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HomeMy WebLinkAbout0321 OLD STRAWBERRY HILL ROAD - Health _ -awberry Hill Rd Hyannis ,t A= -- . A:r — /9 3 1 a e { Commonwealth of Massachusetts /93 Tine 5 Official Inspection Form Subsurface Sewa19,Dissposal System Form-Not for Voluntary Assessments Pro�rh►Address ' R►�• F—VeLYN <r-6�= ��marm is Our®r's Name required trevwy - k-f O4NN LS ✓ �`4 6�l00 pegs. uny/Town state ZipCode 9- Za2Z� Date of Inspection Inspection mutts must be submitted on this form.Inspection forms may not be altered in any Bray.Please see completeness checklist at the and of the form. baPartwit �" A. inspector information 61*-we a*the ftb key to move your Name of itumor- r>s�ctor dUSO the o m P-- A- 012 J C \f key. Company Name -FZ�) Company Address City/Town StaZa Ep Code Telephone tVumtr License Number 8. Certification I certify that:I am a DEP approved system hmgx ctar in full compliance with Sectlon'1S.340 of Tithe 5(510 GMR t5.000); t 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 dial systems.After wing this inspection 1 have determined that the system: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Heeds Further Evaluation by the Local Approving Authority 4. ❑ Faits J- 26 2d 1nqDeCtDeG S" Dafie The system inspector shall submit a copy of this inspection report to the Approving Authority(Board Of Wealth or DEP)within 30 days of completing this inspection. if the system has a design flow of 10e000 913d Or 9r"ter,the Inspector and the system owner shalt submit time report to the appropriate regional Office of the DEP.The original torn should be sent to the system owner and copies sent to the buyer.if applicable,and the approving authority. Please nc fe:This report only describas 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 dim cordons of use. e�peac•rev.�rtsrzo�e rme 5 o Far:&ftWfaos bhp W Syg"•Page 1 of is • Commonwealth of Massachusetts Tide 5 Official inspection Form Subsurface ftw W""M System Fovm-Not for Voluntary Assessments oww Ownees Name bftmmAon is every IKUW for C fT(Ywn State Zip Code Date of Inspection Pow C. Inspection Summary Inspection Summary.Complete 1, 2,3,or 5 and all of 4 and 6. 1) System Passes: I have not found any Information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Li6n�i Y-P 7 �T.¢n✓L t1+lc �'tt w C�Ydct' c ' ` 4-.-4-u\r or�� 2) System Conditionally Passes: NIA ❑ On or more system components as described in the"Conditional Pass"section need to be repl or repaired.The system,upon completion of the replacement or repair,as approved by the of Health,will pass. Check the box fo "yes",°no"or snot determined"(Y,N.ND)for the following statements. If"not determined plea explain. The septic tank is meta nd over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substan. infiltration or exilltration or tank failure is imminent.System will pass ir;pection if the existing tan replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspe ' n If it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is than 20 years old is available. ❑ Y ❑ N ❑ ND(Expia• elow). 1 tloc•rev.711BlZOtB Title 6 O&W tnepediar Form;Suter Sege D Systern•Pepe 2 of 18 Coinrnonw"M 0 ftssachtmfts lipTide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �2( av c-,� vz-fir tL'�'9 Property Address Gt.t r'*--0a9 owm Owner's Name bdWrrIetionis14iJntt S �q 07,Gp 1 �.-9-28 mpAred for every MID. cityrrown State Zip Code Date of Inspecdon C. inspection Summary (cont.) N/42) System Conditionally Passes(cunt:): ❑ Pump Ctamber pumpsialarms not operational.System will pass with Board of Health approval if pumpst' are mired. ❑ Observation of se age backup or break out or high static water level in the distribution box due to broken or obstru d pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if( approval of Board of Health): 0 broken pipe(s)are placed ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is re ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled laced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year ue to broken or obstructed pipe(s).The system will pass inspection I(with approval of the Board Health): ❑ broken pipe(s)are replaced ❑ Y ❑ ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N (Explain below): / 3) evaluation Is Required by the Board of Health: Q Conditions e�xt's�Ai h' uire further evaluation by the Board of Health in order to determine if the system is fading to ealth,safety or the environment, E a System will pass unless Board of Heald► In accordance with 310 CZAR 15.303(1Kb)that the system is not functioning In a manner will protect public health, safety and the enviironmerot: fS�1�t•rev.fl28/2818 TWe 8 Of W hmpeeftn Porn:Suftwkm Sewage Disposal System•Pegs 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subswfaoe D Syst M Form Not for Voluntary Assassmerfs Properly Address owrw owner's Name elation Is for evay I L\A!ojt 5 mqtdmd sryr (-ly ° p24a l - 2a page ft-y mown State Zip Code Dale of Inspection C. Inspection Summary (cont.) CAlA ❑ Cesspool or sp privy is within 50 feet of a surface water ❑ pool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh k System I fall unless the Board of Health(and Public Water Supplier,N any) eteenrdnes the sysbm is haw loning in a manner that protects the ptWC heal t, sl My and ❑ The system h a septic tank and sal absorption system (SAS)and the SAS is within M feet of a s water supply or tributary to a surface water supply. ❑ The system has septic tank and SAS and the SAS is within a Zone 1 of a public water, suppty. ❑ The System has a tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water welt". Method used to determine . *'This system passes if the well water alysis,performed at a DEP certified laboratory,for fecal collform bacteria indicates absent and the resence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no oth lure 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 mast 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 domed SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool •t9v.7l2812D]B Tft 5 OftW hmpecftn Fam:&fturbw Smap Dlspesal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for vduntary Assessments Properly Address a-c) owner Owner's Name won pt„S�cLs l�LG+s i -�r —Zy for every CWTown state Tip Code Date of Inspecdon PAW 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 or dogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is fens than%day flow ❑ Required pumping more than 4 times in the last year NOT due to dogged or obstructed piipe(s).Number of times pumped: ❑ Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ylk Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ dl Any pin of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ( ] �lq- 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 N the well water analysis,performed at a DEP cerffwd wry,for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is a"al to or less than 5 ppm, provided that no otherfallur+e+criteria are triggered.A Copt of the analysis and chain of custody must be attached to his foam.) ® WA, The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system Wk.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system falls.The system owner should contact the Board of ftealtlr to determine what wife be necessary to correct the failurfe. 5) Large Systemrs: To be considered a large system the system must serve a facility with a dasl ow of 10,000 gpd to 15,000 gpd. For large sys a must indicate either"yes"or"re to each of the following, in addition to the questions in Section C. . Yes No ❑ ❑ the system is within 400 f a surface drinking water supply ❑ the system is within 200 feet of a Crib to a surface drinking water supply ❑ ❑ the system is loci in a nitrogen sensitive . Wellhead Protection Area—IWPA)or a mapped Zone If of a public water ply well doe-�.7/ZSIZ018 Me 5 0 Fmm she smw Dispose}system•Pap s of is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52.I Oro �rtp,,)_gt5n� 4�i�L �t7 ftp"Address oWW Ot"efs Name IV kftffm on is ft**ed for every Re— (9p i q- 7,D per, mityrrom State Zip Code Date of trt pection C. inspection Summary (cost.) 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 aft hmpecttons: Yes No ❑ Pumping information was provided by the 6w�octt,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 wafter been introduced to the system recently or as part of v47o this inspection? ❑ PlansWere as bUft Of the System obtained and examined?(if they were root available note ❑ 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? 1 ❑ 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 subsume sewage disposal systems? The size and location of the 8*R AbsItt im AS)on the site has been determined based onAlL.,— A-9 be gfh 6w,w5 ❑ 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)) •rer.7 18 Trite 8 0MQW f"eWtm Farts SuWwteoe 8ewege Disposal Syetam•Pege 8 of 18 Commonwealth of Massachusetts Tine 5 Official inspection Form Subsurface Sewage Dispose System Form-Not for Voluntary Assessments Pmperty address Oamer Owners Nam Nbrmallon is mp*ed for every -- nlVdls �j`�/ o2 9_2ro POW Cttyrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): 1177 �n DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): loC�I'a 1l4 al `12 Iwa, r —7,7a� 5¢9���� �al�/o9ardserad Number of current residents: Z Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ yes j No- If yes,discharges to: K/A Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes 1] No Laundry system inspected? ❑ Yes Eg No tiffX Seasonal use? Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: �9�7cnv � ds.p Sump pump? ❑ YesR No 2aI,o Last date of occupancy: Date •tev T 48 Tie 5 oil b on FUM aftas a serge Dwpww s n•pap?ai is Commonwealth of Massachusetts Title 5 Off!dial Inspection Form Submuface Sewage fNsposdi ftsl em Form-Not for Voluntary Assessments PmWty Addr owner owners Name odbmationis j �i5 Ale 9�2D pa every for Ctty/Town State Zip Code Date or rnspectton D. System Inkmmatfon (cent.) 1114-2. Comme al/industrial Flow Condldons: Type of Estab meet Design flow(based on 10 CMR 15.203): Gauorm per day(gpd) Basis of design flow(seats/ ons/sq ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? 0 Yes ❑ No tf yes,discharges to: 11ndusbiat waste holding tank present?. ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: East 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: ly� How was quantity pumped determined? � s G Reason fox pumping: dec•re+r 7116120,8 Title 6 ORUW ft"eWw Fb=S'ubsudam SwAW Okp*W sysam•ftV 8 or is COmMOnwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage D ispasai System iconn-Not for Voluntary Ast�rssmenta Property Address V-0 fL-V fWr Owner's Name p hdwmtoon is MgWred far every PW city/Tom state. 2tp Code oat0e of Inspection D. System information (coat.) 4. Type of System: Septic tank, distribution box, $oil absorption system Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records,#any) ❑ Innovative/Aftemative 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): xima age 9f all componen ,dat installed k wn)and finf Z,e: zo 1.5Tn< Were sewage odors detected when arriving at the site? ❑ Yes No S. Building Sewer(locate on site plan). r Depth below grade: test Material of construction: ❑cast iron L40PVC ❑other(explain). Distance from privat supply well or suction line: feet Comments(on con jolnts ;n a ce leaka e, etc.): 8oe•rem 7IZ8!ZOfB Tf09 5 Ot[dai lnepeaton Form SubmAm Sewage 0lspamal SYst9m•page 9 of 18 Commonwealth of Massachusetts Tine 5 Official Inspection Form St"u face Sewage Disposal System Farm•Alot for Voluntary Assessments Property Addrew -�L iFFbK9 owner owners Name Q hftm nisPNP*Wft every City/Town State Zip Code Dabs of inspecWn D. System Information (Cont.) 6. Septic Tanis(locate on site plan): Depth below grade: feet Material of construction: concrete D metal ❑fiberglass 0 polyethylene ❑other(e)plain} If tank is metal,list age: yeas Is age confirmed by a Certificate of Compliance?(attach a copy of certficate) ❑ Yes ❑ No Dimensions: l��� d l �i(/ '�/�KI ,�CS^� �— Sludge depth: Distance from top of sludge to bottom of outlet tee 2 41 Scum thickness 4-'f Distance from top of scum to top of outlet tee or baffle faQ Distance from bottom of scum to bottom of outlet tee or baffle How:YZ sions determi ? / �a tmPg�rco m inlet ank tee or baffle tructu #ntegnty, re a ta.# ou ir►v �of leakage, tc.}: shop m•rw.MAWS Title 5 OM"kwedw Fomt Subs &w SmW Disposd Sydem•Fags 10 d 18 Commonwealth of Massachusetts Tide 5 Official Inspection .Form Subsurface gage Disposal System Form-Not for Voluntary Assessments C301 .�')6r7 4�24AAO //4 Property Address Owner Owner's Name rrPomration is /1j/At*VA1(S Ar DZw 9 9- ZD required for every f c{{y/'rown State -Hp Code Date of irrspeo4ion D. System Information (cont.) Grease Trap(locate on site plan): ff Depth be w grade: Material of struction: concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of s\rercommandations, let tee or baffle Distance from bottomof outlet tee or baffle Date of last pumping: Date Comments(on pumpior>s,in t and outlet tee or baffle condition,structural integrity, liquid levels as relateevidence leakage,etc.): S. Tight Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth bel rade: Material of consttu []concrete ❑ m ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacitr. gaitons Design Flow: gagons per day shvAoc•rev.TOMB Title 5 OMW Ir*Wdm FcMt¢Sine 9eWage PWP=W SYetem•Page 11 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form &"Urface searage ftsbsm ftm-Not for Vduft"Assessments �zt 51W property Addroess ChWW Owner's Name i1tofrnationis 1+-/A i�n1lS �1 21b NTAW for every Ctty/Town State Zip Code Date of inspection POW D. System Information (coat.) i VIA 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm Wet: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Dam Comments(condition of ala and float switches,etc.): •Attach copy of current pumping contract(required).is copy attached? ❑ Yes ❑ No 9. DisWbution'Box(if present must be opened)(locate on site plan:). Depth of liquid level above outlet invert �mments�ff x is level and d.=on to ouii teequ any eviddnee of solids carryover any evir#,ence of leakage or out of box,etc.): Alv ��� ��� ll� �� ZZ�� � ����Nl�►/-e!/ d61 �Ge/(`�.e* (may' 'L � Spdoe•teN.Tt28rl01a '[tee5of wmvec&nRMSafesf s""—POP 12of19 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal Sysfm Form-Not for voluntary Assessments Property Address C— C--o(2 Owner owners Name Wbimationis H jIrequIred for every Cfty/fiown State Zip Code Date of Inspection Pam• D. system information (cont) iy 10. Pump Chamber(locate on site plan): Pumps in w ' g order. © Yes j] No' Alarms in worki order. Q Yes ❑ No* Comments(note con tion of pump chamber, condition of pumps and appurtenances,etc.): H pumps or alarms are riot in working order,system is a conditional pass. i 11. Sol!Absorption System(SAS){locate on site plan,excavation not required): O'SAS rt located,explain why: Type: leaching pits number: Iz ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number,length: ❑ leaching fields number.dimensions: ❑ ovefflow cesspool number. ❑ innovativelaltemative system Typetname of technology. •1W.Timms Tice 5 OMdal Mspecdon Forrm Subsurface Sn"o olep"Syftm•Pas 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form IF Subsurface,Sawaga D System Fom-Not for Voluntary Assessments 921 �)10 r Owner's Name kdannation Is as w every Pal9B- for eve CWTown see Zip Code Dabs of Inspeoftn D. System Information (cont.) 11. Soil Absorption System(SAS)(co t.} Comm (n of soli signs of i ri�y�ic failure ve 'Rf PC) ins, m o{ i� °O''��. 9/ay oL v—t-4 4 1 le Ine1w S 0 tt�' v�P f 4412. t'.ess (cesspool must be pumped as part of inspection)(locate on site plan): Number a d configuration Depth-top uid to inlet invert Depth of solids la Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of h ulic failure, level of ponding, condition of vegetation, eta): �tloc•►ev 7/8 8 120 1 8 Tf6e 5 Of@ W Pant&ftWfaw Sewage WqWW System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface SewW Dk pwW system Form-Nd for Voluntary Assessments Property Address (\ Oww owners Game Mbnnationis � state for a cnynown zip code Hate of hxPec"M D. System Information (colt.) 4114 13. P ocate on site plan): Materials of oo n: Dimensions i Depth of solids Comments(note condition of soil,signs of hyd faifure,level of ponding, condition of vegetation, •rev.7/26 to Trft 5 Oftal kapeodm far¢ U mp MVoW Stem•fte is of 78 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Fom-Not for Voluntary Assessments 321 G4 ��tyo�go-� Property Address 611:,-r-P4v OWAV owner's Name man Mv*W for every Cirytrown State Zip Code date of ins Psi pedion 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 bendxnarks.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 � l a (14 r rk-2ij'_ i •rev.7r16/2me Tie 8 Qum hem ft=&ftvowe am"M Syetem•Pege 16 of 18 C==nweaith of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Drat System Form s Not for Voluntary Assessments Property Address r Owner's!dame bdOnnation is 1� P"P. eve at( 1/�� y21�v 1 for ry Cttyrrown state Zip Code Date of Inspection Pam D. System In#ocmat on (cunt.) 15. Site Exam: [ Check Slope (� Surface water WA' [ ( Check c ebr (� Shallow welki l�,�rrJ te.� vccrzsSc� �►� �v"°�t�°��- Estimated depth to high ground water. eel 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 0 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: (� �xJ�a c (� I AS vVn C 4 X.. "J�j�i l� t✓�tSl� Before filing thle Inspection Report,please see Report Completeness Checklist on next page. ce a•rev.MAnws rift 5 0Mdd Wwwo n Fan a,wsrma s Mopose&pwm•Page 17 of 1s Commonweafth of Massachusefts Title 5 Official Inspection Form Subsurface Sewage We"sal%vbm Fwmr -No1 t for Vduntary Assessments 5,27 , Q.4 � 1�nNs iaCx� 1'S 1 c.c. 9 Prep"Address OWW Owner's Name bftffmftn is l-�AI W 1yWOWfor �-�- p 8my City/Town State Zip Code Date of inspetrion E. Report Completeness Checklist Complete all applicable sections of this fonm inclusive of: A. Inspector Information:Complete all fields in this section. B.Certification:Signed&Dated and 1,2,3.or 4 checked C. Inspection Summary. 1,2, 3,or 5 completed as appropfiate 4(Failure Criteria)and 6(Cheddist)completed D.System Information: For 8:TightlHolding 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 •rev.71 18 'title 6 0fftW i Fam&"MOM Sam DWOW SYMM•Page 18Of 18 MN Commonwealth of Massachusetts Title 5 Official inspection Form Subsurfatre Sewage DisPasal SY-StOm fom-W for voluntary Assessments 7WQo � Property nadress ����q_1 owners Name bftMWtkM iS rerttit (q�J iJ 1h W for every _� ! �( �9-zo page. City/Toam State ap Code Date of tnspecWn E. Report Completeness Checklist ComPISte A apPiic"sections of this form inclusive of.- A. Inspector Information:Complete all fields in this section. B. Certification:Signed&Dated and 1,2,3, or 4 checked C. Inspection Summary: ( 1,2,3,or 5 Completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ( 0.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 •rev.7 18 T*B OEM hen Font$Lt*wfece DfapoeBl SYetem•Peye 18 0!18 a •ror 7/Z@iZ018 Title 6 OfBdat trspecifm Pane Subsudace Sewage Disposal System•Pape 10 of 18 DLO C A „ 10 _ S E E PERMIT NO. VILLAGE hhi� INSTA LXER'S N A IM ADDRESS U I L DER OR OWNER _ Z DATE PERMIT IS UED 3� ® ATE COMPLIANCE ISSUED 2/V/ /� .�. - ., � �� w N f W o � " 1 � � , .� �� � � � �' �� � :+ ~ � � � -'�:- �� y �" "� � �" � n f. '� r ' � ail �� . �.�- ... �'� ` `` '`� �� ���� I THE COMAONWEALTHOF�ASS^CHUSETTS BOARD � �- ® ® OF HEALTH ................Town...............OF.........Barnstable-----•----------- Appliration for Uhip al Viirk,5 Tonarurtion ramit Application is hereby made for a Permit to Construct ()Q or Repair ( ) an Individual Sewage Disposal System ...L 7i Old Strawberry Hi11 Rd;LHyannis,...MA---------------- - ..... ......... .. ............ Location-Address or Lot No. _Capricorn Realty„Trust „_„ 6 _,Falmouth_, gad,___H3rann s•_________________ Owner Address Steve--•-I-ae al------------------------------•--------........................ ...-•------•••••-•-.......-••---•----•---.._...---•-••--...---------......_........--•--.......... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms----3............... _.__.Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building RaTI—Oh_______________ No. of persons.......................----- Showers (2 ) — Cafeteria ( ) Q' Other fixtures ------------------------•------• -. W Design Flow..............55.........._._._.._.....gallons per person per day. Total daily flow___..._.......3............................................gallons. WSeptic Tank—Liquid capacity.!q?o...gallons Length_7(R-_--_- Width..4 °!o--- Diameter................ Depth.._r�a x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter ..._.�_.__-_-__ Depth below inlet.....__.�f�..._... Total leaching area... .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - '-' Percolation Test Results Performed by_Eldre-Cog -- 1�gi ear;Ln.g______________ Date__........'_�5:g1 . Test Pit No. ...minutes per inch Depth of Test Pit-------l It___._. Depth to ground water.Noun��,couN i R +d Test Pit No. 2....WA-.....minutes per inch Depth of Test Pit-----H/R_....... Depth to ground a a � water_ __*,�A•-_--____ •-••--------------•---------------•---•--•---•--•-•--•-•----....---••-••-•-----...........--.------......................................................... O Description of Soil , 2...........L - •----------------------------------------------- 3 _�.�. U2'- O' itACDlvnA Nc-l_._LOW � _..._... W !v '!L"� M 0__wri_? M D/TV A eF C�RIe�/L=(� / Nip ,v im j 2l /•--•--------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I'::L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian has en issued by the boar, of health. Signed --------•............... • ------- ........... ------ ••.3/-/83----------- / Date Application Approved By.. �- / B, -----------•--•-•- Date Application Disapproved for the following reasons:.............................................................................................................. --••--......----•---•-•----•--------------------------------•--------------------._...-----•--•._..._---- ------------------ Date PermitNo......................................................... Issued....................................................... Date i No..... .,. .�• FE$..... ••.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH :.arnp.table Appliratiun for Uispu,ial Works Tomitrurtiun famit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: Lot# 71 - Old Strawberry Hill Rd. ........................ •.--....------------.----• ••••••........ .................-••••. -...._.......... ...........- _ Location-Address r� or Lot No. - J^ )__'?COL .+t:ryl'v r "�i9'4 ( ��} ^_171C)U 2 iOGtIS: trp_+7i""1' S ......................»........._.......__.............._..___•____.........._.._..............._ .....:............................._..........._............_..................................... :'ACV Owner Address' W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....:3.................. ..__.Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of BuildingR!?!!�!? p ( ) ( ) No. of persons............................ Showers Cafeteria P4 Other fixtures -------------------------------- - W Design Flow..............5.5........................ per person per day. Total daily flow............... 11 WSeptic Tank—Liquid capacity-!4O°...gallons Length_:�_�e..-.• Width..4. _'a_.. Diameter................ Depth..'�.`�: x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........)........... Diameter....... Depth below inlet........................... Total leaching area...2 '.....sq. ft. Z Other Distribution box ( ) Dosing tank (, ) Percolation Test Results Performed b .................................C...fi. :'... .......... Date....... .............. aTest Pit No. 1 _2. Q...minutes per inch Depth of Test Pit______ Depth to ground Test Pit No. 2....Nk......minutes per inch Depth of Test Pit...... !t!........ Depth to ground water.......'!_i.A......... W ...---•---•••••-----------•••••••..............................•------•-------••--•••••......•••••......................................................... D Description of Soil--------------- = L c^m_��r_.)P , L_ . ••----------------•-------------------••--•-•----•---------•-••••••••••-•---••.._...••---- 1 co aI PuA N E L.L_C?W =^.., ..............•^.............•---•._..-------._' ...------ 1 ....... ----- ---.._..--•--••-----------------•__._........._.........-----------•-------•--------------'--•--•---.....--•------•---•----•---------'- C=,�ftid�4..- / IJz, WAS"f C 12. ................................................. ..- .2' An.. u- ..I 1 f£. .h._,i..r 1......r_.`.. t F I U Nature of Repairs or Alterations—Answer when applicable................:............................................................................... -•----------------------------------------------------•----•-------------------•---•-•...-••---••-•-•-•-•••••-•----•------••......•------•-•-------•-••-••••--••••••••••--••••••••.......---•--.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.....................................................................Pres. 3�1�83... _.. Date Application Approved BY = .*. .... -?,�j�?.._..-•----••-- Date Application Disapproved for the following reasons:............................................................................................................... --------------•-----•---.....----------------------------------•---------•---------------.............................••-•----•---••------•----•-----•--••••-•-••-•••--•---•--•----•--•-••----...._..._ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................I.......................O F..................................................................................... Tnr#ifiratr of Tomplitnrr THIS-IS�TO CERTIIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .. . by--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- at Lot # 71 — Old Strawberry Hills' d-._, Hyannis., Mass. --------- -- -• •• ..• -••.•• ..........•------•••••-• ..... _----•------ - .... has been installed in accordance with the provisions of TITLE: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------IR-,3.1. ► 1............... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM bdl UNCTION SATISFACTORY. DATE...t� l'---....•-----------------------••------......--------------- Inspector.... •. ----------------------------...--•-------------------....--------........ THE COMMONWEALTH OF MASSACHUSETTS d BOARD OF HEALTH OF..................................................................................... ' No...... Xff—�� FEE........ ............ Disposal� ork�111l�uns#r ion amit Permission is hereby granted........................................................................................................................................ »._.. to ConstrLuott( #) or Repair ( } an Individual Sewa�e Disposal System at No.•---•---••-•--•••-••-71......-•� ......-ld S-.trawber... ...._.l...Rd•......Hyannis_,_..Ma • Street• as shown on the app;intign for Disposal Works Construction Permit No------------ -•------ Dated....................................... i - Board of Health DATE........... .......................................................... FORM 1255 HOSES & WARREN. INC.. PUBLISHERS- . � t 7'l L o—r 72 Lor 70 L-or 6$ q (V O\' \0 ` Lar 7/ Pe'P" . � �g3 C. too"r P.e=zl 1000•GAL S27f1G iAw.N N TE"5T 14-o (ZkNc�1 f� _J cl FWD EL z 103.-7 a 4's _T OF qM Q W 1 , I'll 41 S ti 4. IW ' su 1 BM EL- roo PLTN OF M — — — J \ —I _ �_ - — u " gAcarN rs1eJ � cA2e-1 q PHI �r=t1�E of PA.iffmo -r,.;. STR A W aER )/ MLL Roy® p• No. 366 O EGEND EXISTING SPOT ELEVATION OAO CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 ---FINISHED SPOT ELEVATION - Lo-r 7/ .MINSERPu) , ILL ROAR HYAN,vf s FINISHED CONTOUR . 0 IN APPROVED , BOARD OF HEALTH DATE AGENT SCALE, 1" = 30 DATE JAN 19 '83 LDREDGE ENGINEERING CO. IN CLIENT FRANGO• I . CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0:8� BUILDING SHOWN ON THIS PLAN CIVIL LAND` CONFORMS TO THE ZONING LAWS . ENGINEER SURVEYOR DR* BY OF BARNSTAB E ASS. 712 MAIN STREET CH. 9Y= . .� Q. _ HYANNIS MASS, r of es ' SHEET °,OF `Z - DATE : (AEG. LAND SURVEYOR 2a.FT. . MIN.' -'� � /YOT� /F EiTi•/�•4 N� S r�T/�' A V `C �•i ` _E.4Ci///V r PIT ARE /`90RC TN.q, /2"sELOYV �,QAOE� f� 24 �O/A•til ETE�' Ca.�YCR�T CCVER BE BROV6l4T TO GRAOE. GONCRs<rB ' �r_:�O-vc. Plf�C� PlTCN 'A FT/ 4�CAS T �. ��- •: `IRON PJPE OOO.. • o o T �� �/9 MJN:PlrcN G.4L 11 • . I • . r • DlST, SiiPD ST:.ti'E i SEPTIC`` TA , 1 • r r , aaxrl i� � i > � • INFECT/VE .� , •� � 4 .- � 2 E:: i r _ • • r 1 • DEPTH • • • • v � I N4 Sh+EJ S TJ N E • a. • 1 • M • • � 0 / . • D �o GE } lNfiP�t�'.eLEiiATIONS �8.5 x i.a �8 6/ DL 93.E PERT,AT ffV/LD/NCs (� 1 E 1 a FT. 044m C�SE TR,9UL.4Ti'ON, INL ET::SEPT/G'; T.4NX O:S FT P,r.cA�Irf OUTLET SEPTIC 7ANK INLET D,/STR/8l/TJOV 80X I OO. I FT. GROUND 1�ATER TitBLE ' SECT/ON O F DUTLETD/,STR/B[JTION.BOX_�9 S'E,wAGE O/S/�OSA L SYSTEM : . INLET LEACH/NG f��T ag •� FT Y� LEACH///VG P/T TABlJLAT i /•_ O" DIMENS/ON AI FT. DESIGN CRITERIA - SCAL_E- NUMBER OF BEDROOMS ®!HENS/ON C 4 F r(AA I �► GARBAGE DISPOSAL !Jw/r I,tol_lC SO/L. LOG SD/.� TEST T�7TAL.E3T/I►'f�t'rEta FLOH/ 33o GAL.IDAY S0/L TEST A I SO/L TEST,*2 i1lUMBER,OF Le4CNl/VG PITS_ ! ^ELEK 101.1 �~E-1-OrV, PATE OF' SOIL TEST cal •IL • 83 S/1�F LEACH/NG PER P/T ��SQ, RT.. LaArn RESULTS *V)TNESSED BY -� �-)Ac:::3f 3oTTOM LFr4CH/NG PER P!T 7a S4• F71 a-2' �,-oPSe+c_ �cRCOt.�Tiont .e.15TE ;Sf/: � M/ni,/lNcti TOTAL LEACHING AREA 2(�o SQ. FT. F�RC0LAT/ON RATE�2 � MIN;/INCH �r5ERVELEA.CNIN6AREA �� SQ. FT. MED col ras-r- ,S" P tN Of �POIR OF 4f T. 1't LOT -7 - CSLD -I PAW��� C-- t PHILIP N WEINBERGCA I �/ No. 366 DREDGE E/VG/N,EER/NG CO,I NC. 24 �o EL 7/2 MA//Y'ST , HYaa/�vis, I�l4SS. qL ' [lND GROUN[7 ,V,4TER fNC0UNTER.50 CL AS"T: >�N� DATE � cDl �1.8• S 3 / Q. GROUNC YVATER AT EL��! _ �J JOB NO, 83 SHEET�OF 'L