2 4.8 6.4 7.2 30.8 5.2 6.9 10.3 13.7 15.5 25.4 2.5 3.3 4.9 6.5 7.4 30.9 5.2 6.9 10.4 13.9 15.6 25.5. 2.5 3.3 5.0 6.7 7.5 31.0 5.3 7.0 10.5 14.0 15.8 25.6 2.6 3.4 5.1 6.8 7.7 31.1 5.3 7.1 10.6 14.1 15.9 25.7 2.6 3.5 5.2 6.9 7.8 31.2 5.4 7.1 10.7 14.3 16.1 25.8 2.7 3.5 5.3 7.1 8.0 31.3 5.4 7.2 10.8 14.4 16.2 25.9 2.7 3.6 5.4 7.2 8:1 31.4 5.5 7.3 10.9 14.5 16.4 Table 2. Potential water-level rise,in feet,for use with Table 2. Potential water-level rise,in feet,for use with index well Barnstable AIW-247 index well Barnstable Al W 247-Continued WATER ZONE A ZONE B ZONE C ZONE D WATER ZONE A ZONE B ZONE C ZONE D LEVEL LEVEL 20.7 0.0 0.0 0.0 0.0 25.7 3.3 5.0 6.7 8.3 20.8 0.1 0.1 0.1 0.2 25.8 3.4 5.1 6.8 8.5 20.9 0.1 0.2 0.3 0.3 25.9 . 3.5• 5.2 6.9 8.7 21.0 0.2 0.3 0.4 0.5 26.0 3.5 5.3 7.1 8.8 21.1 0.3 0.4 0.5 0.7 26.1 3.6 5.4 7.2 9.0 21.2 0.3 0.5 0.7 0.8 26.2 3.7 5.5 7.3 9.2 21.3 0,4 0.6 0.8 1.0 26.3 3.7 5.6 7.5 9..3 21.4 0.5 0.7 0.9 1.2 26.4 3.8 5.7 7.6 9.5 21.5 0.5• 0.8 1.1 1A 26.5 3.9 5.8 •7.7 9.7 21.6 0.6 0.9 1.2 1.5 26.6 3.9 5.9 7.9 9.8 21.7 0.7 1.0 1.3 1.7 26.7 4.0 6.0 8.0 10.0 21.8 0.7 1.1 1.5 1.8 26.8 4.1 6.1 8.1 10.2 21.9 0.8 1.2 1.6 2.0 26.9 4.1 6.2 8.3 10.3 22.0 0.9 1.3 1.7 2.2 27.0 4.2 6.3 8.4 10.5 22.1 0.9 1.4 1.9 2.3 27.1 4.3 6.4 8.5 10.7 22.2 1.0 1.5 2.0 2.5 27.2 4.3 6.5 8.7 10.8 22.3 1.1 1.6 2.1 2.7 27.3 4.4 6.6 8.8 •.11.0 22.4 1.1 1.7 2.3 . 2.8 27.4 4.5 6.7 8.9 11.2 22.5. 1.2 1.8 2.4 3.0 27.5 4.5 6.8 9.1 11.3 22..6 1.3 1.9 2.5 3.2 27.6 4.6 6.9 9.2 11.5 22.7 1.3 2.0 2.7 3.3 27.7 4.7 7.0 9.3 11.7 22.8 1.4 2.1 2.8 3.5 21.8 4.7 7.1 9.5 11.8 22.9 1.5 2.2 2.9 3.7 27.9 4.8 7.2 9.6 12.0 23.0 1.5 2.3 3.1 3.8 28.0 4.9 7.3 9.7 12..2 23.1 1.6 2.4 3.2 4.0 28.1 4.9 7.4 9.9 12.3 23.2 1.7 2.5 3.3 4.2 28.2 5.0 7.5 10.0 12.5 23.3 1.7 2.6 3.5 4.3 28.3 5.1 7.6 10.1 12.7 23.4 .1.8 2.7 3.6 4.5 28.4 5.1 7.7 10.3 12.8 23.5 1.9' 2.8 3.7 4.7 28.5 5.2 7.8 10.4 13.0 23.6 1.9 2.9 3.9 4.8 28.6 5.3 7,9 10.5 13.2 23.7 2.0 3.0 4.0' 5.0 28.7 5.3 8.0 10.7 13.3 23.8 2.1 3.1 4.1 5.2 . 28.8 5.4 8.1 10•.8 13.5 23.9 2.1 3.2 4.3 5.3 28.9 5.5 8.2 10.9 13.7 24.0 2.2 3.3 4.4 5.5 29.0 5.5 8.3 11.1 13.8 24.1 2.3 3.4 4.5 5.7 29.1 5.6 8.4 11.2 14.0 24.2 2.3 3.5 4.7 5.8 29.2 5.7 8.5 11.3 14.2 24.3 2.4 3.6 4.8 6.0 29.3 5.7 8.6 11.5 14:3 24.4 2.5 3.7 4.9 6.2 29A 5.8 8.7 11.6 14.5 24.5 2.5 3.8 5.1 6.3 29.5 5.9 8.8 11.7 14.7 24.6 2.6 3.9 5.2 6.5 29.6 5.9 8.9 11.9 14.8 24.7 2.7 4.0 5.3 6.7 29.7 6.0 9.0 12.0 15.0 24.8 2.7 4.1 5.5 6.8 29.8 6.1 9.1 12.1 15.2 24.9 2.8 4.2 5.6 1.0 29.9 6.1 9.2 12.3 15.3 25'.0 2.9 4.3 5.7 7.2 30.0 6.2 9.3 12.4 ' 15.5 25.1 2.9 4.4 5.9 7.3 30.1 6.3 9.4 12.5 15.7 25.2 3.0 4.5 6.0 7.5 30.2 6.3 9.5 12.7 15.8 25.3 3.1 4.6 6.1 7.7 30.3 6.4 9.6 .12.8 16.0 25.4 3.1 4.7 6.3 7.8 30.4 6.5 9.7 12.9 16.2 25.5 3.2 4.8 6.4 8.0 30.5 6.5 9.8 13.1 16.3 25.6 3.3 4.9 6.5 8.2 30.6 6.6 9.9 13.2 16.5 I 17. Table 2. Potential water-level rise,in feet,for use with index well BarnstableAl W--247-Continued WATER ZONE A ZONE B ZONE C ZONE-D. •LEVEL 30.7 6.7 10.0 13:3 16.7 30.8 6.7 10.1 13.5 16.8 30.9 6.8 10.2 13.6 17.0 31.0 6.9 10.3 13.7 17.2 31.1 6.9 10.4 13.9 17.3 31.2 7:0 10.5 14.0 17.5 31.3 7.1 10.6 14.1 17.7 31.4 7.1 10.7 14.3 17.8 31.5 7.2. 10.8 14.4 18.0 31.6 7.3 10.9 14.5 18.2 31.7 7.3 11.0 14..7 18.3 , 31.8 . 7.4 11.1 14.8 18.5 31.9 7.5 11.2 14.9 18.7 32.0 7.5 11.3 15.1 18.8 32.1 7.6- 11.4• 15.2 19.0 32.2 7.7 11.5 15.3 19.2 32.3 7.7 11.6 15.5 19.3 32.4 7.8 1]..•7 15.6 19.5 32.5 1.9 11.8 15.7 19.7 32.6 7.9 11.9 15.9 19.8 32.7 8.0 12.0 16.0 20.0 32.8 8.1 12.1 16.1 20.2 32.9 8.1 12.2 16.3 20.3 33.0 8.'2 12.3 16.4 20.5 33.1 8.3 12..4 16.5 20.7 33.2 8.3 12.5 16.7 20.8 33.3 8.4 12.6 16.8 21.0 33.4 8.5 12.7 16.9 21.2 33.5 8.5 12.8 17.1 21.3 33.6 8.6 12.9 17.2 21.5 f V14 Supplement Table 5.• Potential water level rise, in feet, for use, with index well Mashpee NUW-29 WATER ZONE A ZONE B ZONE C ZONE D LEVEL 5.7 0.0 0.0 0.0 0.0 5.8 0.1 •0.1 0.1 0.2 5.9 0.1 0.2 0.3 0.3 _ 6.0 0.2 0.3 0.4 0.5 6.1• 0.3 0.4 0.5. 0.7 6.2 0.3 0.5 0.7 0.8 6.3 0:4 0.6 0.8 1 .0 6.4 0.5 .0.7 0.9 1 .2 6.5 0.5 0.8 1.1 1 .3 6.6 0.6 0.9 .1.2 1 :5 6.7 0.7 1 .0 1 .3 .1 .7 6.8 0.7 1.1 .1.5 1.8 6.9 0.8 1 .2 1 .6 2.0 7.0 0.9 1 .3 1 .7 2.2 7'.1 0.9 1 .4 1.9 . 2.3 7.2 1 .0 1 .5 2.0 2,5 7..3 1 .1 .1 .6. 2.1 2.7 7.4 1 .1 1 .7 2.3 2.8 .7.5 1 .2 1 .8 2.4 3.0 7.6 1.3 1 .9 2.5 3.2 7.7 1 .3 2.D. 2.7 3.3 7.8 .1 .4 2.1 2.8 3.5 .7.9 1 .5 2.2 2.9 3..7 8.0 1 .5 2.3 3.1 .3.8 8.1 1 .6 2.4 3.2 ' 4.0 8.2 1 .7 2.5 3.3 4.2 8.3 1 .7 2.6 3.5 4.3 8.4 1 .8 2.7 3.6 4.5 :9 2.8 3.7 4.7 •�"� 8. 1 .9 2.9 3.9 4.8 . 8.7 2.0 3.0 4.0 5.0 8.8 2.1 3.1 4.1 5.2 8.9 2.1 3.2 4.3 5.3 9.0 2.2 3.3 4.4 5.5 Supplement Table 5.'Potential water-level rise, in feet, for• - use-with index well Mashpee MIN-29 WATER ZONE A ZONE B ZONE C ZONE D LEVEL 9.1 2.3 .3.4 4'.5* 5.7 9.2 2.3 3.5 4.7 5.8 9.3 2.4 3.6 4.8 6.0 9.4 2.5 3.7 4.9 6.2 9.5 2.5 3.8 5.1 6.3 9.6 2.6 3.9 5.2 6.5 9.7 2.7 4.0 5.3 6.7 9.8 2.7 4.1 5.5 6.8 9..9 2.8 '4.2 5.6 7.0 10.0 2.9 4.3 5.7 7.2 10.1 2.9 4.4 5.9 • • 7.3 10.2 3.0 4.5 6.0 7.5 10.3 3.1 4.6 6.1 7.7 10.4 -3.1 4.7 6.3 7.8 10.5 3.2 4.8 6.4 8.0 10.6 3.3 4.9 6.5 . 8.2 10.7 3.3 5.0 6.7 8.3 10.8 3.4 5.1 . 6.8 8.5 10..9 3.5 5.2 6.9 8.7 11 .0 3.5 5.3 - 7.1 8.8 11 .1 3.6 5.4 7.2 9.0 . 11 .2 3 7 5.5 7.3 9:2 11 .3 3.7 5.6 7.5 9.3 11 .4 3.8 5.7 7.6 9.5 11 .5 3.9 5.8 7,.7 • 9.7 11 .6 3.9 5.9 7,9 9.8 11 .7 4.0 6.0 8.0 10.0 11 .18 4.1 .6.1 8.1 10.2 11 .9 4.1 6.2 8.3 10.3 ,.. 12.0 4.2. 6.3 8.4 10.5 12.1 4.3 6.4 8.5 10.7 12,2 4.3 6.5 8.7 10.8 12.3 4.4 6.6 8.8 11 .0 12.4 4.5 6.7 8.9 1 1 .2 Supplement"Table 5. Potential water-level rise,in feet,for use with index well Mashpee MIW-29 .WATER ZONE A ZONE B ZONE C ZONE D LEVEL 12.5 4.5 6.8 9.1 11-3 12.6 4.6 6.9 9•.2 11 .5 12.7 4.7 7.0 9.3. 11'.7 12.8 A.7 7.1 9.5 11,:$ 12.9 '4.8 7.2 9.6 12.0 13.0 4.9 7.3 9.7 12:2 •13.1 4.9 7.4 . 9.9 12.3 13.2 5.0 7.5 10-.0 12..5 13.3 5.1 7.6 10.1 12.7 13.4 5.1 7.7. 10.3 12.8 13.5 .5.2 7.8 10.4 13.0 13.6 5.3 7..9 10.5 13.2 13:7 5.3 ' 8:0 .10.7 13,3 13.8 5.4 8.1 10.8 13..5 13.9 5.5 8.2 10.9 13.7 14.0 5:5 8.3 11 .1 13.8 14.1 •5,6 8.4 11 .2 14.0 14.2 5.7 8.5 . 11 .3 14.2 14.3 5.7 8.6 11 .5 14.3 14.4 5.8 8.7 11 .6 14.5 14.5 5.9 . ' 8.8 11 .7 14.7 14.6 5.9 8.9 11 .9 '14.8 14.7 6.0 9.0 12.0 15.0 14.8' 6.1 9.1 12.1 15.2 14.9 6..1 9.2 _ 12.3 15.3 15.0• 6.2 9.3.. 12.4 15.5 15.11. 6.3 9.4 12.5 15.7 Supplement Table-6. Potential water-level rise, in feet, for " use with index well Sandwich-252 " WATER ZONE A ZONE B ZONE C ZONE D LEVEL 45.9 0.0 0.0 0.-0 0.0 46.0 0.1 0.2 0.2 0.3 46.1 0.2 0.3 0.4 -0.5 46.2 0.3 0.5 0.6 0.8 46.3 0.4 0.6 0.8 •1.0 46.4 0.5 0.8 1 .0 1 .3 4.6.5 0.6 0.9 1 .2 1 .5 46.6 0.7 1 .1. 1 .4 1.8 46.7 0.8 1 .2 1 .6 2.0 46.8 0.9 . 1 ..4 1 .8 2.3 46.9 1 .0 1 .5 2.0 2.5 47.0 ' 1 .1 1 .7 2.2 2.8 47.1 1 .2 1 .8 2•.4 3.0 47.2' 1 .3 2.0 2.6 3.3 47.3 1 .4 2.1 2.8 3-.5- 47.4 1 .5 2.3 3.0 3.8 47.5 1 .6 2.4 3.2 4.0 47.6 1 .7 2.6 3.4 4.3 47.7 1 .8 2.7 3.6 4.5 47.8 1 .9 2.9. 3.8 4.8 47.9 .2.0 3.0 4'.0 5.0 48.0 2.1 3.2 4.2 5.3 48.1 2.2 . 3.3 4.4 5.5 48..2 2.3 3.5 4.6 5.8 48.3 2.4 3...6 4.8 6.0 48.4 2.5 • 3.'8 5.0 6.•3 48.5 2.6 -3-9. 5.2 6.5 48..6 2.7 4.1 5.4 6.8 48.7 2.8 4.2 5.6 • 7.0 48.8 2.9 4.4 5.8 7.3 48.9 3.0 4.5 6.0 7.5 49.0 3.1 4.7 6.2 7.8 49.1. 3.2 4.8 6.4 8.0 Supplement Table 6. Potential water-level f'ise,in feet, for use with index well Sandwich-252 WATER ZONE A ZONE B ZONE-C ZONE D LEVEL 4 9'.2 3.3 5.0 6.6 8.3 49.3 3.4 5:1 6.8 8.5 49.4 3.5 5.3. 7.Q 8.8 49.5 - 3.6 5.4 7.2• '9.0 ' .49.6 3.7 . 5.6 7.4 9.3 49.7 3.8 Y 5.1 7.6 9.5 49.8 .3.9 5".9 7.8 9.8 . 49.9 4.0 6.0 8.0 1.0.0 50.0 . . 4.1 6.2 8.2 10.3. 50.1 4.2 6.3 8.4 10.5. 50.2. 4.3 6.5 8.6 10.8 •50.3 4.4 6.6 8:8 11 .0 50.4 4.5 6.8 9.0• 11 :3 50.5 4.6 6..9 9.2 11.5 5.,0'.6 4.7 7.1 9.4 11 .8 . 50.7 4.8 7.2 9.6 12.0 50.8 4.9 7.4 9.8 12.3 50.9 5.0 7.5 10.0 12.5. 51 .0 5.1 7.7 10.2 12.8 . 51 .1 .5.2 7.8. 10.4 13.0 ' 51 .2 .5.3 8.0 10.6 13.3 51 .3 5.4 8.1 10.8 13.5 51 .4 5.5 8.3 11 .0 13.8 51 .5 5.6 8.4 11 .2 14..0 51 .6 5.7 8.6 11 .4 14.3 51 .7 5.8 8.7 1 1 .6 14.5 51 .8 5.9 8.9 11 .8 14.8 61 .9 6.0 9.0 12.0 15.0 52.0 6.1 9.2 12.2 15*3 52.1 6.2 M 12.4 15.5, 52.2 6.3 9.5 12.6 15.8 52.3' 6.4 9.6 12.8 16.0 52.4 6.5 9.8 13,0 16.3 1 S .7D ,:2S, ;� - Supplement Table 6. Potential.water-level rise,in.feet,for use with index well Sandwich-252. WATER ZONE.A ZONE B ZONE C, ZONE D LEVEL 52.5 6.6 9.9 13.2 16.5 52.6 6.7 10.1 13.4 16.8 '52.7 6.'8 10.2 13.6 17.0 52.8 6.9 10.4 4 13.8 17.3 52.9 7.0 10.5 14.0 17.5 53.0 7.1 10.7 Y 14.2 17.8 53 A 7.2 10.8 14.4 18.0 53.2 7.3 11 .0 114.6 18.3 } Table 7. Potential Water-level rise,in feet,for use Table 7. Potential water-level rise,in feet,for use with index well Sandwich SDW--253 with index well Sandwich SDW-253-Continued. WATER ZONE A ZONE B ZONE C WATER ZONE A ZONE B ZONE C LEVEL LEVEL 45.8 0.0 0.0 0.0 50.8 3..3 5.0 6.7 45.9 0.1 0.1 0.1 50.9 3.4 5.1 6.8 46.0 0.1 0.2 0.3 51.0 3.5 5.2 6.9 46.1 0.2 0.3 0.4 51.1 3.5 5.3 7.1 46.2 , 0.3 0.4 0.5 51.2 3.6 5.4 7.2 46.3 0.3 0.5 0.7 51.3 3.7 5.5 7.3 46.4 0.4 0.6 0.8 51.4 3.7 5..6 7.5 46.5 0.5 0.7 0.9 51.5 3.8 5.7 7.6 46.6 0.5 0.8• 1.1 51.6. 3.9 5.8 7.7 46.7 0.6 0.9 1.2 51.7 3.9 5.9 7.9 46.8 0.7 1.0 1.3 51.8 4.0 6.0 8.0 46.9 0.7 1.1 1.5 51.9 4.1 6.1 8.1 47.0 0.8 1.2 1.6 52.0 4.1 6.2 8.3 47.1 0.9 1.3 1.7 52.1 4.2 6.3 8.4 47:2 0.9 1.4 1.9 52.2 4.3 6.4 8.5 47.3 1.0 1.5 2.0 52.3 4.3 6.5 8.7 47.4 1.1 1.6 2.1 52.4 4.4 6.6 8.8 47.5 1.1 1.7 2.3 52.5 4.5 6.7 8.9 47.6 1.2 1.8 2.4 52.6 4.5 6:8 9.1 47.7 1.3 1.9 2.5 52.7 4.6 6.9 9.2 47.8 1.3 2.0 2.7 52.8 4.7 7.0 9.3 47.9 1.4 2.1 2.8 52.9 4.7 7.1 9.5 48.0 1.5 2.2 2.9 53.0 4.8 7.2 9.6 48.1 1.5 2.3 3.1 53.1 4.9 7.3 9.7 48.2 1.6 2.4 3.2 53.2 4.9 7.4 9:9 48.3 1.7 2.5 3.3 53.3 5.0 7.5 10.0• 48.4 1.7 2.6 3.5 53.4 5.1 7.6 10.1 48.5 1.8 2.7 3.6 53.5 5.1 7.7 10.3 48.6 1.9 2.8 3.7 53.6 5.2 7.8 10.4 48.7 1.9 2.9 3.9 53.7 5.3 7.9 10.5 48.8 2.0 3.0 4.0 53.8 5.3 8.0 10.7 48.9 2.1 3.1 4.1 53.9 5.4 8.1 10.8 49.0 2.1 3.2 4.3 54.0 5.5 8.2 10.9 49.1 2.2 3.3 4.4 54.1 5.5 8.3 11.1 49.2 2.3 3.4 4.5 54.2 5.6 8.4 11.2 49.3 2.3 3.5 4.7 54.3 5.7 8.5 11.3 49.4 2.4 3.6 4.8 54.4 5.7 8.6 11.5 49.5 2.5 3.7 4.9 54.5 5.8 8.7 11.6 49.6 2.5 3.8 5.1 54.6 5.9 8.8 11.7 49.7 2.6 3.9 5.2 54.7 5.9 8..9 11.9 49.8 2.7 4.0 5.3 54.8 6.0 9.0 12.0 49.9 2.7 4.1 5.5 54.9 6.1 9.1 12.1 50.0 2.8 4.2 5.6 55.0 6.1 9.2 12.3 50.1 2.9 4.3 5.7 55.1 6.2 9.3 12.4 50.2 2.9 4.4 5.9 55.2 6.3 9.4 12.5 50.3 3.0 4.5 6.0 55.3 6.3 9.5 12.7 50.4 3.1 4.6 6.1 55.4 6.4 9.6 12.8 50.5 3.1 4.7 6.3 55.5 6.5 9.7 12.9 50.6 3.2 4.8 6.4 55.6 6.5 9.8 13.1 50.7 3.3 4.9 6.5 55.7 6.6 9.9 13.2 l© Table 7. Potential water-level rise,in feet,for use with index well Sandwich SDW 253--Continued WATER ZONE A ZONE B ZONE C LEVEL 55.8 6.7 10.0 13.3 55.9 6.7 .10.1 13.5 56•.0 6.8 10.2 13.6 56.1 6.9 10.3 13.7 56.2 6.9 10.4 13.9 56.3 7.0 10.5 14.0 56.4 7.1 10.6 14.1 56.5 7.1 10.7 14.3 56.6 7.2 10.8 14.4 56..7 7.3 10.9 14.5 56.8 7.3 11.0 14.7 56.9 7.4 11.1 14.8 57.0 7.5 11.2 14.9 57.1 7.5 11.3 15.1 57.2 7.6 11.4 15.2 57.3 7.7 11.5 . 15.3 57.4 7.7 11.6 15.5 57.5 7.8 11.7 15.6 57.6 7.9 11.8 15.7 57.7 7.9 11.9 15.9 57.8 8.0 12.0 16.0 57.9 8.1 12.1 16.1 58.0 8.1 12.2 16.3 58.1 8.2 12.3 16.4 58.2 8.3 12.4 16.5 58.3 8.3 12.5 16.7 58.4 8.4 12.6 16.8 58.5 8.5 12.7 16.9 58.6 8.5 12.8 17.1 58.7 8.6 12.9 17.2 58.8 8.7 13.0 17.3 58.9 8.7 13.1 17.5 59.0 8.8 13.2 17.6 59.1 8.9 13.3 17.7 59.2 8.9 13.4 17.9 59.3 9.0 13.5 18.0 59.4 9.1' 13.6 18.1 59.5 9.1 13.7 18.3 59.6 9.2 13.8 18.4 59.7 9.3 13.9 18.5 �v sTT 1 E United States Geological Survey, e/ servation Wells �LBt�/h l- . � MT As a service to Cape o icia s, er interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources.Office. The water level measurements shown below are taken monthly from United States Geological Survey(USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. To.see what's happening in real time at a separate well in Brewster, visit the USGS site: USGS 414630070014901 MA- BMW 22 BREWSTER,MA For further information about any of the data or links on this page,please contact Hydrologist Gabrielle Belfit at the Commission offices (508-362-3828). April 2006 Water Record Record Departure from USGS Site Number**** Location Well No. Level* High* Low* Average** (links to USGS national Monthly Overall water-level database) Barnstable 230 23.1 20.5, 26.6 -0.4 0.6 413956070164301 Barnstable 24w 22.6 20.5 28.6 1.2 1.9 414154070165001 Brewster BMW 21 8.6 6.9 13.6 1.3 1.6 414518070020301 Chatham CGW138 23.4 20.9 26.6 -0.3 11 0.4IF 414100070011101 Mashpee MIW 29 8.2 5.6 10.0 C0.6 0.3 JI 413525070291904 Sandwich SD 2 46.8 45.8 48.2 0.1 0.4 414418070241601 Sandwich SDW 48.5 45.8 55.1 1.1 1.6 414124070265901 Truro TSW 89 11.8 10.2 13.0 -0.3 0.2 420206070045901 Wellfleet WNW 17 10.5 7.3 12.8 -0.8 -0.1 415353069585401 * Measurements are in feet below land surface. ** Measurements are in feet above mean sea level. NA Well inaccessable ** USGS national water-level database provides historic data,hydrographs, and site maps. The USGS compiles the above data and other water levels into a monthly, online Water Resources Current Conditions Report that covers all of Massachusetts. Town Of Barnstable Regulatory Services Thomas F.Geiler,Director • anii�t�i►;a�;e. • Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-700-6304 Installer &Desisner Certification Form Date: �2 Designer: Installer:'. SCC3V (� Address: '4S-f b ®W Address: (� C} J On 7 6 was issued a permit to install a (date) (installer) septic system at . CUB dJ-VEeq6& a 4*NIG based on a design drawn by --� ' ,�,� (address) ✓�V � A50 • '- M i ,,J dated (designer) 7. certify that the septic system referenced above was installed substantially according'to '� ie design, wlrich may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify ,that the septic system referenced above was installed with"WI jor.changes'(i;e• greater thin l 0' lateral relocation of the SAS or any veati6al'=loo9Iion of any component of the.septi(system)but in accordance with State.&Local: Regeilahons. Plan revision or certified-asbigfby designer to follow. Z bAVlt) (Installer's Signature) m 6. (Ins �. UASON . v,R, . lie (D er s Signature) (Aft ei's Stamp Here) PRASE RETURN TO DARNRtAkkzPURLIC-HEALTH DIVISION. RTIFIC w. OF. C MPLLANCE , N0 E UEIIt; BOTH:TES�gOM BUILT-CARD ARE REa D BY THE.R ST +'AR PUBI,I D SION. THANK YOU. . Q:Healtfi/Septi esigner Certification Font • S/ TOWN OF BARNSTABLE LOCATION 3(4 MO VI)i V<-rl,(JA SEWAGE# VILLAGE ASSESSOR'S MAP&PARCELc2&7 INSTALLER'S NAME&PHONE NO. Six ? " SEPTIC TANK CAPACITY &A k- Jo_� (Sx LEACHING FACILITY:(type) & X 6 L cq G� .�ie (size) 16 ( t (j� aO&P NO.OF BEDROOMS" Ll � OWNER PERMIT DATE: 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility See Pl feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) - - -k C g feet Edge of Wetland and L. aching Facility(if any wetlands exist within 300 feet of leaching:facility). feet FURNISHED BY ITT 'c w - No. Fee ` THE COMAONWEALTH OF MASSACH-USETTS Entered is computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPCicatiou for Dig og 1 *Pmem Cow5truction Permit Application for a Permit to Construct( ) Repair(y Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. ("� csvv� l➢ �tin G Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �47s Designer's Name,Address and.Tel.No. �f j� I ,v t � 4 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t� Design Flow(min.required) l q 0 gpd Design flow provided T �� gpd Plan Date < Q 110 p Number of sheets _�—_ Revision Date Title Size of Septic Tank 1 p `�y Type of S.A.S. Description of Soil 0 ` X 40_'x /v .)!�6 r. Nature of Repairs or Alterations(Answer when applicable)�G C L e K � �r�l y� 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 thi oard of Health. Signed Date h 7 40 Application Approved by erDate Application Disapproved by: Date for the following reasons Permit No. ,.®d 2 26 Date Issued d ------- --- ------------------ -- No. 00� �,o�a6. w ' s3 {s .t,`' '. p//ti w�•."' Fee �yu Y THE COM'I�IIIONWEALTH OF MA, S,ACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes ZippYication for aigpotal 6potem Construction Permit` t , Application for a Permit to Construct Repair( Upgrade( ) Abandon( ) [S;Cbmplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel s'i } Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � 40 /) f M _ 9 Type of Building: -+ i Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (W Other Type of Building No.of Persons Showers( ) Cafeteria(! ) f Other Fixtures " Design Flow(min.required) l(�.(� C.� gpd Design flow provided .3 0� Plan Date l Number of sheets Revision Date Title _ 3� Size of Septic Tank ` (� Type of S.A.S. _4 Description of Soil s �( Q //1�Jc /0 +i Nature of Repairs or Alterations(Answer when applicable) �G C ic K l y4 _Qs_e_s5®A t, ' N r Y Date last inspected: i Agreement: - i 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 thi oard of Health. Signed . Date Application Approved by ( V) UT, t�r Date Application Disapproved:by: V "� V Date R for the following reasons a Permit No. Q d 2 Date Issued YT 41 =-------------.-- ---.—.---- —.--- - ------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( � Upgraded ( ) Abandoned( )by V1__ at �. - +�lC) r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Constructs n Permit No. 00,� dated -�310 5 Installer �(� CZ-.�.� Designer #bedrooms Approved design flow gpd (, The issuance of this Wet{sha not be construed as a guarantee that the sylstem will fu ctio a es gned. Date /� � Inspecctor No. Ql]"!'"2 . .--.Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS T'J%igpotar *yttem Conttructton Permit Permission is hereby granted to Construct ( ) Repair � Upgrade ( ) Abandon ( ) System located at 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. 4 Provided: Construction must be completed within three years of the date of th' pe Date �'/� /(�% Approved by �" 'Town of.Barnstable P# . Department of Regulatory Services ,THE rod Public Health Division Date 200 Main Street,Hyannis MA 02601 BARNSTABIM v� i61q °lf�MplA Date Scheduled001�jTime Fee Pd. ''Soil, SLtability}j�j � Assessment for Sewage Disposal Performed By: % ✓ "(N 5✓ / Witnessed By:lit/ . MI............:...:.....:-.::,...:.,.....,., I Location Address 8(A MQ,^� Owner's Name �Aycl-r\mt Z �p r� Address Assessor's Map/Parcel: j t Engineer's Named NEW CONSTRUCTION. RE AIR Telephone# al-2 1617 n 1A Land Use Slopes(°/a) � a Surface Stones Distances from: Open Water Body �ft. Possible Wet Area I OD ft Drinking Water Well /ft Drainage Way to ft Property Line v ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to.holes) l I l CP -- a U Parent material(geologic) "'"'�T� i /. Depth to Bedrock I Depth to Groundwater:. Standing Water in Hole: �� Weeping from Pit Face r " Estimated Seasonal High Groundwater ; YATf(11 l Cl1;A ( HtHAT1 ' ,, -. .. _ ..... .... __.. .- ........ Method Used: Depth Observed standing in obs:hole: in. Depth to soil mottles: in. . Depth to weeping from side of obs:hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ ............................................................:...._.......:............:._,....::.....,..........., .. ._.. ......... ... ... ...N7... .......,.:..:. qi ITT STI,;:: :, :;:,� p ��:: : :;,:�:�::,;�_:... .►�.............:......_:.::.:.;�' , Observation Hole# Time at 9". Depth of Pere - \ Time at 6" Start Pre-soak Time @ ON Time(9"-V) End Pre-soak r 1 Jy Rate Min./Inch + Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----=—�— Q:HEALTH/WP/PERCFORM 4-1 Depth from Soil Horizon Soil Texture Soil Color Soil (her Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % F. P`::. : R TIQl :H: :liE : ::G<'<'>:'>> . H.oI #:;::::::.>< > Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (MunselQ Mottling (Structure,Stones,Boulderes. % bit- Op e i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Depth from if Horizon Soil Texture Soil Color Soil Other Surface(in.) (i7SDA) (Munsell) Mottling (Structure;Stones,Boulderes. r� "e Gravel) r Flood Insurance Rate Map: / Above 500 year flood boundary No es V Within 500 year boundary No Yes Within 100 year flood boundary No V Ye.s Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perA us material exist in all areas observed throughout the area proposed for the soil absorption system? If not what is the depth of naturally occurring pervious material?_44 . Certification , 1 certify that on �� (date)1 have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the,required training,expertise and exjvrience deb 'r ed in 310 CMR 15.017. Signature "/ Date 7 ��� r 26'-0' 26'-0- 1 - 0 _ 13'-2- 11,-2- o V o • � N o 3 r 1 6- oq ct m a N, 0 mai o A ktim yam I Z gym+ 2 yo m F 0 2 0 m om 0 e� m y 3 tb L y -- T ' 14'=0' 12'-0- 12'-0' - 26'-0" vl— I y 1 I 3 w o 1 I I I I 1 I I o I 'I _ I r N 0 . I 0 u 4! It A Z 1 1 -2- 3 ' - I I 1 - I 1 00 ❑❑ . - j ® n - Lo ^ - / V - 14'-0* _ - 12'-0- m Z n v x m > m RENOVATIONS TO THE m KAREN B.KEMPTON AIA N -o r M'OREY RESIDEI`IC g -� > 0 ARCHITECTURE Z I co �„� z Z (34 OUNT VERNON AVE 43 ANGELA WAY WEST BARNSTABLE, MA. 02668 HYANNISPORT,-MA , (508) 362-3447 (506) 362-1236 FAX karenkempton®comcast.net (Z- 8/26/2009 2:25 PM VI e: m ^, rn ___ -____ ,-- , \ R y Ezm �' ►� Ski . ,� i i Y VJ! , l � e m _ m r m • � � r 11 � �� � � � '� w ,� c,,. i�� Ok p� 0 t raj Jj o _ vo qj - U) 00 \ O 3 � VV m m m D RENOVATIONS TO THE n m KAREN B.KEMPTON AIA N �' -� MOREY RESIDENCE 8 O I ARCHITECTURE Z n34 MOUNT VERNON AVE WEST BARNSTABTABLLE w 43 AY Vl. , MA. 02688 b = HYANNISPORT; MA (506) 362-3447 (506) 362-1236 FAX - - - karenkempton®comcest.net il 8/26/2009 2:25 PM LA tXI i . I• I } C RD R MILL s RD O D � 40 GR � YAY ' GI z lid . •.;,'':S . ap� pV •: . . EDGE OF PAVEMENT AV r:., q9 l ( KEY E X-IrS TIN G A.Amnia melanocarpa- Black Chokeberry 9 3 gal. DWE L L ING B. Myrica pensylvanica-Northern Bayberry 29 3 gal. C. Clethera anifolia `Hummingbird' - Clethera 28 2 gal. D. Amelenchier `Autumn Brilliance Serviceberry 15 4-5' b&b E. Viburnum dentatum Arrowood Viburnum-- 12 3-4' b&b I \ F. Lindera benzoin- Spice Bush 3 3 gal. 30 ' I G. Viburnum trilobum-American Cranberrybush 11 5 gal. EX IsT I N 6 T KE Zo WFa6F-P, nrck I r•• I v Cv �e E X..I S T../ N .G G. A W N ..� r '7 5 J ' \ I r W- -'(ZZSP0SED-• MtTIGp11.oN _QF.1Q-- z2o0 54 1=1'— ' SCALE: i T/ - APPROVED BY:• rDWN 8 T'b_T1-1 �L/l�S"1'I N DAZE: SED J�1 � � • NUMBER E_ DRAWING (��(•15TTN:G.� .. .._�_ �`39'..: �"`�••._V�RrloMl fc:`�, �-`��. 2T.. .._. L1.•I: IDS....l;I ti1 _. C�hC�S:.:..... . >✓X I STi N G . ._. . .___ - - = - __ .. ASSESSORS MAP : WIZ8 7 TEST HOLE LOGS --_._—.- --- PARCEL t�C it,( R1D r_._.._,__-�_ _.. __ SO I L EVALUATOR I Vl� Gi _ _ FLOOD ZONE; ,�,/o"i' �¢t�GIG���E - � ___ WITNESS : I � mw&1 ra '3�.a ., 3.v11-}.._ REFERENCE �,'► .� 11' � 3 d� t,t I -- - - DATE: Y _' I �� /74 /.__._- (514Du�vr1 PERCOLATION' RATE: L Z t11q- 1 SST' y,� ,. �7,DO ! �g�' t t,, 100 V/� _ . � _ .. s. ._�42a� � s _ v .t r�_. . - . TH-2 "TC� �4(�?r,�` ", lC7�j�� wl�p. S�<-�-11Q� E, 1`1 Lam to } r z}, +d.,� 11 ( ----- —.� _ - _ 5 cv L LOCAT I ON MAP '►5r 5 _ ' t fit, � , �o�d�..1._ -' �^-t? -�'L. >�w _ - _ ID v '4 0 - - . 7�IE'�t2.1�t�t>vlb.'fi1tx.- �. nnu X uj Trr SEPTIC SYSTEM DESIGN - �� __—_ �v`2. Y�1-hG �.►4'F�IG t-1?� - FLOW ESTIMATE .SbL�Q t3�sl / EDGE OF PAVEMENT BEDROOMS AT 11D GAL/DAY/BEDROOM - 1qb GAL/DAY QF�,�q� r S S�I��cP��e �{d S22V�1a �)� OK DAVIB ��' Ve�t�c��rn�'�'r� i� A r SEPTIC TANK D ``� ro co 12s.s6 rt o Q 2( Cs) ----- -- -- I c �s• a 1 44DGAL/DAY x 2 DAYS - GAL ti° I - = _ - - - ---- - ( wxciA o dit.Lc - o LL SEPTIC / 0 �- - - r S01C ABSORT10�1 SYSTEM - - W 0. I I -- x EXISTING LING � � SIDE AREA: ' ,-., /�hL✓� ; ti BOTTOM AREA: :��,�;1JO X /0 �( 0, 7 ' qiLee TOP OF FNDN c I SEPTIC SYSTEM SECT I*ON EL 14.10 ,j; ; , . I r.s _ m I �vJ „ pus �d�- • / PGl.1�bW ' N N qj 1'� (16-1 ' s t otx �1E't�4'1t,. Fw>�t� I BENCH ARK i /.��.Q:l�i�[N!'... ���^,,::. r � - R :�--+�-;i:�-i; ' . f.Kf ;i_•F�( �r.il�Ft'�r �t•j��� PAINT SPOT 0 c1� + "�"f I Y j RETAINING ALL �E ti _ ;• o:, �. e ?�ti e ELEVATION 16.9� h0(71.C5� I - GAL * • b 't� I ,. ' A b e BARNSTABLE IS DATUM SEPTIC TANK I(�L ( fox iq tit 140.37 rt , bit- --- w SITE AND SEWAGE ..,PLAN �orb: - _ (�_�_ a�u�._ l..l�►G. 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