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HomeMy WebLinkAbout0105 OLD STRAWBERRY HILL ROAD - Health 105 Old Strawberry Hill Road Hyannis \ A= 249-001 I v,sn ut epirw s woovice tus a' bdFn HOGS Z^ON I TOWN OF BARNSTABLE LOCATION l85 6f-D SST#q,4WPgW 14ILL R SEWAGE# ;tO Ilg a16 VILLAGE C'tY�i�lli(-9f$ ASSESSOR'S MAP&PARCEL 4�t`��i °7 5 50Ya INSTALLER'S NAME&PHONE NO.k. A wt>pS � � ►� '��� �F7t_� �, SEPTIC TANK CAPACITY on GA4A,0 uS LEACHING TACILITY:(type) (size) NO.OF BEDROOMS OWNER TAAkaLs,f' PERMIT DATE: COMPLIANCE DATE: �J- 101 > ®( Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4l!! A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) AJ A4- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within �p 300 feet of leaching facility), N Feet FURNISHED BYk, 1A �,9(be r , N r- tillo N 03 <7d a W uj 11 W CA3 \N N N N -F r � � 1 � N _ _ I SLK i ;`i(( No. AO/91. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Vol, 01pplitation for Misposal *pStrm Coneftuttion i3Prmit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I S p Q) _S1TA"4 kj?1-1 Owner's Name,Address,and Tel.No. Assessor's Ma /Pazcel ,} 11, CS�c�"r— S� t44cAW-I t&g Lv_ -r� p 414 LQ t C Installer's Name,Address,and Tel.N . Designer's Name,Address,and Tel.No. G4B1Sw006 (J AJ56-s j " G0 _ C_ 1E&)GW 6aQBk45r � G0 Tf pe of Building: Dwelling No.of Bedrooms Lot Size ®--Sq.ft. Garbage Grinder( ) Other Type of Building R.-_4S l ID GIL)T JANo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4y'D gpd Design flow provided 4 55;as� gpd Plan Date (0 d a&- O I S ���N�uumbeer,�off sheets � Revision Date Title b®o n t�—eb— ?'�Rx`�l s'�—W i(u•_ao Ab toYAijljK Size of Septic Tank l (� Type of S.A.S. (31 500 Cry.. C_0&4&.XS Description of Soil O DAIRS&S1ubp¢� C &JMQF �qA" /65� PL444/ Nature of Repairs or Alterations(Answer when applicable) X"lJ C-r"L, WE g) b-4Il,� ��C�-� Z� C uj c TO -/ r=Cif" 6-!3� &&6Aa Axs�SuPAU 2L.1h l L)C-Z-- 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 t is Board of HeaUh. rgied ® Date 'aS Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �"` Date Issued •+.:�'. ". -.:. ._.., ^r! ....+�-. ...n. "Mors•^ �'M.,,r,>�•{.-e=,.."_..... A'iYYYY4•�y.r -�'7�yn,. '" -�' ..`f �s. _ -its 00- Ot/ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION=TOWN OF BARNSTABLE, MASSACHUSETTS Yes f 21pplitation for )Disposal 6pstem Corgi„struttion Permit Application for a Permit to Construct( ) Repair YA Upgrade( )>Abandon( ) ❑Complete System) ❑Individual Components Location Address or Lot No. 10 5 ®(,b -r�,1J Owner's Name,Address,and Tel.No. , ,- S kw#44.�4 �c.v 't'1� • Assessor's Map/Parcel 7 .. 1�Y r_,>>LUr-_GftitZ%4 WIL4,1ZID Installer's Name,Address,and Tel.N9. Designer's Name,Address,and Tel.No. 50 t -P i, �! t Type of Building: Dwelling No.of Bedrooms L Lot Size (�°sq.ft. Garbage Grinder( ) Other Type of Building QCS 'r� LNo.of Persons Showers( ) Cafeteria( ) j Other Fixtures f f Design Flow(min.required) gpd Design flow provided gpd Plan Date 1,-a(0- A0I's Number of sheets � Revision Date Title J WS 00 !KtOwboa i�tm,H/a Vir4 xjA_jK Size of Septic Tank b Type of S.A.S._e3l 560 _Gr" C0A9(&,X S Description of Soil n S C & GAdvir,1 41� �/ 1�� tad lk/ Nature of Repairs or Alterations(Answer when applicable) _r G Li _ .. T Moo GAL 6 f (C + .�. .0) - a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of `Compliance has been issued by this Board of Heath. �4�_21VZ/ n Date �', ,� " 0 Application Approved by / l / Date Application Disapproved by Date for the following reasons ' Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS A Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned(.._),by Lt,3 l UL !P p"n9,e yg l.< �5 ! w at (��, /') � o�,�'r, t�� Qrj�j as been cons cted in acV,r,7ted 'e with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer i . AL�(��t�' pQI. l Designer CIS l Jl- 11.� ** 1 #bedrooms Approved desgn�flow, ,., �G � gpd The issuance of this permit shall not be construed as a guarantee that the system will fimctio asdesigned "'�. Date �1��/ Q Inspector - - - - -_ ---- - - ----------------------------------------------------------------------------------- Fee U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS BIsposal *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon • System located at f r )�,�-nt�( 11 ("! Y , i�,✓ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:.Constrd tion :must�e o p BEd within three years of the date of this permit. Date /7 Approved by & u. VI/ IV/GV IV 1J.JJ :/VO4IJV001 8t5V4L r. VU 1/VUI ' 'own' of Barnstable Regulatory Services �,. Richard V. Scali,Interim Director n�atasr�at�. 26 Public Health Division o Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form / Date: g Sewage Permit# ;;.t3i7S -D.6L Assessor's Map\Parcel Designer: TG Ert9tr,eerin , �� Installer: G�apWj c4_ EVhr ff(Se� Address: ZSS'i G!'onberry Address: 153 CoAmcrcial Strec,+ Cask u)are.)nownn , Nk _0 5�$ �'(0JVLee.e- o Z6 y 9 On � —��� g aueWtdt CMEefefi e.s was issued a permit to install a (date) (installer) septic system at_-10 5 old Skcot"ertr 9-00d based on a design drawn by (address) 7:YC C-O's in ap-C i nct Too dated -TuV1e. Z(o, Zale� / (designer) V/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. flan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i ianee with the terms of the M approval letters (if applicable) H �asq y JOHN L G`^�, CMRCMILLJR in ( er's re) CMI, .41 o , (D ner's SignaturVARNSTABLE (Affix De p Here) PL SE RETURN TO PUBLIC HEALTH D SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL ROTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepticMesigner Certification Form Rev 8.14.13.doc i Town of Barnstable P# C e c Department of Regulatory Services I / Public Health Division Date 5 6 200 Main Street,Hyannis MA 02601 .£ Date Scheduled �07-7 Time Fee Pd._ (00 I.rk t 1:. Soil Suitability-fAssessment for S e Disposal Performed-By:( J ibad V eAW , �tt �r (.Sc Witnessed By: J- LOCATION&•GENERAL INFORMATION , Location Address Owner's Name 165 (ZRC_5V_ � 6UC Address kt 4' /0-7,5_/0-0 ct-x-t 6PZKL565 Assessor's Map/Farce►; Engineer's Name G-C GA)G e! NEW CONSTRUCTION REPAIR 7� Telephone# 50'9-2-13 —p 3-71 Rtte-S �5-5_6_-271`0377 ' Land Use- �t'SI�� �G't � ^'�L' �/ y� JJ rr Slopes(96) J �O Surface Stones e V A Distances from: Open Water Body 7//J ft Possible Wet Area >l50 ft Drinking Water Well 2—is—oft Dralhage Way >/ ft Property tine >�0 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes) See 44aJej , Parent material(geologic)0(AT�rA ' loft) ]7 a65 Depth to Bedrock i/ / 7 yR� /• Depth to Groundwater. Standing Water in Hole: � • Weeping from Pit Pnea Estimated Seasonal High Oroundwater BET R KATJON FOR SEASONAL-HIGH WATER TABLE Method Used: Q f 0.�k� � (�r, �r Depth Observed standing in obs.hole: (n, Depth to loll mottlell: • Depth to weeping from side of obs.hole: > /'. --In. Groundwater A4jugtment Index Well-0 Reading Date: Index Well level Adj.factor, , r Adj.fJroundwater Leval__= PERCOLATION TEST butt,62-1 TIMO 10.0 " Observation 1 _ � Hole# Time at 9" Depth of Pere "ia 6rrV' .,— Time at 6" w Start Pre-soak Time @ Co•�Jad A rNme(9"•6') End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Palled: Additional Testing Needed(YIN) A Original: Public Health Division Observ'stion Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP,OBSERVATION HOLE LOG Bole# Depth from Soli Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones(;Boulders. Consistency, O 7 C." LOUrut �nd ID "-LIX . TP L oar,,, &A loyrr §/a uaN-g� C-I coasa Seta I S y 616 m4uil &l)J DeSY 61 - doe 6 e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) + (Munsell) Mottling (Structure,Stones,Boulders. _ 1 DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldera., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, 0 Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No v' Yes Within 100 year flood boundary No.,,-,,/— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Eve,�.._ If not,what is the depth of naturally occurring p rvious material? .. .�...,.. Certification �y I certify that on 10 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protect n and that the above analysis was performed by me consistent with . the required training,exper 'se an x erience described in 10 CMR 15.017. Signature Date Q:\S.BPrlCVRRCFORM.DOC LqLqMALM3jD MAP �N •. • v o CO 0 F F I / � ` cO Certified Mail Fee Er ( �� Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopY) $ ❑Return Receipt(electronic) $ 10��ostnnark p� r ❑Certified Mail Restdcted Delivery $ P� + Here 1-3 ❑Adult Signature Required $ ``••...__ - -.`` ❑Adult Signature Restricted Delivery$ C3 Postage -- - —— m $ r.a Total Postz BUCK, CHESTER C & MARY H TRS � Sent To 99 BLUEBERRY HILL RD C3 3lreet and HYAN N I S, MA 02601 City,State,, :.. r r r rrr•r• Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verMcation of dgiivery,or attempted return receipt for no additional fee,present this— delivery. ; USPS®-postmarked Certified Mail receipt to the'-, ■A record of delivery(including the recipient's retail associate. 1 signature)that is retained by the Postal Service' Restricted delivery service,which provides r— for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent �, Important Reminders: Adult signature service,which requires the t- ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which is Certified Mail service isnotavailable for requires the signee to be at least 21 years of age. International mail. and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). �.. of Certified Mail service does not change the ■To ensure that your Certified Mail receipt Is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a_j certain Priority Mail items. USPS postmark.If you would like a postmark on rrr ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for p_ the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record. Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F , You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. —, electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPOKAN1:Save this receipt for your records. Ps Form 3800,April 2016(Reverse)PSN 7630-02-000.9047 Barnstable U. °F«r Town of Barnstable Regulatory sn MASS. Re ulatorY Services Department 1 1 9. ' Public Health Division ��ON4P�p 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0022 May 16, 2018 BUCK, CHESTER C & MARY H TRS 99 BLUEBERRY HILL RD HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 105 Old Strawberry Hill Road, Hyannis, MA was inspected on 04/27/2018 by Shavvn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH cKean, R.S., C Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\105 Old Strawberry Hill Road Hyannis.doc IV Town of Barnstable r + BARNSCABLE, b 9 A Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An ...... marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or pondin e surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc . I a�q-��-_oaf TOW Commonwealth of Massachusetts Title 5 Official Inspection Form r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address !p Ron Buck t.a Owner Owner's Name I I information is c required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection to 9 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 Sly � 300(4P 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ' ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further E i n by the Local Approving Authority 4-27-18 1 spector's Signa 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 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. t5ins'.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 God ja VS Commonwealth of Massachusetts ' Title 5 Official Inspection Form hl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page, City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "ConditionalPass"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 es", no or not determined (Y, N, ND) for the following statements. If not Y 9 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 El ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts �- Title 5 Official Inspection Fora "�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ 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): ❑ 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.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 i,�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r >' 105 Old Strawberry Hill Rd J Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑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 ; E. ❑ 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 Y2 day flow t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r T, Commonwealth of Massachusetts If Title 5 Official Inspection. Form �f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 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 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- 1 0,000g pd. ® ❑ 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.cloc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 � .. Commonwealth of Massachusetts . ;a Title 5 Official Inspection Form ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the,previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of ' this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ®• ❑ Was the site inspected for signs of break out? s ® ❑ 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? ® ❑ Wasthe 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): 4 Number of bedrooms (actual): 4 DESIGN flowbased 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 fir► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 1._ 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name - information is required for every Hyannis MA 02601 4-27-18 page. 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: 2018 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.6/16 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 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: n/a Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rI/ 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1960's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: See Cesspools Pg.13 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: Sludge depth: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form -I Subsurface Sewage Disposal System form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis. MA 02601 4-27-18 page. City/Town 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 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? Comments (on pumping.recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.)-: 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.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts ,r Title 5 Official Inspection Form ► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments n f¢` 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name informati for every yon is required Hyannis MA 02601 4-27-18 page. City/Town 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 N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* 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 C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. 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: ® overflow cesspool number: 1-64 ❑ 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.): Overflow cesspool had obvious signs of failure with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-Inline Depth—top of liquid to inlet invert N/A Depth of solids layer 0 Depth of scum layer 0 Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts 3 Title 5 Official Inspection Form i I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Old Strawberry ry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 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.): Both cesspools show signs of failure with stain lines above inlet inverts. 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form ! i► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is Hyannis MA 02601 4-27-18 required for every H y - page. City/Town 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 i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: + ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form � t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r >° 105 Old Strawberry Hill Rd Property Address Ron Buck Owner Owner's Name information is required for every Hyannis MA 02601 4-27-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is H required for annis MA 02601 9/18/08 Y every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out /I 0-7,5—G 6 ,forms on the ztli "computer, use 1. Inspector: only the tab key to move your Carmen E Shay cursor-do not use the return Name of Inspector key. Shay Environmental Services, Inc. Company Name r� 185 Ashumet Road Company Address Mashpee MA 02649 erwn City/Town State Zip Code 508-539-7966 3080 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails N ❑ Needs Further Evaluation by the Local Approving Authority '�f ',v�.• °SSA.. �. .; -E 9/18/08 _ Inspectors Signature Date ait The system inspector shall submit a copy of this inspection report to theyar _a ty (ward of Health or DEP) within 30 days of completing this inspection. If the systelxt - sterpr has a design flow of 10,000 gpd or greater, the inspector and the system owne suftit thT report to the appropriate regional office of the DEP. The original should be sent tiD 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� 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Overflow leach pit has 1' Liquid., primary ccesspool level equal with outlet invert. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): I ❑ broken pipe(s) are replaced ❑ obstruction is removed 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 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 '/2 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. 105 Old Strawberry Hill Road,Hyannis-03/08 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 4 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 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. 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for �H annis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 440 GPD Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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)): Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 105 Old Strawberry Hill Road,Hyannis-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is H required for annis MA 02601 9/18/08 � every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) General Information Pumping Records: Source of information: Board of Health 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): Approximate age of all components, date installed (if known) and source of information: 1966 Were sewage odors detected when arriving at the site? ❑ Yes ® No 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2.5 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.): No evidence of leaks, plumbing properly vented Septic Tank (locate on site plan): Depth below grade: 1.5 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 TORN t3� B. +ISTABLE -n ) LOC'A�`�IOfd.. d5 c��SEWAGE# , - -- `� �' v3I,TAGE 5/Q�n 6 5 ASSESSOR`S`I4# '&L.OT 7NS-A3.T.ER'S Ti4ii+f &;'iifll i34 SE�''3"IC TANK CA3?ACTI'X 5 S _ LEACFIING FACIAMtAtype) S S (size) 0.GFBEDROOIS EUS DER. OWi�iER PERMFFDATE ©W"." rTCE:DATE. Separation Distance Between.Ebe Irt3aximumAdtusted GroundwaterTable to ilia Bottom ofLeachingFamlzty Feet Pnvate Water-&pply ell anciLeacbattg ar 3tty fang weI#s ex un site ur.anthh ?AO feet of 3e sag i'ac tty) esi Edge of Wetland and Leactnng T�aaI (if any we &exist wit?un 3(34�feet a teactung facility) Feet:` Furtushed � � � t � � � � �� � _ s � � '�I � � � _ � , — � ` _ i i R� � � '� c� TOWN OF BARNSTAABL`E ,- LOCATION I bS O1�ir�.� { �11 l-�C�SEWAGE# tJ VILLAGE N uann S ASSESSOR'S MAP&PARCEL 0 ID01 INSTALLERS NAME&PHONE NO. I R SEPTIC TANK CAPACITY I coo a►G` . block C4551�0A Ga C^�cnC_ Ta�x< —� LEACHING FACILITY:(type) 0LNE-C�\ou-3 (size) GS NO,OF BEDROOMS �} Cees C'�^ OWNER �hek PERMIT DATE: VJ I IA- COMPLIANCE DATE: N'A- 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) NIA Feet Edge of Wetland and Leaching Facili (If any wetlands within 300 feet of leaching facili ) Feet FURNISHED BY f 1 I _1 S c kP r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-Box Present 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.): No D-Box Present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. I ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 -6'diam x 6' D ❑ 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.): SAS fuctioning properly., 1' liquid in overflow. 5' effective depth available. Primary liquid level equal with outlet invert. Both covers are 18" below grade 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 r • � Commonwealth of Massachusetts W Title .5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for y H annis MA 02601 9/18/08 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 105 Old Strawberry Hill Road,Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 „ Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: C� �ti; C� Lot No, Owner: Ch � U.L Address: Contractor: C�f-QQ c � -A- Address:_ Notes:Q. V -- --o--Q CAAOC” STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date t3 J-= mon&day/year STEP '2 Using Water-Level Range Zone and. Index Well Map locate site and determine: i O Appropriate index well.................................................... n-D OB Water-level range-zone STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to wager level for index well 9 . L mo th/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 28) determine water-level adjustment ................................. 4, 41 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 11 ..................................................;.,.................,....... 3� i S® Figure 13.--Reproducible computation form. 15 So I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 14 feet feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 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: Inspector has performed engineering design and perc test on this street. 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Old Strawberry Hill Road Property Address Chester Buck Owner Owner's Name information is required for Hyannis MA 02601 9/18/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth —top of liquid to inlet invert 101, Depth of solids layer 3.5' Depth of scum layer 1/4" Dimensions of cesspool 6' x 6' Materials of construction Cement Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. No evidence of hydraulic failure. Cesspool acting as a septic tank with an overflow leach pit. 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.): 105 Old Strawberry Hill Road,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 TOP OF FOUNDATION = 54.3�± INISH GRADE OVER D-BOX- 54.0'' PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE _ - FINISH GRADE OVER CHAMBERS = 53,8' - 54.2' �- PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCT ION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 54.04 F.G. OVER TANK EL.= 53.8'± /-5" DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 19) STONE OFE OR GEOTE XT ILE FILTER FABRIC DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER (3 TYP.) 9"MIN. DESIGN ENGINEER. 36" MAX. 3.5' MAX. TOP OF SAS-SO.00' PLACE RISERS ON ALL PROP. SCH. 40 - CHAMBERS WITH , PVC SEWER PROP. SCH 44 SEE NOTE 22 t�0.00' SEE NOTE 22 � INLET PIPES TO 6" OF 3. 4' SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. PVC SEWER � BREAKOUT EL= 49.50 FINISHED GRADE MIN.SLOPE Q 1% 6" 3" 2" DROP MIN. 3„ 9„ L - 5O'± 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3" DROP MAX. MIN.SLOPE @ 1% PROVIDE WATERTIGHT o o ELEVATION =49.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVC IN FROM JOINTS TYP. o oo 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" \- 50.25' SEPTIC TANK • LEACHC OUT ING FACOILITY O °° O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CDl �1 --1 i 1 o o' i -{ 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 50.50' ALL TEES MUST 49 47' MI 6" - o00 ! 1 L__J L_J o o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. BE CENTERED 48' OUTLET TEE MIN. 49.30 2 � � � � � � � � � o o' o � � � � � o UNDERNEATH o0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK RISERS 6"CRUSHED STONE 00, C) AS BAFFLE OVER MECHANICALLY o 0 0 0 0 0 0 0 000 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS COMPACTED BASE o _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 10.6' OFFSET TO FND. d 0, I ` 4 0, I I I I AND DESIGN ENGINEER. 3 OUTLET DISTRIBUTION BOX 8.0 lYr) 4.0 4.83' 4.0 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 55.00' 6"CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE 33.5' (TYP.) ESTABLISHED ON A HYDRANT BOLT AS SHOWN ON PLAN. OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET < 42.00' COMPACTED BASE C C PIPES TO BE LAID LEVEL. 47.00' GROUND WATER ELEV.= 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK 3-500 GALLON H-20 CHAMBERS S MIN. 'HAMBER END VIES^` THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6' WIDTH 5"1 DEPTH 5`l (Dimensions per ON VIEW J 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES ACME-SHOREY) r.. I , CROSS SECTION yy < TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. , _..�0 . . 4._,�I N E3 i 1 h D E T A f L NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING T ` : 4;w. • `• / .Y REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTES: _Oft . • 1 F /r PERC NO. 15685 APPROPRIATE AUTHORITY. ' • /• . INSPECTOR: Donald Desmarais, IRS _ 1.) MAGNETIC MARKING TAPE SHALL BE PLACED t t �tt ' • • •�/ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H 10 LOADING UNLESS LOCATED • .. J .< • , ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM Benchmark UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR COMPONENT. Hydrant Bolt " ';, , w �, �► EVALUATOR: Michael Pimentel, EIT, CSE Elev. = 55.00' �7,L •� 'l • '' Oct. 1999 TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. i..)ttl� Q C.S.E. APPROVAL DATE: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN g Approx. M.S.L. "�, • + , June 7, 2018 13, DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. THE LOCATION OF THE PROPOSED LEACHING BLUEBERRY 13 • r{ , DATE: SYSTEM TO ENSURE CONSISTENCY WITH TEST PIT ERRY HILL r • �7 . " - TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER - p" -� (40 WIDE I•AYOUT)ROAD ; ,, • ., j �" •, • „ ,)1 - MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. U % r ELEV TOP 54.00 AND LOCAL BOARD OF HEALTH !F SOILS ARE NOT REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, CONSISTENT WITH TEST PIT DATA. �� �' / • 4. ELEV WATER= <42.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). .e-. ��� any-:r. � �• \l x •�„J" 3, , • •L�• .P' y ~Y ", "" ""� •' •' w' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 3). ENTIRE PROPERTY IS LOCATED WITHIN THE �- - + !_ PERC RATE_ < 2 min./inch l '``�^ - �`" _EDGE OF P ° " E ��!l r, SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. LIMITS OF A DEP APPROVED ZONE 2, THE ESTUARINE '�-�`� "'�----.._AVEME�T h � ` � � f' WATERSHEDS, AND THE WELLHEAD OVERLAY S7 // PROTECTION DISTRICT. 0 8°24,S ti `'~--- v „ tlr,•ae o i}�' ,j'� 1 ? DEPTH OF PERC= 42" -60" 16. PROPOSED PROJECT IS LOCATED WITHIN: • l > r' )�, A y, Vll 0 68 78, i? E \ '� '--4 •\`� �� , << � /i • '!` TEXTURAL CLASS: 1 ASSESSOR'S MAP 249 LOT 75-1 4.) SWING TIES SHOWN ON THIS PLAN ARE PROPOSED INSPECTION PORT (5) �. ---rr 4f F R THE 10.0' r'3 11 1 •�_, Y OWNER OF RECORD: CHESTER C. & MARY H. BUCK TRS PROVIDED ONLY AS A COURTESYO }, a , r ••' -) ,� 3 INSTALLER. INSTALLER SHALL VERIFY SWING TIE PROPOSED 3-500 GALLON PINE 3 �, a f-..� .`` \\• , 0" 54.00' MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING H-20 LEACHING CHAMBERS �`� �' - .___ -- •,�-. 3 � 4 4�AK 10"OAK ) tNF `' 1 F'� • � q Loamy Sand ADDRESS: 99 BLUEBERRY HILL ROAD THE SYSTEM. CONTRACTOR SHALL NOTIFY WITH AGGREGATE ��,� 3.5 { ) ? \ -` �. 6„ 10Yr 3/2 53.50' HYANNIS, MA 02601 ENGINEER IF MEASUREMENTS APPEAR TO BE r) hi r � '�' =� d•�`;, - • INCORRECT. / 1G,, r,k`}_ ' •� •I� LOCUS • . `` FEMA FLOOD ZONE X PROPOSED 4" PVC VENT PIPE OAK/ / /� Loamy Sand EXACT LOCATION PER OWNER i , ~ I, h h ` B 10Yr 5/6 COMMUNITY PAN L 3 5„ S#�RIJC N / ' ��` �r' I [ ' 17. DEED REFERENCE" BOOK 80G ACE 173 # 5 1 Cl! (6) ° ��r' • • •: t ,� * eke `( ' 42" 50.50' 18. PLAN REFERENCE: PLAN BOOK 187, PAGE 51 _ *� • 19. A 4" PERFORATED SC1-1. 40 P`/C PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A ., �!� • . '�.: - DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A o • , . �- f � •`• � r ; ,,- Coarse Sand n PROPOSED H-20 s 7 �, -� •e ( •1!• • • •,a (� ,� C-1 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. DISTRIBUTION BOX - �' (3) to ,''� ••� • . , + •,; (10% Gravel) 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 1$" OAK TP 1' - =i ` •'I� "� • ` �_ • ' 84" 47.00' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY % 4 , � � tQi t ' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 12" PINE 21. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL C-2 Medium Sand REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. MAP 249 TP 2 N 2.5Y 6/6 LOCUS PLAN t� (Loose) 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE LOT 75-2 r APPROVALS ARE REQUESTED FROM 310 CMR 15.221(7): 20" OAK 54x0 J, SCALE: 1"= 1000' (1.) A 1.2' WAIVER (3.0-4.2') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. ?, �� ► 144 42.00' - �- - f (2.) A 0.5' WAIVER (3.0-3.5') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. Z� No Mottling, Standing or Weeping Observed HC-2 �`y o ' PERC NO. 15685 .. �'"c�^r •� EXISTING SPOT GRADE � ;, E S G S O INSPECTOR: Donald Desmarais, RS HC-3 NUMBER OF BEDROOMS 4 EVALUATOR: Michael Pimentel, EIT, CSE EXISTING CONTOUR � Co DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED SPOT GRADE 00 i� Q PROPOSED 1,500 °0 GALLON SEPTIC TANK - _._-_ 2 0 TOTAL DESIGN FLOW 440 GAUDAY DATE: June 7, 2018 r, a (2) ti _ TEST PIT#: 2 PROPOSED CONTOUR O J J DESIGN FLOW x 200 % - 880 GAUDAY EXISTING OVERHEAD WIRES ##105 �0 ELEV TOP= 54.00' EXISTING ,= Q USE PROPOSED 1,500 GALLON SEPTIC TANK 10 61 (1) 4-BEDROOM MAP 249 1 �.. �2 ELEV WATER = <42.00' EXISTING GAS LINE DWELLING LOT 75-1 PERC RATE _ 10.g, 15,750±S.F. EXISTING WATER LINE �''' -..o- m INSTALL 3 - 500 GALLON H-20 CHAMBERS w/ STONE DEPTH OF PERC = TEST PIT LOCATION BH TOF = 54 3'± - i Q SIDEWALL CAPACITY TEXTURAL CLASS: 1 s,- LENGTH + WIDTH (2 SIDES) 2' HIGH 0.74 GPD/S.F.) = GAUDAY PROPOSED 1,500 GALLON SEPTIC TANK -HC-1 co 1 (33.5'+ 12.83') (2 ) (T ) ( 0.74 GPD/S.F.) = 137.1 GAUDAY 0" 54.00' _ PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE Loam BOTTOM CAPACITY A 10Yr 3/2 d 6" 53.50' PROPOSED H-20 DISTRIBUTION BOX f (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY I (33.5' x 12.83') (0.74 GPD/S.F.) = 318.1 GAUDAY } Loamy Sand PROPOSED 500 GALLON H-20 LEACHING CHAMBER I B 10Yr 5/6 TOTALS: 3 42" 50.50' REV. DATE B / TOTAL NUMBER OF CHAMBERS � APP'D. DESCRIPTION GARAGE \ TOTAL LEACHING AREA 615.1 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 4552 GAL./DAY Coarse Sand �. C-1 2.5Y 6/6 PREPARED FOR: (10% Gravel) CAPEWIDE ENTERPRISES 84 47.00' SWING-TIES j LOCATED AT C 2 Medium Sand 2.5Y 6/6 105 OLD STRAWBERRY HILL ROAD DESCRIPTION HC-1 HC-2 HC-3 (Loose) HYANNIS, MA 02601 F TANK INLET COVER (1) 22.0' 34.7' - `" ' •� �'�"• 144" 42 00' SCALE: 1 INCH = 10 FT, DATE: JUNE 26, 2018 TANK OUTLET COVER (2) 26.T 28.9' - R"': LL M1 ) 0 5 10 20 40 FEET No Mottling, Standing or Weeping Observed K of CORNER OF STONE 3 - 26.9' 32.6' / O .° RESERVED FOR BOARD OF HEALTH USE o� ¢° L ti� PREPARED BY: CORNER OF STONE (4) - 39.2' 43.T ` CHP CHILLJR. JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY CORNER OF STONE (5) - 45.6' 65.4' = 1 S EAST WAREHAM, MA 02538 CORNER OF STONE (6) - 35,5' 58.5' SITE PLAN - 508.273.0377 SCALE: 1"= 10' Drawn By: SJI Designed By:SJI Checked By: MCP JOB No. 4240