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HomeMy WebLinkAbout0007 NOB HILL ROAD - Health 7 NOB HILL RD. , HYANNIS A = 288 119 i 0 �I o �f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address " Kristin&Suvranu ;anguli Owner owner's Name information is required for every Hyannis Ma 02601 _ 6/2/2021 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important: When fillingng out out forms A. Inspector Information SI ( S KC)- on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not. S.M.Jones Title V Septic inspection use the return Company Name key.- 74 Beldan Lane Company Address - Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmaii.com, SI4522 sean@smjonestitle5.com 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 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: -1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6/2/2021 Inspector's Sign re 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.7r28/2018 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road `-' Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is Hyannis Ma 02601 6/2/2021 required for every y page City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The property located at 7 Nob Hill Rd Hyannis is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 precast leaching chambers.Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Comp 9 Compliance indicating that the tank is less than 20 ye ars old is available. ❑ Y ❑ N ❑ ND(Explain below): t5nsp.doc•rev.712 612 01 8 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every Hyannis Ma 02601 6/2/2021 _.� page. Cityrrown state Zip Code Date of Inspection C. Inspection Summary (cant.) 2) System Conditionally Passes(coot.): ❑ 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): I ❑ 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: t5ktaP doc•rev.7r2MOI8 TRis 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of IS c Commonwealth of Massachitsetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments v 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every Hyannis Ma 02601 6!2l2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well_ ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method-used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to all Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® 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 t5insp.doc•ray,7/2fMie Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Gan_guli Owner Owner's Name information is required for every Hyannis Ma 02601 6/2/2021 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont_) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool r . El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2.day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no to each of the following, in addition to the questions in Section CA. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑. the system,is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection ❑ ❑ Area—IWPA)or a mapped Zone 11 of a public water supply well t5insp.doc•my,7282018 Idle 5 official Inspection Form:Subsurface Sewage Disposal System!_Page 5 of 18 f c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owners Name information is required for every Hyannis Ma 02601 6/2/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of Jquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/2WC18 Idle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every Hyannis Ma 02601 6/2/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: i Number of bedrooms(design): 3 -- --- Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t Description: Number of current residents: 0 Does residence have a garbage grinder? i ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes M No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No 5 Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown y Date i t5 nsp.tloc-rev.M26=18 Title 5 Official Inspection Form:SLAraftoe Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is Hyannis Ma 02601 6/2/2021 required for every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/SMI8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 16 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is Hyannis Ma 02601 6/2/2021 required for every H y ` page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system 4 ❑ 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: system installed 5/31/2000, d-box replaced for inspection permit#2021-175 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1.5 Depth below grade: feet Material of construction: cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Sewer line was found to be settled and had standing water. Pipe was replaced for inspection permit t5insp.doc-rev.7M018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of I Commonwealth of Massachusetts ll ap Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Flame information is required for every Hyannis Ma 02601 6/2/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: eet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth.- 5' Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7'r Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance.water level was even with outlet,tank was not leaking and was structurally sound_ t5insp.doc.rev.U28f2018 title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Gan uli Owner Owner's Name information isreq Hyannis Ma 02601 6/2/2021 page.e for every Cityrrown State Zip Code Date of Inspection D. System. Information (cost.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc-rev.7/2SW18 Title s official inspection Forth:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts � Title 5 Official Inspection Fora v P. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every Hyannis Ma 02601 6/2/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan).- Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D-box was replaced for inspection permit#2021-175 t5lnsp.doc•rev.7126COI8 TdL-5 Offldel Inspection Form:Subsurfeoe Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli owner Owner's Name information is required for every Hyannis Ma 02601 6/2/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ . leaching pits number: ® leaching chambers number: 3x500 gals ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: El innovative/alternative system Type/name of technology: t5i Wdoc.rev.7rAW18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealoi of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is Hyannis Ma 02601 6/2/2021 required for every y .._.__ _ page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): Leaching facility was video inspected and found dry with no signs of past overloading 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet Invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.726=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusett's Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner owner's Name _ - information is required for every Hyannis Ma 02601 6/2/2021 page. Cityrrown 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.): t l t5bnsp.Coc•rev.7/26I2018 - Tale 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 18 i t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Gang_uli Owner Owner's Name information is Hyannis Ma 02601 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A f 3 2 AZ 3 6 Z Y Z I Tr i~ A3 qt-. �s 33 r 38 t5insp.doc•rev.7/2 M18 Title 5 official Inspection Form:Subsuttaw Sewage Disposal System•Pape 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every Hyannis _ Ma 02601 6/2/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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: sate ❑ 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: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. tsinsp.doc•rev.7rmmi8 Tiffs 5Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Nob Hill Road Property Address Kristin&Suvranu Ganguli Owner Owner's Name information is required for every y H annis Ma 02601 6/2/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1,2, 3, or 4 checked ® C_ Inspection Summary: 1 r 2, 3, 0 5 completed as appropriate ro riatE 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.doe•rev 7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is 1a I S required for every Ma 02647 4/4/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered,in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your iL cursor-do not Sean M. Jones use the return Name of Inspector key. x. S.M.Jones TitleV Septic Inspection ' Company Name y 74 Beldan Ln. Company Address Centerville Ma 02632 City/Town _ State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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`:. ction 10,40 0 Title 5(310 CMR 15.000). The system: J. f, ® Passes ❑ Conditionally Passes ❑/ Falls;'.w. 1 Co ❑ Needs Further Evaluation by the Local.Approving Authority 0 4/4/2013 CDrc-u', Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Boards.. of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �6( �I t5ins•11110 Title 5 Official Inspection Fo :S bsurface Sewage Disposal System• age 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every Hyannisport Ma 02647 4/4/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 7 Nob Hill Rd Hyannisport is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 500 gallon.leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for".yes", "no"or"not determined" (Y,'N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every HY P annis ort Ma 02647 4/4/2013 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N . ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information isequired or every H annis Ort Ma 02647 4/4/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within f 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•11/10 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 M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every H Yannis ort P Ma 02647 4/4/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or 9 Y❑ ® 99 obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area.—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection 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 �M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every HY P annis ort Ma 02647 4/4/2013 _ page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You mast indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every Hyannisport Ma 02647 4/4/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No I Last date of occupancy: current If 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•11/10 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 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information isequired or every H anniS Ort Ma 02647 4/4/2013 page. Citylrown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every H Yannis ort P Ma 02647 4/4/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: original system installed 5/31/2000 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Q,1 Sludge depth: V t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is H annis ort required for every _Y P Ma 02647 4/4/2013 page. 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 3' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements 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 needs to be cleaned soon and again every 2 years for proper maintenance. Water level was even with outlet invert, tank was not leaking and was structurally sound. Outlet tee was intact. I Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness % Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every H Yannis ort P Ma 02647 4/4/2013 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every Hyannisport Ma 02647 4/4/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D box was in good condition. No rot, water level was at bottom of outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is p required for every y H annis ort Ma 02647 4/4/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type. ❑ leaching pits number: ® leaching chambers number: 3x500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching chambers were video inspected and found to have approx 1' of standing water with no sign of past hydraulic overloading. 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•11/10 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 °M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is p required for every y H annis ort Ma 02647 4/4/2013 page. City/Town 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-11/10 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 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every H Yannis ort p Ma 02647 4/4/2013 page. Cityfrown 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 G 1 Z i3..� 3 3> 30 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 7 Nob Hill Rd Property Address BANNISTER, HENRY F Owner Owner's Name information is required for every HY P annis ort Ma 02647 4/4/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 114 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: 1/3/2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database explain: You must describe how you established the high ground water elevation: Design plan indicates that no groundwater was observed at 11'and system is designed to have a seperation of 54 between bottom of s.a.s. and adjusted water table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 7 Nob Hill Rd Property Address, BANNISTER, HENRY F Owner Owner's Name information is required for every Hy p annis ort Ma 02647 4/4/2013 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION �] �� `A\ SEWAGE#010 a I --1?5- VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. L O i ,A FRAM(, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER V 0 ` PERMIT DATE: COMPLIANCE DATE: (Q I a a2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility(If any wells exist on site or within 2Wfeet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY cOA . Ask 24, Qa - Zk -repluLe z A3 : 3:5 Q3 3 MOB TOWN OF BARNSTABLE LOCATION 4=6 4A (Q SEWAGE # VELLAGE ra- ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO: llleke4 C4� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (5w s (size) NO.OF BEDROOMS UII..DE OR OWNER q"-�J PERMIT DATE: 'gyp r 0 COMPLIANCE DATE: I GYM Separation Distance Between_the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility. (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet o e hing facility) Feet Furnished by 4 [v O Q ID r Joe Z TOWN OF BARNSTABLE ° LOCATION vl l/ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.—z!!Z�o� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS T �1 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site.or.within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist .within 300 feet of leaching facility) Feet Furnished by Q 0 : `� �� 073� ' 9'' � Q 1 t �e No `�V c: Fee . _ 41%j( THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppttcattort for Mtopogai *p5teut Cougtruction 3dermcit Application for a Permit to Construct K)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 7 ",0( Owner's Name,Address and Tel.No. f/�raNnts Ooi--t S{z,pho.� O t NL�Gl Assessor's Map/Parcel Q- K S f-t��v.ncs �c rF 1 i1 i� U2L s Ian e Z g8 (-'r t_ 1 i q � Installer's Name,Address,and Tel.N Designer's Name,Address and Tel.No. m 'Br,r, k� Qy e of Building: :g Dwelling No.of Bedrooms Lot Size /� 8� 3 9 sq.ft. Garbage Grinder(4 ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 ti jgcP' b�cla-o gallons-pe�day. Calculated daily flow 33© gallons. Plan Date l Number of sheets eW_?A Revision Date Title s / Size of Septic Tan /Scr6 %; /4 Type of S.A.S. 1_eac4 /o y x 3A Description of Soil: R'.. "L,— L. C" ec cr k Nature of Repairs or Alterations(Answer when applicable) vvv Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedhy this B d e th. Signe b 4 Date Application Approved by I X Date Application Disapproved for the following reaso s Permit No. Date Issued 5 Noe,� '..a- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE& MASSACHUSETTS }' 24-VJ— Application for Migoml *p.5tem (Construction Permit Application for a Permit to Construct K )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 7 Nb,, A;// -OU Owner's Name,Address and Tel.No. f�y%Nnis Dorf S�pyWr O t N L i it Assessor's Map/Parcel 190, 13cx S .H a h V1 4s po r-t MIA UZ 6- _f _ Z t98 fx 1. 11 q ., � t Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. n�cr� tJ�e k �O/I�M gYcv /3riC S,Z m4 t"l � I slrrrUl ILL MrA 0Z. .5 S Type of Building: Dwelling No.of Bedrooms fir- Lot Size_a.63 51sq. ft. Garbage Grinder W ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I 1 bid,. , ga4effs-per-day. Calculated daily flow 33 O gallons. Plan Date !/.31 2.vaa Number of sheets e,3A7 a- Revision Date Title " • Size of Septic Ta /5rE6 4; // Type of S.A.S. 4coc-4 lq,/d /o�ix 34 Description of Soil: R_C-G,� vt, _ 4.0 Cry I 1Q �+ >JL4 to j Nature of Repairs or Alterations(Answer when applicable) 1- /r 1( 1 i V1, I 1 Date last inspected: .j v' Agreement: V3 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this B and�Health. Signe . a Date -� 0 rJAAb Application Approved by �1 v /1` / Date Application Disapproved for the following reaso s 77Y Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,t at the On-site-Sewage Disposal Sys1tem C nstruct/d( )Repaired( )Upgraded( ) Abandoned , )by, � i r < C, �! V)At� K �/�- 1�1 . at (7 ° l_�i� I J � � t fXl AM I �� lr(II 1 haWdated constructed in accordance with the provisions of Title 5 and the for Disposal System�Construction Permit No Q ' Installer Designer The issuance of thi p t shall not be construed as a guarantee that the sy"temll fund on as desig ,I Date r``7 Inspector / yell e ) No.— �C �� Fee�! ^r� THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mt!5pogar p5tem (Con.5truction Permit Permission is hereby r ted o Construct_ onstruct( Repair G U ,grade( ) a on( ) r 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 5 and the following local provisions or special conditions. Provided:Cons ction musebe completed within three years of the date of th rtn' Date: Approved by / J � u MOB TOWN OF BARNSTABLE LOCATION 7 4A (Q SEWAGE # ;WW,a�9 VILLAGET iri err ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. P?e4, c4a n_rT '7 SEPTIC TANK CAPACITY fU LEACHING FACILITY: (type) 5Z<4 A'A (size) NO.OF BEDROOMS UII DE OR OWNER I 't- PERMITDATE: ,S-.3o— COMPLIANCE DATE: - 000 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and.Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o e hing facility) Feet Furnished by r 00 to c I i 'I i > NUM ,r Q 1. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM, BACKFILL ` BENCHMARK 0 �� l• SMITH WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT SET K °per ST MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE THAN 90% RETAINED hepp J� LOCUS OR LESS TO PASS No \` EL = 82��\ e/e0tr ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% G OND 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED ` x 17.2 ` se,� �J BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. Ce �, catch basin ~ (�/ °LEAN pvE 2. LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS ���� 16.9 '� I O 12.6 Z m PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL MAKE X THE REQUIRED NOTIFICATION TO DIG SAFE (1-888-344-7233) AND APPROPRIATE Z: WATER DISTRICT TO DETERMINE UTILITY LOCATIONS. 77 / h 16.4 �`�./ `� \ • 3. ALL COMPONENTS LOCATED IN AREAS SUBJECT TO TRAFFIC OR BURIED DEEPER HYANNISPORT THAN 4' SHALL BE H-20 LOADING. / HARBOR FN D 15.4 ®`�� 12.8 R #1 nP^'OP s l v�V> -xi to x 13.6 I CERTIFY THAT THE PROPOSED FOUNDATION / ^ 3 ® 13.8 0 15 -(_ - 14.0 e drive / \ ca LOCUS` MAP COMPLIES WITH THE TOWN OF BARNSTABLE SIDELINE �� 2 y AND SETBACK REQUIREMENTS AND IS NOT LOCATED l� 48 Op4E w, e SCALE 1 25,000 WITHIN THE FL❑❑ LAIN. / •^. RESER / 126 59 x 12.6 ` 13.1 ASSESSORS DATE: I.25•�SNII�T R.L.S. /14.8 gRe�E s r \ \ \ MAP 288 THIS PLAN BAS ON AN INSTRUMENT SURVEY AND ` / in V U s \ x 13.4 PARCEL 119 THE OFFSETS SH BOAS BE USED TO DETERMINE LOT LINES. / / \ �' 9.2 LOT 41A 12.4x Uj G x \ x x 3.4 ZONE 13.3 A.P. / / G ,� x R F-1 U PROP o. to 9.8 8.5 MINIMUMS x 10, Q GARAG f x 8.4 .0 AREA = 43,560 S.F. W ti G c9 O FRONTAGE = 20' 0 8 �n deck 10' 30" douglas fir a 12.9 WIDTH = 125 a FRONT SETBACK = 30' l / �n 24 00 �p SIDE SETBACKS _ 15; 1-1.5 WASHED STONE /a� eoXT �`� ,,.D LOT 4A REAR SETBACK 15 • ; 10, _ 11,839 S.F. co �� r, - BUILDING HEIGHT = 30_ - /o TgN/t min• / 9.3 �0 ti .a,.. • • . o Q F OPOS f0 13.4 o x 13\ !•... .'. 1.5 0 NOq T10N x x 8.0 0 1 t.9 1.P. x a.6 / a 34.0' FN D.OFF 48.6' o \ DESIGN DATA x 9.9 �5 a PLAN OF LEACH CHAMBERS "o ° s ' #2 SINGLE FAMILY- 3 BEDROOMS 49 - _ NO 9.0 13.5 DAILY FLOW ARBAOGEXGRIND 330 G.P.D. NO SCALE ` N75°18 '50„� 13.5 12/13 SEPTIC TANK 330 X 200% = 660 - 12„ hem/ 10.0 / X.P. USE 1500 GAL. SEPTIC TANK ooks ND x LEACH "FZ0 DESIGN p1 N 11.4 4.4 ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED 10.5' _ WITH CAPPED ENDS FINISHED GRADE 1" = 20' USE 1 - 4" DISTRIBUTION LINE 36"MAX.- 12"MIN. i�>iii�>iiii�y��ii� ��i COMPACTED FILL IN A 10.5' X 34' WASHED STONE FIELD AS SHOWN \��\��\��\��\/\��\�/�\��\�/�\�/�\�/�\�/�\�/�\�/� x 5.1 LEACHING AREA REQUIRED a,...........'a 2 PEA . ONE �,b* _ 14.5 S`T 330 G.P.D./.74 = 446 S.F. `ry`L • a. „ 2(34 '+ 10.5') X 1 = 89 S.F. SIDEWALL AREA • ° .a 3/4„ TO 1 1/2 J 1 (10.5 X 34) = 357 S.F. BOTTOM AREA ' • ': DOUBLE G! IS , p 446 S.F. TOTAL PROVIDED •° I WASHED STONE u. �9Sf'fi a• PERCOLATION RATE 1"IN 2'OR LESS 1/08/99 SOIL CLASS 1 3 4.5' I 3' I {¢ L�_, Y C, LEACH FIELD SECTION NO SCALE SEPTIC SYSTEM DESIGN TEST HOLE #7 NOB HILL ROAD COVERS LOCATED TO WITHIN BAXTER & NYE INC. HYANNIS PORT 6" OF F.G. JANUARY 21, 1999 DAM' #P-9341 JAN. 3, 2000 F.G.= 14't TOP OF FND PIT #2 PLAN CE . .� .���� F.G.= 13' PIT #1 ELEV. = 14.5' ELEV. = 8.8' 15.0' PLAN BK. 111 PG. 93 INV. = _EVEL x III III 13.0 1500 GAL. 4" DIAMETER 2 < -I SANDY LOAM -I E SANDY LOAM DEM wv. = SCHEDULE LEACH FIELD I IIUri: 10YR.6/4 IIII 10YR.3/1 SEPTIC TANK DIST. �'' JANE M. BROWNE & RAY W. McMULLEN 12.8 INv. = ULE 40 P.V.C.12.5 INV. =12.3 BoxwV. -12" ........... INV. =12.1 = 11.9 B SANDY LOAM B SANDY LOAM BOOK 854 PAGE 544 10.00' ••••••• --6" STONE BASE 10YR.5/6 ............ - --- -- 1 oYR.5/6 APPLICANT: MIN. -36 BOTTOM ELEV., 10.9' ';-54'' PERC .TEST `!„m -54" PERC. TEST STEPHEN O'NEILL L6 Cl MEDIUM SANDWV Cl MEDIUM SAND 10YR.6/6 10YR.5/4 BAXTER, NYE & HOLMGREN, INC. -2.3 ADJ. WATER LEVEL PROFILE -96" ELEv. - 5.9' LAND SURVEYORS, CIVIL ENGINEERS 62" WATER OBSERVED $12j1T STREET SCALE C2 MEDIUM SAND ELEV. = 3.6' 1 OYR.7/3 OSTERVIIlE,MASS. -132" NO WATER 1-72"ELEV. = 2.8' ELEV. = 3.5' #99000CSP4A