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Home My WebLink About0034 OLD TOWN ROAD - Health r.. - .�^. . ..ter ell "34 Old Town R6ad Hyannis A= 267-154 , r � 1 • i 1� r TOWN OF BARNSTABLE p� S . LOCATION a �-c�U�-N'" '�` '►/ SEWAGE # "s2-9 `PLLAGE ' V`f yd4a— ASSES R'S MAP & LOT l S INSTALLER'S NAME&PHONE ;SEPTIC TANK CAPACITY BLEACHING FACILITY: (type) `�!�'a�C� C�,R,w,, 5 (size) ld��f O i' NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: .? d COMPLIANCE DATE: P 3 D3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by. A J C O� 1 No. � ) Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF QARNSTABLE, MASSACHUSETTS Yes 9ppliCation for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair( ) UpgradeV, ) Abandon( ) ❑Complete System Q5(Individual Components Location Address or Lot No. 3 L( 0 L 4 Tow o% 2a 4qd Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 to'1 — Ek exwv% S z',:w`e-5 -3 Lo L ck T L-k l n ➢ Installer's Name,Address,and Tel.No. 30, W j w<L. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size l l Doe sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2j C) gpd Design flow provided 3 42 . 19 gpd Plan Date — 1 'LAZ"Z Number of sheets 7-- Revision Date n�(} Title 3 - CO(,4 -V-0 WV, Size of Septic Tank 10ov Type of S.A.S.�2� Tew L.o Soo t L• C . Description of Soil T Nature of Repairs or Alterations(Answer when ap licablef _ 1�P.�9 �� — 13- ,tw�� - T'lr9c�(2� 1_ -?.b �o �J�c. l,Q �A b- SM� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He 'j Signed Date `► Application Approved by Date Application Disapproved by 1 Date for the following reasons Permit No. 0 )-0 '—t Date Issued ;t-d - ,,, .•>,....r•�..'' .,d"...�'aT....,. ,_. • aa+a`. --•�• l,',°. r .... +�'. 71,..r, t.. r.4.,- i .- ....- ., .., .:F- - ^.%«.. �. Fp =TM No. Fee THE COMMONWEALTOOF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN`OF BARNSTABLE, MASSACHUSETTS ftplitation for Bisposal *pstettt Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System S©jndividual Components Location Address or Lot No. *3 L( 6 L cA T*j Owner's Name,Address,and Tel.No. 1 7 s� �!� P c'S�M ��✓a+' e S -3` � � �-� Assessor's Map/Parcel 4 4-1 Installer's Name,Address,and Tel.No. 3u3 Wtq,Ve) 6 \L, Designer's Name,Address,and Tel.No. ^y ��ln t 1�7• 0.�( C0 .t',Vvc S wM �C1✓r r..`1" �� "1 _ fix ��t-t 1 �� i � 53 I J Type of Building: Dwelling No.of Bedrooms Lot Size i b°o " ,'F sq.ft. Garbage Grinder( ) Other Type of Building 90 vi No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j ci gpd Design flow provided —3 4 2 . f- gpd Plan Date (4 1 ?j — LQ? C Number of sheets 2-- Revision Date A y4 Title 3 q Q(,,A Tc•,,� Size of Septic Tank 1000 Type of S.A.S. %4,y u t `�i? y '► t tom• Description of Soil 0 rY %'cam 7u Nature of Repairs or o"r`Alterations(Answer when applicable �1�P.r.J .A 2 a� '1' - lam• T��t ``► 's L C+ iJJ ly,�hZ c• - � r A Date last inspected: Al A Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health, Signed _ Date Application Approved by („✓%c.� - r C t`( " E y Date Application Disapproved by G ( Date for the following reasons Permit No. 0)C),," Date Issued l i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) ` Upgraded.(644) Abandoned( )by {,y O k-w.r- Z• O 0, (4 • jmx,- at Ul~ii T;,,,,,.rn. m yiJ W has been constructed in accordance ) with the provisions of Title 5 and the for Disposal System Construction Permit No.2-090- ((Fdated ~' Installer 1) n tC� Fl. U.,Jf 0, .tat_ Designer Cfj<1-<A, n V(,Ll-t #bedrooms 3 Approved design flow _ gpd The issuance of this/permit shall /g�of be construed as a guarantee that the system will nction as`designed. Date P7 / d► 3/ Inspector \"-.� ------ ------ - ---- _ __ --- No. �. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit _ Permission is hereby granted to Construct( ) Repair( ) Upgrade O Abandon( ) System located at 3 Li 6 U 7r> aA 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:Construction must be completed within three years of the date of this permit. !� Li- CJ - Date: t Approved by � 1 Town of Barnstable nL IMEOF tp� yQti Regulatory Services BARNStABIE, = Richard V.Scal.i.,Interim Director tN MASS. , Public)Health Division d0 39� �0 pTED `Y� Thomas McKean,Director r 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fat: 508-790-6304 Bate: +f 2q f / Installer& Designer Certification Form Sewage Permit# to '2-o - I `� Assessor's Map\Parcel Z6-7—r-S-11 ��ec '1CC'k+e-e r Designer: c ;,n eQ�; t�cttic s vi1C Installer: '14'ab:'4 Address: 2 L11r s f c� Andress: 3&3, h t 4e.-s �Vet(Wl On Y-23-2-v2o ��1��!t3y- vt�o 1 was issued a permit to install a (date} (installer) r septic system at :34 61 T(-3c P^ r2_4 k y qy h 1 S based on a design drawn by (address) �q i ;Aq 1'7 No✓Z(s p fk( dated "i"913�?_® f (designer) � 1 certi fy that the septic system referenced above was installed substantially according to the design, 'Ai..ch.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 stem septic but p sy ) in accordance with State &Local Regulations. Plan 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 in .I with the tenns of the AA approval letters (if applicable) �fA pdtaEl�TE. (I ller's sianat e) 0O,35ioq gEQiS.S�¢ (Designer's Sigmathrre) (Affix Desig11 ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiYIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD.ARE RECEIVED BY THE BARNSTABLE PUBLIC I�EALTII IIIV)fSION. THANK YOU: Q:',Septic"Desi?ner Certification Form Rev 8-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill_The engineer did not.supervise construction of the system.The installer assumes.responsibility for all materials,workmanship,:backfilling to specified grades with proper compaction and setting riserslcovers as shown on the design plan_ /4# 1- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades der Owners Name Inforrequ mation is requ Hyannis MA 02601 SW2013 ired for every pop- lly/Crown yG; T,p Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Importurinling am forms " A. General Information filling outiortns on the computer, useonlythetab 1. Inspector key to move your curw-do not Winston A.Steadman II' use the ream Name of Inspector Y• All Cape Environmental Ina company Name P.O.Box 235 Company Address Yarmoutb Port MA 02675 Oityi i own State zip Code (508)776-6219 S113045 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information repotted below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Digitally signed byWinston A Steadman II DN:cn-Winston A.Steadman I Date:2013M280724 DS.-04'00 5/28/2013 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority.(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 1�-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. tStru•3M3 TSlos of 3l 1MP=jW Foam:$VzL m S&-z"DIs MI$Atw•ft"t.of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 34 Old Town Road Propetty Address Maria Eftimiades Owner Ownefs Name rtfamtquin:d fo required e isvery Hyannis MA 02601 5/2312013 re page. C1y/Tawn State Zip Code Date of[nspewan B. Certification (cont) Inspection Summary:Check A,S,C,D or E/always complete all of Section D A) System Passes: ® [have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the'Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes°,"no"or"not determined"(Y,N,ND)for the following state rents.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 ifthe existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection IIf it Is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Q Y ❑ N. Q ND(Explain below): . .. Life•3l'ri - Thte SOKedol InspeCSOn Form:S�atace Senpo Disposal Sy90m•Pa8e4er17 1 Commonwealth of Nlassachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Properly Address Maria Eftimiades Owner Owners game inforrnafionis required to every Hyannis MA 02601 6/23/2013 required page. Cityfrown State ZIP Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes(oont): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to.broken or obstructed pipe(s)or due to a broken,settled or uneven dstribution 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 tSlim•8PI8 TMo50Petl811ropeCkn.FOan:SUewr;aoo5owa{N dbPosel Systam-Pepe9ortt Commonwealth of Massachusetts Title 5 Official Inspection Form 5 Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments. 34 Old Town Road Property Address Maria Eftimiades Owner Owners Name information is Hyannis MA 02601 5/23/2013 requiredforevery -- page. CWrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier;if any) determines that the system is functioning in a mannerthat protects the public health, safety and environment: Q The system has a septic tank and soli 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 l00 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. S. Other. D) .System Failure criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the.ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ' 73 fib 5 Omehi Iro,7oeu'en Fenn:Subswlaeb SOWOPDiSPMI SySM.Page4 er 77 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road ProperW Address Maria Eftimiades Owner Oxnefs Name information is Hyannis required for every MA 02601 5/23/2013 page- CrVTown to Zip Code Gate 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:0. ❑ ® 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- 101000gpd. ❑ ® The system faits.I have determined that one or more of the above failure criteria east 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 efther"yes"or"no°to each of the following,in addition to the . questions in Section D. Yes No r ❑ ❑ the system is within 400 feet of a surface drinkng 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 I I of a public water supply well tf 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. t9re-and TMb 5 tMiolel lisspoebn rarm:5lmsurraea aoaage Dir;�OSsI srsism-daps s d t7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades OWW Ownefs Name information is Hyannis MA 02601 6/23/2013 p gededforevery Crtyrf page. 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 imthe 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 WA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® Q 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 sae 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): 3 DESIGN flow based on 310 CMR 16.203(for example:110 gpd x#of bedrooms): 440 64m•3M� - - T*5MivllnspeOMFar:swovitaae Sawape DISPoSOt Syeam•Ppp06 d 17 _ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades owner Owners Name �ffon.eon is required for every Hyannis MA 02601 51=013 page Cit crown State Zip Code Date of Inspection D.System Information Description: Number of current residents: 5 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? Z.Yes E No Seasonal use? ❑ Yes ® No Water meter readings,if available(Iasi 2 yearn usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied CommermaUlndustrial Flow Conditions: 'type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.t,eta): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-san'dary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t51M1f•&78 ritlo 5 O ficol Invedvn FaM:SWbsudaW sowege 04=1*MM•Page 7 or17. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Owner's Name rrt fo s equ d Hyannis MA 02601 W312013 page. forevery grown State Zip Code Date of Inspection D.System Information (cunt;) Last date of occupancy/use: Date Other(describe below) ' General Information Pumping Records: Source of information: Was system pumped as part of the inspection? Q Yes Q No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septc tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool - ❑. Privy. A ❑ Shared system(yes or no)(if yes,attach previous inspection records;if any) ❑ Innovative/Alternative technology.Attach a copy ofthe 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): SSau•aH3 'trot$0MCWL rnspeeft Fom:SWW.1ftae$ewage 0190 11 Symm•Pape a a 1! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-NotforVoluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Owners Name information is Hyannis MA 02601 5/23/2013 re0uired for every page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information:. New Leaching installed 2003 Weresewage odors detected when arriving at the site? 0.Yes R No Building Sewer.(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑cast.iron ®40 PVC ❑other(e)plain): Distance from private water supply well or suction line: >50' feet Comments(on condition of joints,venting,evidence of leakage,eto.): Pipe Joints appear to be tight Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete I]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 I] No: Dimensions: 5'x 9'(1,000 gallon) Sludge depth: 18„ cuss•ana TWO 5 OftW I V=10n ft":bt+OVID A SMW DiSOWI&.stem•Pape 9 of IF Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Ownees Name information for every Hyannis MA 02601 5123/2013 Me. c4rr— State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle NIA Distance from bottom of scum to bottom of outlet tee or baffle NIA How were dimensions determined? Measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): During inspection the outlet tee was found not to be installed.The Tee was instaled as part of this inspection.There are no signs of leaking and liquid level was at invert out.It.is recommended that stem be pumped out 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 Sm'ah8- TWO 5 Oftal ttpoom Fam;560wirm s*wW Dbpxal Syswn.psp jO MIT Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road PMertY Address Marta Eftimiades Owner owners Name rM n is Hyannis MA 02601 :S12312013 ev requiredaired for ery page. Cityfrown Stain Zip Code Da*oflnspection D.System Information (cunt) 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 I Wien-3M3 - - TMG 5OMGW Impeow Form:Wbwrface Sawepo o4pofal Symm•pop 11 e117. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 34 Old Town Road ProperyAddress Maria Eftirniades Owner Owner's Name i1ff0e`0r's required for every Hyannis MA 02601 5/23l2013 . page. CnYlrr— State Zip Code Date of Inspection D.System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): On Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equat,.any evidence of solids carryover;any. evidence-of leakage.into or out of boy,eta): There is solids carry over due to no tee being installed at septic tank Pump Chamber(locate on site plan): Pumps in working order. E 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 worldng order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain whyt t4ha•3n8 - Thle 5 Officlat lnspwdm Pam:SuOsuKm Saaepo Dlspooal SMw Phpa 120117 r f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Notfor Voluntary Assessments 34 Old Town Road Property Address Maria Eftim'iades Owner owners Name Information is Hyannis MA 02601 5/23/2013 required foreveey Pap. cityrrown State Zip code Date of Inspection D. System Information (cons.) Type:' [] leaching pits number. ® leaching chambers number 5 ❑ leaching galleries number. leaching trenches number,length: ❑ leaching fields number,dimensions:. ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): Leaching area is level with no signs of breakout Cesspools-(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top ofiiquid.to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction indication of groundwater inflow ❑ Yes ❑ No twa•SMS Tbo5Of "atMspoWm Form:Ukffm Sawa Dbomw*MM•Pap 17 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 OId Town Road Property Address Maria Eftimiades Owner Owners Name i d• required fors eryHyannis MA 02601 5/23=13 Page. ctblrown 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, eta): Privy locate on site plan): mY( P ) Materials of construction: Dimensions Depth.of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): r5hs-ut3 The S Official VZPB bn Form:SUDWON Sewape DLVN l SyXW-Pap 140117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 old Town Road Property Address Maria Eftimiedes Owner Ownefs Name InfomebO°Is rewired,for evey Hyannis MA 02601 5/23/2013 page. C'Ity/Town state 7.Ip Code Date of Inspeodon D. System Information (cunt.) 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 welts 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 tsms•phS TNO S Ofieiel IropeCtlon Farm:SuDsafaea Sa<,rapo Olspesel Sygmn•Pepe 15 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 34 Old Town Road Properly Address OWW I Maria Eftimiades Owners Name information is requbvdforev* Hyannis MA 02601 S23/2013 CRY/r— State. Zip Code Date of I nspedon D. System Information (cons) Site Exam: ® Check Slope ® Surface water I$I Check cellar ❑ Shallowwells Estimated:depth to high ground water. 'S feet. Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked;date of design plan reviewed: 10/30/2003 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: C Checked with loq►excavators,installers-(attacK documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Desi n shows no water at elevation 86.50 bottom of leachin st elevation 91.50 Before filing this Inspection Report,please see Report Completeness Checklist on next p p page. �:•sns TfftS O fiCbl IMPMM FQ=SLbstaC*Swaps DISp oo 6yrAm•pap 16d 17 I i I i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Ownees Name information is required for every Hyannis MA 02601 5/23/2013 page. Ctty/rown State Zip Code Date of Inspection . E. Report Completeness Checklist ® Inspection Summary.A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 1$or attached in separate file �a+•.ana - 71ue 5 of"'MPC'pn Fo":SLGvrtaoe SMM W DltPOW`st&—•Page T7 of 17 A g Location#1 is outlet end of 27 Septic Tank and is located under deck.(access cut into deck. A1-22'-0" 81-12'-01' A2.35'-0" B2-25'-0 N.T.S. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-No',for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner owners Name iegwmdfore H annis MA 02601 5/23/2013 n is required for every page. Gtylrown State Zip Cede Date of Inspection Inspection results-must be submitted on this form.Inspection forms may not be altered in any way-Please see completeness checklist at the end of the form. important A. General Information , (] on theearlputer, use only the tab 1. inspector, A Acurso t9 i Key to move your use th return Winston A.Steadman it use the return key. Name of Inspector All Cape Environmental ino. Company Name P.O.Box 235Address Company Address Yarmouth Port MA 02675 Cdyrrown Stale �508)776.621 g Zip Code Telephone Number S113045Ucense mwnber B. Certification 1 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 properfunction and maintenance of on site sewage disposal systems.I am a DEP approved.system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Dighally.signed bywinswn A.Steadman it DN:cn-Winston A.Steadman it Date:2013.05.28 0724:o5.04.0Ci 5/28l2013 Inspeetofs Slgnabae 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner Shall submit the report to the appropriate regional office ofthe DEP.The original should be sent to the system owner and copies sent to the buyer,Napplicable,and the approving authority. "-This report only describes conditions atthe time of inspection and underthe conditions of use atthat time.This inspection does not address how the system will perform in the future under the some or different conditions of use. .sin•ana 'O*5 0%1 hn0a UN Farm So-`mrra0!$aw`-ga D'getal Swum—Pogo I all? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 34 Old Town Road Pmperyaddrass Maria Eftimiades owner owners Name nzluaed forevery b Hyannis MA. 02601 5/23/2013 Palle. CWT— Stale Zip code Date of Impee ion S.Certification (cant) Inspection Summary:Check A B4O,D or E/always complete all of Section D A) System Passes: ® I have notfound any information which indicates that any of the failure criteria described in 310 CMR 16.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments:. 8) System'ConditionallyPasses. ❑ 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. Cheek the box for"yes`,"no"or"not determined"(Y,N,ND)for the following statements,If`not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration orexfiltr&Von 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 tankwill pass inspection if it is structurally sound,not liking and!fa Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N. ❑ ND(Explain below): �•.� TiW501fiecl lntpaCJen Form:&erurtxesewoo CL•oos�t s�arn,•v�yo2a:7. . Commonwealth of Massachusetts lugTitle 5 Official Inspection Form .Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Owners Name nfofmationk �annis MA regrSredSTrmery. 02601 5/23/2013 Ciry/rown Aa9e. State Zip Code Date of Inspecdon B.Certification (cunt) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont): Q 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 ❑ NO(Explain.below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of.Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below):. ❑ obstruction is removed ❑ Y ❑ N ❑ NO(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 sSta-aas TYkS WOW I-SX0bn FGM gw=rroca So+zSo otpo W ayaom•paW]of I - r L\ Commonwealth of massachusetfs lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 34 Old Town Road Property Address Maria Eftimiades Owner Owner's Name information is Hyannis requivedf6revery Cryannin MA 02601 5/23/2013 State Zip Code Date cf Inspe adCn 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 anal the SAS is within a Zone t 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, y s,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into faal'ty or system component due to overloaded or clogged SAS.or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Lquid depth in cesspool is less than 6"below invert or available volume is less than%day flow TO S Offielcl ttic;oaion Fay:Suwunr4 smgo oicpmi Sr+l0.'o•ip kp4g iT z AM 2 k* a oiju l ' CD C.r, I O I GO r 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is y required for Hyannis Ma. 02601 11/12/2009 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 rermn City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/12/2009 Insp ctor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 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: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box.due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ' ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect,public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is Hyannis Ma. 02601 11/12/2009 required for Y every 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 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 El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for H annis Ma. 02601 11/12/2009 y every 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- 10,000gpd. El ® 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts H v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 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? Q ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon tank,D-Box and five 3050 chambers. Number of current residents: unknown 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 Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11/12/2009 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•09/08 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 �M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every 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: 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every 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: New leaching installed in 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the 3050 chambers. Septic Tank(locate on site plan): 2' Depth below grade: 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: 1000 gallon Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments �M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every 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 27" I 3" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee.or baffle 101, How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness 'M 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voiuntary Assessments °M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for H annis Ma. 02601 11/12/2009 y 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.): 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-09/08 Title 55Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 34 Old Town Rd. Property Address Emerson Soares _ Owner. Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every 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 No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for H annis Ma. 02601 11/12/2009 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-3050's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Chambers had 3"of water at time of inspection. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size zoom Out In 7f R IC y ♦ ♦ / / x, s a a { �c,i � yl��rvF3 F n CP � n6vC A. n 0 20 Fe „€ _. Set Scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER f nn%Mnh#9n(1r._9OAO T-Ain of Rnrncfohln AAA All rinhfe meant, http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=267154&mapparback= 11/14/2009 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 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: Bottom of leaching 13' 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: 2003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you.established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Old Town Rd. Property Address Emerson Soares Owner Owner's Name information is required for Hyannis Ma. 02601 11/12/2009 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 { ' � E •!19 lA - a A IT :rL;Ui1VE- vr'rICE OF hiNVIRON"NIEti AT. AR- ArRc _ } BEY RT ANT 4r ENVIRONMENTAL PROTECTION Ay TITLE LE 5 Ol Fib I A3.. FNSrE CTIF0N r� i-:T;i r vic v V U uN T AX Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYST-1 EM.. r�1D,-%a FART A ri T CERTIFICATION 1-5 Property Addy ?cl 11"T" n� � Address. v-t VIM It'xilvb dCr NSA Cowner's Name: 2tCY'J tscit�reSs:_ T ��Y Bate of Insnectinn._ t`q 6 v Name of inspector: least print) Y I I T14I.C.6 I E%eA)_AN Company N Me: w p jailina Atiyiress• Telephone Number: rrr ring •Ti V!�! ca��ar arts l STATEMENT � f I certify that i have personally inspected the sewage dicr%01 S—ten,at this addres d ti t ., r 7< --"-a- Y"•"" J•""•" •+•��u ua..aa wi uaat utc litlVLt11CUUt1 Ce�I-tCQ below is trite.,accurate and.complete as of the th-UC U—tStC lii3j3eGChi:n.!ne inspection was performed based on friy !X! tiaullrlg and experience in the proper function and maintenance of on site sewage disposal systems..-T-am a DEP approved system inspector pursuant to Section I5.340 of Title!;Dille rmlZ j5.nnrn. The s te:n: _.; At PassesPQ Conditionally Passes Needs Further Evaluation IM the Lrocal Approving Autilt'niJ, �^ Faris Inspector's.Signature: %dl The system inspector shall submit a copy of this inspection report to the Annmvina Authority,regard of j-leattlh or DEP)within 30 claw of fnsnnlptirly this iyn�nont;... it.l �- 'Y'�"'b"'••` 'Y`•"clvaa.a taaL.s�stLl3l 15 a$Fla:Clt syJtClit Vl :tit,a tt�slYl,.R t1t3W OI lf�,i�Ul1 ^^t^' ts,i:;nspectoi and`dic system owner shad submit the report to the appropriate regional office of the aY".,. �a...u�,, DEP.The original should he sent to the system owner and copies sent to the buyer, if applicable;and the annrovina authority. 'Notes and Comments -"*This report only describes conditions at the time of inspection and tender the conditions of use at that time.This inspection does not address[tow the systeLn war Yngrferm in the future growler the g;;;n�n.differenta'.c1i'laifionr Wiese. T itle-5 inspe ction Form 6ii5TCKiv page j a ti Page 2 of l l ►'ftT.TSl1T f 3 b1TR9lYT/Y4.9t\1T TATIS� NOT alY3TR E OJ' T Ur r 3��1,JUN SFd'C t JLUTN r UKNI--ITU I r iu �%i 1.i3i� Y EL��fl�+.��i'i'!l.lel i s PSI A CEW 171 MC TIT0N�ecn mne�� n Property Address: 0W_ A Date of Inspection: inspe an Summary: 'Cuc,A k t�i�;;�� va'E' 1 AMWAYS complete Di of.S-ectioa v A. System Passes: �_ i have-not Poland any information which indicates That any of the failure criteria described in 310 i,:c`M 15.303 or in 310 CN4R 15.304 exist.Any failure criteria not evaluated are indicated below. �pml8tcnts: IL system Conditionally Passes: / vice yr more 5"yaacul Gvutponcuu a3 uwcr"lued in Ole Cvutuuvual rags aea.uvu av vc tcylaccu yr repaired"The system,upon completion of the replacement or repair,as approved by#k Board of%leaW will per. s y Answer yes,no or not determined(Y,N,NDD)in the for the foiiowingy te�ntnis.ii DUI:iCiVriIllrtCtt� picBJe explain. / '1^L t.:_�_�_t nn_. el it '/ l..L L-r m ♦al ♦\ .w..act,...-"Ay Y lie sGFlll-".rak la metal Gnat V V VI Ll3 yG'd1 J Vlta or G1tG SG c eaetk 4�'Y11�.i12Gi 432Fiaat or llVa�i3:rat ltA.alGaaacy unsound,exhibits substantial infiltration or exfiitration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as aa�r,�oved by the Board of Health. 9 ueWl$e'��.�.^v tank will pass iia:peLa`�'iQit if it i$s udaua U $^vL:a`�,'aiot lealGin .'�^=d if 3 Certificate.^.f CGmnliawnt�a, indicating that the tank is less than 20 years old is avai#aoie. + Nib explain" i Observation of sewage backup or brepk oirt or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken_settlad or uneven distribution box.System will pass inspection if(with spproysi of Bo ward of Hw_hh): I / p;pe" rmiiaced aY� ✓obstruction is removed digfri6ig^em u`:i�c trnrvI�Pti nr rPrlarpri ND explain: � 'Ta... .L__ • .L. L_:.7 L..a.... ♦..:i .J� '1`i+ itac Systcist Icclui.� fiilTiputg ruvrc Luau ro%macs a yenr uate iv rlvlCeu�r vuSuucte,i i `(0). sate pass inspection if(with Approval of the Board of Health): l Ul VRGIa pa4PGi J)Ql G 1 G aL'LGLL obstruction is removed irU explain: Page 3 of 1 l T S € I " RM aNg,-.%,`I' FOR VOa,LW'JrAR'%'AS.V.FsRMI rN Q `X7 A ITV- T%yQ srae•Air [er[�nRT-am Tnrr.nr.e....>..�, FORM _ TV to iB ii -K%jo'e6 E. a$13!t€.ivil JUNa 'EC Y IO f'ORM PART A CER I YF P CA j 10N(continued) Property Address: AOOP 4 da9 6✓i 3ld L/\,8 0w1ICl: Date of Inspection-� ....,." a .a,U-1-11 u Required by the Board of Health: Conditions exist which re_.mj're flirtl1er eYai» t:r...1....1h ri n.i .Funnl.t :_ 1 __. z-- vy u b MXQ 01 11calth ut order to determine if the system it failino to nmrPrtnni.i:..1—a- o to r•nta Y ='�,a.a,uy sa1c1y or tnc environment. 1. System will pass unless Board of Wealth determines it accordance th 3rn CM-n r_303( .,U t 8V LivSS6 SJ.JEfJt$�1$j�,jjd(the SV$jern IC LIot fi�nrtinnin�i;a wanner av;ich will protect public, aitn,safety and the environment: Cesspool or privy is within 50 feet of a surface water / — Cesspool or privy is within 50 fPet of 1-'CrA fib� /fA•-----i/��iiai�d or a sGii fiat Jii f System will fate unless the bard of HealtlaAnd Public Water Supplier;if anvl dpterminoc that tl;e system is functioning in a manner that p 4 the public health,safety and envhr oninent. _ the system has a septic tank and Ail absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary toA urface water supply: — The rys�e.;: =;a septic iaV and SAS and the SAS is within a Gone l of a public water supply. T"he system has a sentiVtank and CAS and the SAS,g xvith;i ';A feet-Fa 'te`v.;i�.Su 1 pn.. pp,y v:c,1. _ "lie 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 vfell".Method used to determine distance **This s rrre.....nn[ C L tt_.. ,�•••.,Mapes h1 u1e iHeil water analysis,performed at a UEr certified laboratory,for coliform bacteria and voohle organic compounds indicates that the well is free from pollution from that facility and the presence oYammonia nitrogen and nit iajP nitrogen ice that in or l s 5 nnm nrnv;ic`i r{.�r r u.,si.o. fallllrf'rnt#- J n eccl,an are t,Z'o..—A A r.t,. 1.._•_ L_ L h• c •�• ,...... copy of uic analysis must be auaa ue7u tG uus 10lth. 3. Other: f Dage 4 of l 1 OFFICIAL,ITN-SPE nN FORM_Nt>T ORVOLUNTARY A-cESe NI-rQ _ U ns U is Ali,jk,W.AGE DISPOSAL S�EW!'lqJYEcUION FORM i>A vqr A E;ER'.1-I CATION{contimied) D, -�' Property Address: �, v t yl •t11A e� —Them- V 0 u e Date of Inspection: A -System Failure Criteri-n annlip—ahte to oil s„ete- : You Must Mdli.aM<yes"or iIfi"`to e=4Cli of`tue f011owing for ail inspections: Yes No Backup vfs�gage Hato 1QLi11 y or system coin-1ponent due to overloaded or clogged SAS or cess-pow Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool /.4Ctatil;.liquid level in the list-ibutio^1'.^7:.aboo`ve^,:tlet-,.'.:1;'—t dl'�.�,t^.'�.,:'o.�1. ded o. Cl.^,r'ge ,�,A a r.- z--- d.. ^K..... .A -_1 fiessp VI . Liquid depth in cesspool is less than 5"below invert or available volume is less than%day flow —ah�- f dRequired pumping more than 4 times in the last_year NOT Line to r_.logaed-or nbshucte d pinek)_NnrnTiwr { oupe$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 crater caimnly - _ ^l t�iiy poi hou(9l d ees5pum or privy is wi ain a Zone 1 of a public well. Y Any portion of a cesspool or privy is within 54 feet of a private water supply well. Any portion of at ceggpnnl or privy is less than i(1v feet hot S greater than 51 feet from a private water l e113eu acceptable water � � 1%is. es tes(ate pywt, sh' R Me welt water is93Y'byssiry performed at a DEP certified laboratory5 for colifarm Bacteria and volatile I organic_compoaBds indicates that the well is free from pollntbonfrom that acility and t m he presence of ammonia ►eeti'der.'�.n-a:t fP ultror-.0�, w— tw��i<�-en�'wmaf0 5 ppm,pr ovidrd that otli.er fiiG .i••e c:'n.�.^ia Are triggered.A copy of the analysis MUSK De attacked to this form.1 *'k/v(Yes/No)The-. tem fnik,T'n_avP determined that one or more of Ole above.failure-crrit?ria exict as I 1 V S -j iirvyr� i5.u5yacu vIIe % M L1v or o J %iIu1Jv , cethe c � jhouiduuAuc rad F.ealm to determine what will be necessary to correct the failure. 1- Large Systems: . To be considered a large system the system mtast serve a facility with it design flow of 10,000 gpd to 15,000 Vn„ .d:nn�n �i.....uy n v la dst in di.-M Vattc ses or Ilv av cac..la vl UM tseUU WF -, i he following criteria apply to large systems in additio criteria above') yes no the sysiem is within 400 feet of a s zace dritixing water supply �d tW1e Cvc4em is Nafiul,.i1i'T(1t1. fre il a sla ibla:�c y to u,ilaaiful:.e dc,��:^f,^viuu-i.Qi pYl J _ the system is located Va nitrogen sensitive area(Interim Wellhead Protection Area—1W-PA)or a mapped 7nnQ 11 of a TnllhUrZ-%ter asm"ly mall If you have answered'Yes" y des'to any question in Simon l;the system is considered a significant threat,or answered "ve8"lYi SeCifott Dve-.the la_rgP gVgteZIl failed_ she ov�nar or�tnarad4nr of any large system Cnr9rirrPii a- ifica A.....sZ _G.] .7_.-.1_-c.__ 1 _ 1_. , ., z. Y .1_ •-. ^.n�.1 fr. significant auacayauldcr Saection of haled uuucr as uun D shall upgrade the sysiem in ae:cordance with 3iv CNM 0.304.lie system owner should contact the appropriate regional office of the Department. 4 i pane i of i i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS Ur"IDPLr7l;RF1iVE `.�r'i�i DISPOSAL aiaariv�i�� ,i sivi�tviuvi PAST B sS 0.4-+lr-- /�t/ L!ti !i ndureaS` F ! 1.w A9' € 7 •�2j V LOB 11, A 9 Owner: nt� s.arte v al f Y'a-"i4su.tiVu t on.. d.� T Check if the folio:.^;^u —b aVe been done.Vi ou u + AZ-2ULndS +. or no".as to each oC.h e rfo flo iilg: Yes No — rumping information was provided by the owner,occupant,or Board of Health JK Were any of the system coTMYone"tM Y.roped out in"the pre ii--M two wee'. _ Has the system received normal flows in the previous two week period? _} HavellargevoliSiaiLes v riisLEr v M-A iraLLtiGUCCC Lo thC_yasem rece ntl or as pa'L o:tuaJ iuSp"Lfon : _ Were as built plans of the system obtained and examined?(If they were not available note as VIA) n'as the facilivy or dwelling uispected for signs of sewage back up? I — Was the site inspected for sips of break out? q/ Were ail system components,excluding the SAS,located on site? w the captl t-L—%.%%,L oles--n-ce--ere,",opened,and the intenior. of two tart.i ;pecteed for the of the uafiles or tees,nianerial of cox►struction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the failyowner( ndnrratQfif rent ltwnnv�i Pri with infnrmatinn on the.proper ....�... Uis _ i n 232Ud22<412U2dHi+v2$uvJLat2a4G 3e vY a�je LLiJ;JVJIIt Systems i ie si x and location of Cue Soil Absorption System(SAS)on the site has been determined based on: Yes no �Rf� uxi$ug information.For example,a plan at the'Board,of Health. - r (Y — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is i n-acce„tahlold[3 i^f'A,tD t c 2r»/3-iff-1 i/wvav V14\ 2J.JVi�J AVJ' 5 pate 6 o 017FICIAL YN PVr a``nth VnP'm_wmr imu vi-ii tfrai-rEtauv �c --mac c 1 fray 8 A lP A9 Ai 6JET 8d-L8E Y F..ia31.739 . V "I'l KF'��.�' S11'.e'�`SEWt-GE. DISPOSE SYSTEM EM II�SY1 CTION FORM -APAL i C- SYSTEM I'.itPORtEi}A"TION `, Property Address: �y V Ik�__C � I Late Vl 1rlspecilon: FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(desigri j: v iv umber of bedrooms(actual): 11� DESIGN flow based on 310 CMR 15.203(for example: 110 apd x I of bedrooms):C534YU_ Number of current residents: L/ 'Does residence have a gala�,3.. i.. �. �l garbage..r�""i u,u�l kycs Gi ri0). . .s!1111liiy uii a separate sewage system dyes or no).AOW (it yes separate inspection required) Laundry system inspected(yes or no):t Seasonal use:(yes or no): n3 i a. 'T meter ra+µY Igs,i2 a`eaild0-04S G years usage d � tgP )1= Sump pump(yes or no):Di v Last date of occupancy-i t4 afoo Cvi�ii�iE1�"at,L/IidLuS T KiAL Type of establishment: `- Design flow(based on 310 CNM 15 203)• ...,,t 1?s15 of des:....,y..,v..1i....." a ------ - xuiycis Grease trap present(yes or no):iiusisy�.J: Industrial waste holding tank oresdt(yes or no):_ Non-sanitary wactP dices}a_roPriAn the �" SySkru,�yt.o yr riv j. Vater meter rcadirtgs,if ayliable: East daze of occupancye:— -— 1SJ/do- GENERAL INFORMATION Pumping Records .civu.'Cc of)rill/)k`11atiUri: Was system pumped as pant of the inspection(yes or no): POO If ves.volume Dumped: al_lons—How was 1iiaritity pumped determined? Reasson fnr—t umping: TYPE OF SYSTEM A/S-I -- Pan g rjigtri€sirtinii bnx�Ss.il abso Y;ior,syste'^ Single cessp001 Overflow cesspool Privy Shared system(yes v^r i_j(if yes,die k. }-1rc'viuci5 inspection is-tf5rw if ally j _innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tioht tank- G ttwyh 4 co,..,of tie nrD i -�7-'- Yl -�a..a �iYprvviae _Other(describe): Approximate age of all coulpuneu ems, 'di i leg g(if Known)and source of information: J / /&lot I �'ctL.ce. Aj.;ke se wag"vuvr5 k�iCtGCicu rii,Eii aitlrlri�at the S7lC(yes or I}O)_ t) Pao-e 7 of I I OF t 9l l«JL INSPE ?i ION FOR-A—NOT FOIR VOL UN Y ASSESSMENTS 3Ty?C1: V A P i. .CvLii7rAs sz.JLFA jx%Jot%A�,�7 i tCs a s.tsa i$�i vi a aiiliY ;�stA�A PAR i C S>s XT&I'l, ltd wrrad ff t Ti e,wT A a a 1 IVI 1`i-ir Uiz'.iYL i IUN (continued) A )Pro-oerty Address: 1W fl i j l.�t it'6d E'b 6 Owner: Date of Inspection: BUILDING SEWER(locate on site plan) . Death below e: r - sd ad� , Maieriais of construction:_cast iron d 40 PVC_other(explain):_______. Distance from private water supply well or suction line: I nmmPntc(nn r/�niiitinn of•-lore r w a , c t"-• �1•••....v.. j•.aa..,yE iYelatlllb,eYlt3encc.of leakage,etc.)- SEPTIC TANK: X =aYvt,att,qi2 Sitc fstn22) Depth below grade: Material of ronczmwtinn- d I...,.�oie n'erwii fal'ieF�iaSS�SVi�e�iia'yi't iae �vufS cr<ea fiid'u2) It tank is metal list age:` Is age confirmed by a Certificate of Compliance(yes or no):—(attach a coDy of certificate) / D;me-ns.o 4 A00 ^W j Sludge depui: -U _ Distance from top of siudoe to bottom of outlet tee or baffle: a Scum thickness: _ZI-N it a.riStalLL2 uvl_L 1OP Oi sr-uisi to top o ouiiet lee or battle: Distance from bottom of scum to bottom of outlet tee or bade: /_t> _ How were dimensions determined: C onisnenttr(o • t"''d"Y:sag awlifiuifeiftsdat3vnS,uuct also nutter tee yr Valfi�LCfFSU1LSVLSY Jtt[24t.tflQi ii1t�V iiya Lis�stitt aca�t_ a5 reiaied LO uCiet invert,evidence o-I eakage,eta): •2 9 g- (r-S S Cam'° GREASE TRAP: (locate on site plan) Dcpul below grade: Material of construction: concrete metal/fiberglass polyethylene other (explain); — - — - - — L-Iuli rlsiorls: Scum thickness: � Distance from top of scum/t/o.t'nn of outlet tee nr ha ffle: D; to eJt..nv..ce from b-ft—nr.41 . a� V k-" ,r-..+I-.. 1. a _. V1�D4 Ada dE l VVtISLY VL V6EtIC2 tGL VL VGf-�iL. Date of fast pumping/ Comments(on puA'tine recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to nYT Pt�nve y ey dena:�'.�i�ieuZ'u-`-`e a*^a..�• 7 f Nee A of I OFMCLU,INSPECTION FORM-NOT FOR VOLUNTAL Y ASSESS, NTS 5� �'LT .�° '�E a�ddtiv�;ISPOSr f. l a'a ivi a%NSP t i�i,N +pit PART C '1[�TT1" T'T\ T1 s� a ,��- OR IATION(continued) AC Y .n A Propertg Address- .-?Cf yrj 9y ei PW $ef: Mte of Inspeetion: +;9 TIGHT or 1+3O1.,1r DING TANK: (tank must be pumped at time of inmection)(}orate on-Site nip,) Depth be'ow—,1e iv'aterial of construction: concrete m 3'" fiberglass polyethylene other(explain): Dimensions: CapaciLr: lions Design Flow: .. / gallons/day_ Alarm present(ves or nol- .-�ecu::.e of riitai•Eii#;€lruc:�ve5(3f G(D}: Date of last pumping:4 Comments(conditio$of alarm and float switches,etr_..): d Drw=`_° TIT-3-,Df;X: _(if present must be opened)(1ocate on site plan) Depth of liquid level above ou*aet invert OWAV f_ornamentc fnnie ifbrx rS le�,el i Riau distribution.av out' —` evidence orf W.tds eariyover,any evittC_ Ica»c IlGe Ol e Ito Or out of box,etc. Le/r S d t/�l -&Ga ICI' M P al 10 Y11 �S!4 t0,1:3` `PI MP CHAMBER: (locate on site "1 1?iuups in Worxiiig order(yes no Alarms in working order Lyes or no): Comments(note cond t-JOIn of mmmp chamber_condition of pLyps and appurtenances,etc.). r^-- d s s -- Page}of 11 6 W8Y-11 A I vfte,. -. sestT GR eye! va K2- aria. AF®aSEC1-1CIN OR —NiGI FOR�$��1�� '��C� t��!',��a�� n V Y g EM gl 35FOIRA. .A.IL LO3� icont.UlupS�ij Property Address: Owner: .? Date of inspeeion: c A C%:CJiL ABSORPTION SYSTEM rkA � —�ntv-a-c or,sit c plan,excavaiiGn nvi required) If SAS not located PYn'Y ailaiim :hy- . Pe leaching pits,number leaching chambers.number. — _1QZrhi�o oalleriPg a 0— leaching t.ericlies,number,length: leaching fields,number,dimensions: overflow cessrnroi_ mirnhe-r- irro va tive;alte.:zat;ve systerii i y-pe/riainc of technology: Comments(note condition of soil,signs of hydraulic failure,level of pondin„damp soil,condition of vegetation, etc.): _ CESSPOOLS: (Ce;�pvol uaust be $� -pan v" Site plan) Number and configuration: / Depth—inn of liquid to inlet inv- A-c}rui w wuw aayct. Depth of scum layer- Dimensions of cesspool / -- Mate^:ais of c^nstructi ^ Indication of grJumdv�ater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.;: PRIVY: (Iocate on site ylanj Materials of construction.: /' Dimensions Lepth ofsolids: --7 Comments(note coXdition of soil,signs of hydraulic failure,Ievel of aonding,condition of vegetation,etc.): 9 f pSf C of YAR t `. V.V4Z'YWm TWVnID IATIOii uj Property Addr - 3C! C)I lam.. 61.0 �ic Owner: �_ 60�tV_ ` Date of Inspection: ! l SXETCH OF SEWAGE IDISPOSAL,SYSTEM Provide a sketch of the sewage,d]S^Y`S i Sv`tei^..' Cf'u'�ua t3eS ti S' iwit lwo PC, relcrEnce landrnaisa of J v:LICI Hal Locate ail weirs within 100 feet.Locate where public water supply enters the building. ! ! \\\\ ► I /f 27 \N Ai- �n i ae-e €I of I I I � OF ICLAL iNSPECTI ON,FORM—NOT FOR VOL L-1247A Y ASSESSMI EN rS aYTB•YCYis374 n d"`� ��Yt a r�� zr�a,rao a i oiiora�lee slaTC•a,>t�t�^��.trsat rr`,nt�,a vv uv va�s'1'ft.8i vgi!S t•1V i. ili��yJ�?t`4i.s �I J i$i 17$ ii�a�i ii�i Rill♦ i'iJ d\:V$ PART S 1 a lam.r Yi JUNr OWAA i 11%G' (continued) Property Address- -2-0 l' O Ci7tn w� Owner: :)60 j' Date of Inspection: �I o4, aa i Ic :{eil�i In Slope flu. Surface water W IN Shallow wells Mj Estimate i depth to g ou id:gate:tr� ��+L, Please indicate(check)all methods used to determine the high ground water elevation: Obtuut'd liom systeiin design Marls on record-if Checked,daie of design daft review-CL'l, Observed site(abutting property/observation hole within 154 feet of SAS) Checked with Iocal Board of Health-explain: Checked with local excavators,installers'(attaucli do%iixiacuiaiivn� AA A------d%iSGS database-explain: You s r t,io - �. how Llisiled 1_ high _ :uuu•u..$.'�.i i c,t...J you c�tuvltslccu ulc ue�u�rviYiid WsltCP etYY'a�CfVil- P 7 tares _s`W&tJ3 e1��i i&it iB�J! e � t} R ye F a e k f-4 4 � V � d 0 I C (� x. 4 'r r x N H v v M Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N • U� S/2S%01 :',,`OTICE: This Form Is To Be Used For the Repair Of Failed 1 Septic Systems Only. PERCOLATION TEST AYD SOIL EVALUATION EXEMPTION FORM — hereby certify that the engineered pian signed by me urtec 10 3v 6 1 concerning the properly located at `_t &L .-_�«O�s�s1 � e�r„S� meets all of the fcI owing :nten3: This failed system is connected to a residential dwelling only. There are no :ommer,la.! or business uses associated with the dwelling. -F�e soil is ciasst,iad as CLASS l and the percolation rase is less than Or equa to -%—)u(ts per inch. The applicant may use historical data to conclude Ns fac; Or may _Z)rduct tests at the sire without a health agent present • T her: :s no increase in flow and/or change in use proposed There are .to variances requested or needed. • The bottom Of the proposed le-aching facility will not be located less than fourteen aonve the maximum adjusted groundwater table elevation. f Adiust the r)undwater table using the Frimptor method when applicable) Please complete the following: �. T,Dp of Ground Surfzce E:zvation (using GIS inforrma!tOn) 5; C.W E!cvat:or, ad;ustment for wgh C�.w. 39... _)7=7 11 EN .F. BETWEEN and B (0 G'atED _ DATE: lO 3asec j,on ire alnve information, a repair permit wil! be issued for )ear^Oms ;ddi(ionat bedrooms are authorized to future without ,ngtnce(ec i:ept.c syae n plans. 9Caih:C:du poccam9 Permit Number: Date: ! Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: 3y \� �Lv.`�1St l�� (311i) c< - Lot No. Owner: �'2� n �� -� Address: Contractor: �LIY�. _ Address: �,VY1ovT� Notes: CU(� STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date l'o �bJ mon h/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... M OB Water-level range zone ..................................................... C STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to C, water level for index well ........................... month/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water level adjustment 3 sq STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ..................................................:.......................................................... f; Figure 13.--Reproducible computation form, 15 No.2Vo`3-6_Z9 FEE COMMONWEALTH OF MASSAC14USETTS EC Board of Health, Vom��_ Na APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repairx Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location (7r Owner's Name Map/Parcel# Zip-1-1 5 0 Addres Lot# 15 Telephone# Installer's Name N)PIZA-S Designer's Name C. 5 G 2 Address ,D, k�� 1 ann 15 (Nq Address 9 X tp a? oZ;.!3 Telephone# , % ,/ Telephone# — --b Type of Building 5 id Lot Size 0 sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow(mi .req 'red) gpd Calculated design flow Design flow provided gpd Plan: Date 0 36 Number of sheets I Revision Date it q -0 Z Title Description ofSoil(s) �e l � e{� Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS VAIWY I �'p�l��r'a ENGINEM iV AND CERnFY lv t' 1,4 The unde, ' ed agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr to of to place tem in operation until a Certificate of Co pliance has been issued by the Board of Health. Signed Date 7 �7 ffpections� ,��7a...`'r':.n.---• -y'"'�.�.f�.r•.s�"'�i"'....rr.^x'7'�```^`rr7i�J'f'"tiw*"��r*S�'€�'"°7hi�� q^�f*�-�-�,�y''�"-.-�.a'��.Q'�"M`.�"�'.�xft`. 44"�;"'.�,� No.2 00 3- S Z 9 d7YMASSACHUSETTS FEECOMMON �..r �11 1 C -- Board of Health, G 5�� MA. APPLICATION FOP, DISPOSXL SYSTEM CONSTRUCTION PERM— .01 4 A ( ('Application for a Permit to Construct( ) Repair );Upgrade Abandon - ❑Complete System ❑IndividuahComponents ra v' Location w-r�w i t Lw Owner's N a'l ' 11 Map/Parcel# y Address Lot# l f Telephone# Installer's Name S Designer's Name /_ Address v,D• ``R� Wt4onn r5 Address X (PG •C a(o,r Qz5 ' }0 Telephone# _7% —� Telephone# �.,: f Type of Building �e5'i01 e n +I `("'� Lot Size lo &'q 0 sq.ft. , Dwelling-No.of Bedrooms �� tc f'0 ( `� 'Garbage grinder Other-Type of Building No.of persons Showers(,),Cafeteria ( ) Other Fixtures Design Flow (min-rre/q� fir�ed�Z, �i �(n gpd Calculated design flow '�)d Design flow providreld 44;4- gpd Plan: Date �6 �u�Ch.� Number of sheets Revision Date - 7 3 � r Title } Y Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS f : i The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Sign-,d 1�.{J�Q i Date YoVex y Inspections k.... f No.ZUU3 �}�]�aA FEE �®�'1 MON�� ALTH ®F MASS CHUSETTSBoard of Health, n SJ o-� , MA. CERTIFICATE OF COMPLIANCE Description of Work: ©'Individual Component(s) ❑Complete System I The unders ned hereby ce dfy that the Sewage Disposal System; Constructed ( ),Repaired ,Upgraded ( ),Abandoned ( ) by: P1L5 -�ee-�'-niC/.fir I f, '!1� at 64 0)d 1 uo Y ► Voo r, i 'F� lit n nf) S lao- t has been installed in accordance with the pro •si ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.2VU3-SZ dated �' �' 03 Approved Desig Flow (gpd) Installer Vu� � e r^ Designer: Inspector: / Date: 3 103 YeV The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ' f ' No.2003-52 " r FEE -510 COMMONWEALTH OF MASSIACHUSETTS Board of Health,3'.V i A S U Lam`--� , MA. DISPOSAL SST EM CONSTRUCTION PERMIT Permission Jiissfh�e,Ireby.granted to; Connstrja( ) pair( �4 Upgrade( )Abandon( ) an individual sewage disposal system tt old ,/V KJn 6 a o— a n Oj5 as described in the application for r Disposal System Construction Permit No.Z0 03-- SrZ<i,7dated i r �,/ c 3. y-� Provided: Construction shall be completed wi in hree years of the date of this pe it. d_ c n abn� be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 3 Board of Health ' I CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O.Box 627,East Falmouth,MA 02536 November 4, 2003 RE: Certification of Title V Septic System Installation: Residential Property 34 Old Town Road,Hyannisport,MA Dear Sir or Madam: On October 30, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 34 Old Town Road, Hyannisport, MA, based on a design drawn by Shay Environmental Services on October 29, 2003. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions,please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMENE. SHAY ENVIRONMENTAL SERVICES,INC. \_\H OF, 41 g°a CARMEN ctii� o E. `m ; S HAY No. 1181 � Carmen E. Shay, R.S., C.S. o President s c�s T ERA 4N/TARIPN f TOWN OF BARNSTABLE LOCATION SEWAGE # - 519 VILLAGE ` ASSES R'S MAP & LOT �� S ` INSTALLER'S NAME&PHONE NO. � . SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (size) fDD �f �f 0 NO. OF BEDROOMS J i BUILDER OR OWNER PERMITDATE: 3 d? COMPLIANCE DATE: j Separation Distance Between the: Maximum Adjusted Groundwater a to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee(of leaching facility) Feet Furnished by i i 1 Lei' All TOWN OF BARNSTABLE C- LOCATION © d. SEWAGE # la3 VILLAGE_ ARK ASSESSOR'S MAP & LOT " 7- 67 INSTALLER'S NAME & PHONE NO. kjt/�'t kIa SEPTIC TANK CAPACITY l r LEACHING FACILITY:(type) W., nA/i_ tocT- (size) 5 I-OJ� NO. OF BEDROOMS PRIVATE WELL.OR PUBLIC WATER BUILDER OR OWNER .it- - t�'�� DATE PERMIT ISSUED: 2 liZ q DATE COMPLIANCE ISSUED: a� y VARIANCE GRANTED: Yes No t/ u CN THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH8ar t TOWN OF BARNSTABLE Appliratiuu for Biupuuai Workii TouRru.r Date Application is hereebbyy,made for a Per to Construct /(, /) or Repair� ) an Individual Sewage Disposal System/at: �1� Uw/•°', (�✓ iY��/�/ 7�� ..... f--.V.. - .................... .. c to dress �t No. .......... ...... .......... -.. • ........................ ....................... . ..... ... ....................................................... W p i y�/� 1/t Owner ��y /2 ��/ ares � �,�� (✓./C%JL.,1L �1 3 TJ 2 G I�/`mil(/ !.....•-- . Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other-Type of Building ............... No. of ersons:................._........................... Showers — Cafeteria 04 W Other fixtures -------------- Design Flow. ....................................... gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/&4Z)?)..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length......._.__......... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....................................................-..................... Date........................................ ,.� Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a' -----------------------------------------------------------•-•-••--•---••-•---......_-----•......................................................... 0 Description of Soil...............................................................................=........................................................................................ W v -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W -------------------------------------------------------------------------------------------------------------------------- ----------- U Natur 1�. pairs or A rati ns—Answ en applicable.______..___ _ ___ ____ _____ C ---------5--ra--------�----�-�-------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not place the system in operation until a Certificate of Compliance has been iss ed by e board of health. 2 Z Signed --------------- - ------------------------------------ ------- ---- ��---q-------- Application Approved By ............. ....... Y Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------- ------------------ -- ---------------------------------- .............. .. .......----..........------..---- ---- ------.....-------- -------- --......------------------- -- ---- ---- ....--------------.......--------------- Date t PermitNo. ..... -�---------------------------- Issued ........................-Date--.............................. ... �,... J �a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE� 7 -"1 y off Appliratiun for Disposal Murky Toustrnr#iu, prrnti# Application is hereby made for a Pe ' to Construct ( ) or Repair (x) an Individual Sewage Disposal System dress orot-L No. ..__...,.----------- - --------------------------•— -- --- ----- �(G - W ,i4 Yt' VV L'✓L/ ---------- Ownero� Installer Address Type of Building Size Lot_------------------------Sq. feet aDwelling—No. of Bedrooms_______________ ________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------------------------- -- W Design Flow-------------------------------------------gallons per person per day. Total daily flow------------------------------------------_gallons. WSeptic Tank—Liquid-capacity/.gallons Length---------------- Width---------------- Diameter----------------Depth---------_----- x Disposal Trench—No--------------------- Width--------------------Total Length--------------------Total leaching area--------__•_.--sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet------------------- Total leaching area_-_-_..---__--sq. ft. z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by------------------------------------------------------------------------- Date-------------_-----------------__ aTest Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_-___-__-__-__-"-_-_____ 44 Test Pit No. 2----------------minutes per inch Depth of.Test Pit----------------- Depth to ground water------------------------ P4 ------------------------------------------------------------------------------------------ ------------ -- ---- ------ 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------____ V - - ------------------------------------------------------------------------------------------------------------------------------------- W ------------------------------------------------------------------------------------------------------------------------------------- ---------- - - U Naturyof Repairs or Alt 2 ops_ hen applicable----- ---------- -----------------_ C ---------- - ------------------------------------------------------------------------------------------------------- --- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by a board of health. > Signed--------------- ---- -2Doe q Application Approved BY �1 - - - V Date Application Disapproved for the follouring reasons- ---------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- PermitNo- ---- - ------------------------------- Issued ----------------------u n---- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE QlPl'ttftrak of QIontplianre THIS 7Gj,�C�FY, That the I div-idual Sewage Disposal System constructed ( ) or Repaired.. ( X ) by---------------- - -� ------------------ - - -- -- -- - --------------------------- at ---------------�4-------------- L "�----v------------ ------------- ---- - ' 1 ,5 - f- ------ - has been installed in accordance with the provisions of TITLE 5 of a State Environmental Code as described in the application for Disposal Works Construction Permit No- _______� -- _ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------- -C f - - Inspector ----- -`-—-- ----- ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE%pusal Fig1w Tun fturflan i1jermit Permission is hereby granted_____-_____ __- 5 7� to Construct ( > or R 'r � an Individu S age Disposal Sy at No------3 --- -5!L/ w y�/- �jc/ _` ` /f XAA/(�/�k 7��— street as shown on the application for Disposal Works Construction Permit No_22 Dated__—___--� Board of gem ---- FORM 365M FI01388 Q WAMML W_- F1tBLESKERS -- L0CAT10 � SEW E P ItMIT N0. VILLAGE I N S T A l R'S NA i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED 9 DAT E COMPLIANCE ISSUED � 27,79 _ � T �� - ', 4 . SJ I, .� No.. 9�F F s....��'�� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH lv ..............-OF.. �'/��,��'........................................... Appliration for Uiipnsal Works Tumitrnrtiun ramit Application is hereby made for a Permit to Construct Ah or Repair ( ) an Individual Sewage Disposal System at: O/� _ x ......aG '..._..4>.......:........ 1r�.:.. .. -!' :.-- --... !1!�t.. ..._.........--------------................. Location-Addresses O or Lot N + er Address / ............................................ ............ ..- Installer Address Type of Building Size Lot../4dtlia____.._..Sq. feet U y ) Dwelling—No. of Bedrooms._._..._..._________________________Expansion Attic (�) Garbage Grinder. Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -----•-••--•--• •-••--••-----•--•--•-•••-•••-••-- W Design Flow................... 5. .........gallons per person per day. Total daily flow-------:330.....................gallons. WSeptic Tank—Liquid capacityAOTO.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...... .. >ameter.... Depth below inlet...... Total leaching area.�`6A-....sq. ft. z Other Distribution box (v Dosing tank a Percolation Test Results Performed by....... �Pl� ..... .. ..... Date.... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....A!1/V-------- --------•-------------------•-•••-••---•--••----•-••--............. •----------•. ....... ... .. O Description of Soil �� P� ?901 c !--"t= j � �o? ��......�.. e'e �.� � ...._. x .ill's ......... .....r l` J-<:Z��a!-----5 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 iITLE 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. Signe � `... . ................. .... _A Date . / Application Approved By--••.•.- •- -- .•. ---- .•••---.... •... ----------- -- -_ — - -—,.Date._. Application Disapproved for the following reasons:---•-----------------------•--•--------•----•----•-•-----•----------------------------•-•-- •••-•.._.....--•--- -----------------•-----------------------------------••-----•------------------------------•--------------------------•--------•---------........------------------------...---•---••••--••-•---------- Date Permit.No................................................... Issued. ? ..................... Date N .. .X. FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH OF Appliration for Elispnsal Workii Tonstrnrtiun Vrrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: --�' - ............. ✓1 I Location-Address /� (� /or_Lot No. /1✓/„�/t/Z A- .� cl. . (;+�Il��'" ,i/✓Ori� J.`.c...d-------------------------------------- d/✓/f�� De!'i'f W Owner �^ Address .. (r. N .. `G --- .......7 -- — -- -•-- --------------- -- f :..... .. Installer Address Type of Building Size Lot.. Sq. Dwelling—No. of Bedrooms............ ..........................Expansion Attic (� Garbage Grinder t� 'q Other—T e of Building No. of persons............................ Showers — Cafeteria al Other fixt es . . --•--...-•---•.......................•--•--•-••--••------------------------.....-••-------------------- Design Flow------------------ .$=..........gallons per person per day. Total daily flow....... l .....................gallons. W - - WSeptic Tank—Liquid capacity............gallons Length................. Width................ Diameter................ Depth............ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.._......sq. ft. Seepage Pit No....... ------------ Diameter....e 44_ ...... Depth below inlet................. Total leaching area..-- 15a ....sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by....... _C _ �,,,. Date...._5/ M:;7 .......................... Test Pit No. '1................minutes per inch Depth of Test..,Pit...._............... Depth to ground water......&..Zx.'7... _.. fTA Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water----e�&-------. R+' . ............... ...................................--............................................................... D Description of Soil-- �'_' �o EisY� ,/ ; - ? ' s-. ?:. .._*�r .'.__..F..... ^p r p r ` ---------------------------------------- ----- ----..! ^_ ______________ __•:__.._j--------- '^6 F .. ..All... •__' VW ........................................................................................................................................................................................................ 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 TIT:_:: y g g p y S of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. SigSig .......::•+!.... 1. ... ..... •-- ----- I hate w Application Approved BY { 1:� •.. . ....... ...... t-�------.....----- G Date Application Disapproved for the following reasons:................................................................................................................ ----••---•--------•-----••-----------------------..-----'--------------•------•-•-------•----------•-----------.............- ......------•- Da — PermitNo.................••-'----•---------•--.............•---•.. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k TWrtif iratr of &mplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....... J,!rZ...4.'... .... . .A..,/.< 1 r Installer/ at...... •--------------•----•----........---------`'----••- ----------...... ....................... - - has been installed in accordance with the provisions of . j of he State Sanitary Code as descrr�the application for Disposal Works Construction Permit N ._ .___ '�}�� .............. da.ted__,j�_-! .;.�_��----..-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEQ AS A GUARANTEE THAT THE SYSTEM W L F pVC�TION SATISFACTORY. DATE...... --•------.... ....... ................................... Inspector.... ..........----•-.......... - •----- THE COMMONWEALTH OF MASSACHUSETTS -- BOARD F HEALTH , R ye, ...........................................OF............................................................................... . No.....................•... FEE....................... �i��a��tl �rk� ��an�trnrtinn .rrntit Permission is hereby granted..............................................--------------•--...-----------------•-•---•--••-•----•----.......-••-•....................._.. to Construjt-( ,7) oS-Re�Pa )fan Ir�dividual�Sewa e disposalstem at No ' Street 0 w 2 2- 7(. << l as shown on the application for Disposal Works Construction Per 10, !� Da DATE................................................................................. ........ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS +i ti �► frame ,ti:►'' w � G � / _ M 2 S 38 4a Z� ' --A ., tir C Q3gPU, shy t 3 8113 IF A rt �� ✓y. �� OF ROBERT, F P. a, BUNIKIS � >'f 3 A p N0.22162�Q ., .. - 9 FGISTO t `3yONA'L ` l LEGEND : . EXISTING SPOT ELEVATION OxO , CERTIFIED •P LOT. . •;.PLAN. ' EXISTING CONTOUR =— = p S OLD Tc,W�f/ 120.4/y FINISHED SPOT 'ELEVATION 0.0 FINISHED CONTOUR 0 ----- =: !� Y.AN./v N APPROVED : BOARD OF HEALTH7149 " .r . BATE _-..._ 'A`GENT _ SCALE ' / �=_3o DATE L DREDGE-, ENGINEERING CO. ING - CLIENTS ^' I CERTIFY THAT-THE .PROPOSED" : EGISTERE� REGISTERED JOB N0 7.2 0Z.C� . BUILDING SHOWN ` ON THIS PLAN".''` CIVIL LAND DR. B.Y ►._• /i ?• CONFORMS. TO THE ZONING LAWS_.' ENGINEER SURVEYOR - -- OF BARNST BL MASS 33 NO MAIN ST. r 712 MAIN �.. CH, BY; �- ��. 7�. �• SO.' YARMOUTH, MASIS HYANNIS, MA;;S. .. � _ SHEET_L 0F _— DATE—.. REG. LAND SURVEYOR -.4 4< ,W, . '1V0 C 7 7N A SEL 0.4v lyi/V(:7 znr A MORE 7 -V 'CO PeR, CONCA-IF 7 JS . Ip PT. M/'V SNA&Z &AF &WOU6.q r 770 4MA OK CONCRETE IRo^l GO V4=jOR' 5,41,4 1-4. 45%0 Al 'o'7 oNe,4VY CA S /,F' A? 0#T/V,,=;V*A Y' COVER Y8"'osm' CoV CCAr 77,95 2% MIN. 5), COVER c CLEAN .SAND A, & L A ------ 'Llgalp LEVEL "LAYER 3/45 4" CAS IRON p le 0 0 00' ' 44. • WA SH,-D 57ONE --4 MW JC111rct, DISr S,6,0771C TANK WAsqh:'p STONE 17 PRECAST SEEPAGE P/7 OR Z' -, AD I AIVeA 4 R VA 7/,O*V.5 q 6 .07 INXERT AT &ZI/1-DIAICY F r M C SEE 7AB ZI L A 77) F7. 471A t,4/v,<� ±0_t, 5* Fr O4/^,7'/,=T SEPTIC 7'AIV.A< /Df--3 F7- GROUND WATER rA,64E --jN4Fr.015710,011PON BOX 0071-,67,015MRIBLITWIV BOX . ....... vo ay"=WA Oj=_ 01.SPO%SA 4 -S KS 7Aff Al�':-� �:,:�- i'�' ,- :xff4ll-A -1,V457' LrACHI'Va ")7 4LEACH11VCw O. 47jm.=1vs1 oAl A FT TCALE. F T. AFM IA PINK A/ 51 6N. Of/7' 3 NUMBER OF '&eL>'qO'oAfs GARAGE DISPOSAL(�N/T_ SOIL, I-oa- 'TEST SA011 7, TaI 7 "A7 AL *V-3-3 -0-6,44-/PA 7-- Ar A/ .DATE -0,07 SOIL TE-5-7, NUMBER OF 4,eACHIM6 c'/7,S_ • X S/OE LEACHING PER P/7 RESULTS IVlTNESSED BY Ia- RATE j* 7;0"'Mjtv'/ aor7-0^f Af Cr P�=-,R P/ so. INCH 4464 CHI Ant CO3LAT1 0 IV.RATE Ak 2.S 0,*1-- TOTAL 4,-AcH1wc-r AR�=A FT, 2-b6- 7.- R R-T-,=R V4-c 4S4 4W I ACr 4 RE.A sq 'A _6L' Flqa r P_ OBE A/ S' LA C3 �a BUr NIKIT % N vc N NG CAhWRI ray F, C-l-, 7 G eIST '-7/Z' "A/,y 33 A V, 40 NQ cr ovo'UN�P' GR 2'�,lj-" 'JO45 ro �R. LEGEND N � jTer, 98 -- EXISTING CONTOUR•x 100.98 EXISTING SPOT` GRADECD a °W OVERHEAD WIRESEXISTING S.A.S. G EXISTING GAS SERVICE ABANDON OR REMAIN W EXISTING WATER SERVICE Sunset CONNECTED WITH BULL TEST PIT Kenned LnRUN VAL VEBENCHMARK �', N 22'17'20" �V�C �j 8.75 98.69 74 50' x Croigville Beach Rd � LOCUS MAP U.P. SHED '•'" NOT TO SCALE ----------- - - 9,00 GENERAL NOTES: f.. .... :�99.02.:,. Y----------- l:• ;::::.... _;�°:;.�;`.•; ,.•.;>. •••• . >, `: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �� : BOARD OF HEALTH AND THE DESIGN ENGINEER. BULL RUN x 98.90 0 TP (10/300:3)`: >'; VENT 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS VALVE �TP-1 99.15 _ `: ;:.. : (OPTIONAL) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WALK SHE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: `. ::•' �Q1' TP-2 310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL ' O ; 98.84 1) A 10' variance, S.A.S. to cellar wall, for a 10' setback. 99.12 x "', . :. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR EXISTING SEPTIC TANK 0 BM,, :.,•.'.,j': .`:: , „ DESIGNPE TIONEER AND APPROVAL BY THE BOARD OF HEALTH AND THE TOP OF TANK, EL.=97.48 PROPOSED S.A.S. Zr iPORCH DECK 99,36 ,.,. .;.. :. ?,.<•,.: lNV(OUT)=96. 15t 2-500 GAL CHAMBERS 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING (no crawl) SURROUNDED W/4' STONE FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. .`o 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. :.STONE. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF "OR/VEWAY !.;; THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF SEX/STING Z HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 99 4 HOUSE(#34) 98.87 Q Z' '.:':`.;; 8. THERE ARE NO PRIVATE WELLS WITHIN 100' OF THE PROPOSED S.A.S. r.o.F.=ioo.of BENCHMARK 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS PAVED:'`• `.;. .: BULKHEAD CORNER AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 98,99 p OR/VEWAY EL.=99.36 DIRECTED BY THE APPROVING AUTHORITIES. / `' 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 9 .94 x 99.36 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING /. ••.`' ` ;98.999.19CONSTRUCTION. 11. _WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS + 8.43 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 98.39 118.00, 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE S 31*1 O'30" E INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 98.03 P, 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS U NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 97.71 �N* OF MASs9 edge of 97.63 pavement 9748 PARCEL ID: 267-154 Q 7. 7 C' 9 9 7. 4 yo w 9 2 o PETER T. �, PROPOSED- SEPTIC SYSTEM UPGRADE PLAN McENTEE 34 OLD TOWN ROAD, HYANNIS, MA CI3 5109 N OLD TOWN ROAD No. Prepared for: Robert B. Our Co, Inc„ 363 Whites Path, S. Yarmouth. MA 02664 REG/$TE � �� En ineerin b : SCALE DRAWN JOB. NO. OWNER OF RECORD 9 9 Y SCARES, EMERSON D Engineering Works, Inc. 1"=20' P.T.M. 163-20 34 OLD TOWN ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED f•� SHEET HYANNIS, MA 02601 (508) 477-5313 4/13/20 P.T.M. 1 f 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED EXISTING SEPTIC TANK FINISH GRADE SHALL NOT BE < EL. 95.5 FOR A DISTANCE OF 15' AROUND THE PROVIDE RISERS WITH COVERS OVER INLET $c PERIMETER OF THE S.A.S. SHED OUTLET MANHOLES SET TO 6" OG FINISH GRADE., PROPOSED D-BOX INSTALL RISER & COVER PROPOSED S.A.S. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=100.Ot SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=99.2t F.G. t F.G. .1 t F.G. EL.=99.0f VENT G EL. 99.2 .G. EL. 99 N MAINTAIN 27. SLOPE OVER S.A.S. p cc3` L - 8' ® S=196 (MIN.) p S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2" 3 ,Fj �. 4'SCH40 PVC 6„ 4"SCH40 PVC DOUBLE WASHED STONE 6 aaa�aaa (OR APPROVED FILTER FABRIC) DECK 74'• 2' EFF. aaaaaaa EXISTING as" LIQUID DEPTH aaaaaaa --3/4" TO 1-1/2" DOUBLE p LEVEL ADD GAS PROPOSED 4� 4.8' 4' WASHED STONE (no crawl) '. �9.5 BAFFLE INV.=95.67 _ INV.=95.50 INV.=96.15t EFFECTIVE WIDTH = 12.8' (VERIFY) 3 OUTLETS EXISTING SEPTIC TANK INV.= 95.00 H-20 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED 3" LAYER OF 1/8" TO 1/2" 1EX/STING DOUBLE WASHED STONE HOUSE(#34) TOP CONC. ELEV.= 96.1 t (OR APPROVED FILTER FABRIC) T.O.F.=100.0E BREAKOUT ELEV.= 95.50 INV. ELEV.= 95.00 aaaBB NOTES: aaaaaaaaaaa aaaaaaaaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.= 93.00 SEPTIC LAYOUT INVERTS, PRIOR TO INSTALLATION. 4' 8.5� 4� 4' OF NATURALLY OCCURRING VARIES-REFER TO SKETCH 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL AND PERVIOUS MATERIAL TRUE TO GRADE ON A MECHANICALLY COMPACTED STABLE 4' (MIN.) ABOVE G.W. SOIL LOG BASE OR 6" AGGREGATE BASE, AS SPECIFIED IN LEACHING SYSTEM SECTION 310 CMR 15.221(2). BOTTOM OF TEST PIT, EL.=87.4 = 3/4" TO 1-1/2" DOUBLE DATE: APRIL 7, 2020 (REF#TPT-20-60) 3) INSTALL INLET & OUTLET TEES AS REQUIRED. WASHED STONE SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH 98.9 A O 98.9 A O„ LOAMY SAND LOAMY SAND 21.3' OLD SOIL LOG 98 4 10YR 4/2 98 4 10YR 4/2 B 6„ B 6„ DESIGN CRITERIA PROPOSED N DATE: OCTOBER 30, 2003 (WAIVER) SANDY LOAM SANDY LOAM LO SOIL EVALUATOR: CARMAN SHAY CSE 97.1 10YR 5/8 22 96.9 10YR 5/8 24 co S.A.S. UNWITNESSED C C NUMBER OF BEDROOMS: 3 BEDROOMS ELEV. TP DEPTH n PERC SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) 8.5 30"/48" r') 98.5 0„ DESIGN PERCOLATION RATE: 5 MIN/IN 12.8 ALOAMY SAND DAILY FLOW: 330 GPD PERIMETER 320 97 8 B 10YR 3/2 8„ 2 5D 6/6D M2 D. SAND Y 6/6 BOTT.AREA=320 SF DESIGN FLOW: 330 GPD SAS DIMENSIONS SANDY LOAM GARBAGE GRINDER: NO-not allowed with design SKETCH 10YR 5/6 95.2 40" LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF C PERC 40"/58" .74 GPD/SF 87.4 138" 87.4 138" PERC RATE <2 MIN/IN. "C" HORIZON EXISTING SEPTIC TANK: 1000 GALLON CAPACITY NO GROUNDWATER ENCOUNTERED PROPOSED D-BOX: 1 INLET, 1 OUTLET (MINIMUM), H-20 RATED MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 7/6 SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 34 OLD TOWN ROAD, HYANNIS, MA SIDEWALL AREA: 76.4'(PERIMETER LENGTH) x 2'(EFF. DEPTH) = 151.2 SF Prepared for: Robert B. Our Co, Inc„ 363 Whites Path, S. Yarmouth. MA 02664 SUBTRACT SIDEWALL AREA NEXT TO TANK................................ = -8.0 SF Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA:............................................................................ = 320.0 SF 86.5 144" Engineering Works, Inc. N.T.S. P.T.M. 163-20 TOTAL AREA:.................................................................................... 463.2 SF PERC RATE <2 MIN IN. "C" HORIZON 12 West Crossfield Road, Forestdole MA 02644 DATE / CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(463.2 SF) = 342.8 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 4/13/20 P.T.M. 2 Of 2 . w _ _ - I 2000 +I SECTION ECTI N A A T PKS FROM ire ' ALL ouTLE s IPES ARE 70 BE 4 SCHEDULE 40 ,P.V.G; 10 min: from NOTE. ALL P ._. a 'ri.:O15TRBUTgN BOX SHALL 8E " tY COVER. o ndotion 'o' tic tank caNcRtTE Existing F u house t sap PROFILE VIEW OF LEACHING SYSTEM sTrr u:vEi FOR LEAST z�. k must be tan coves _ Septic - "r ELEV. ;100.00 Assur»td TOP OF FOUNDATION � ) : Not to colt �. _ - - . . within 6 to bt fTnishsd ode over SAS - ELEV=9&50 O s•-r.« .+ - 9r _ <. 3 5 OUTLET .. 2 2 �/ a - _ Grade over D-Boz 9E 50 f . Grade over Septic Tank 98.50 g S T :. . .::.. KNOCKOUTS STREET a nt A /_ ..es r...m�.` ss MnET a/�f b r l/? t►.rAwt tY,r�i 57ew. OUTLET , . tY � . 02 3 HOLE H 10 cf -T load - Elev. =95.t33 asr. Box 3 Maximum Cover oP -,-• ... '.• � n : • Exist.: .OI or t S Greater _ ' � T f AS Etev.= SO .1 m - rn op o S 93 : iss xTsr.a>rE o 1 000 GAL. s- o.ot toot _ q F � � PK , 4 SCH. 40 Te t.Ts• Q\� -� w r 2O T a 1 - O 1 FTtDI faIMDAT1aN a, co SEPTIC TANK Gr w H-10 LAN SECTION CROSS—SECTION CTION h n «. �.. o tneetne aspen `1 P SEC 0 SE `d Ro n o O a SITE o CONCRM FULL FOUN ATIO - > n q W 24 EH�the q C m m o RAIG V s .- 7 _ , ILLS , 0 5 units e 3 HOLE H 10 DISTRIBUTION 80X EAC s in.of 3/4 3 N H ROAD SYSTEM PROFILE n > .: cted storm - - - 4 ,: 35' , <, c cor^Do > ' u u > _ n NOT TO SCALE _ _ rn S 5 Nat to Scale c u _ LpCU MAP > v 10' a S c 0, r Effective 1/kfth Length.' u Effective Le T 8 in.of 3/4-1 1/2 ® GENERAL NOTES acted atone SOIL ABSORPTION SYSTEM {SAS) comp P 1. Contractor is<res onstble for-Dl safe notification T RISERS T WITHIN BELOW GRADE p 9 NOTE. ..ALL COMPONENTS MUST HAVE SER O 6 <� o •. . o and protection of all underground utilities and:pipes. COm INFILTRATOR MODEL 3050 CH 10 LOADING)/ SUMNER & DUNBAR p 9 p p ' shall a et` 2. The septic tank an -distn tion box s o b s OR EQUIVALENT) P „ t!. Bottom of Test Hob 1 Elev.=86.50 � Q level >on 6 of 3/4 -? 1�2 stone. , I 4' 1, d I sand or ravel with no . NOTE. OVERALL HEIGHT OF INFiLTRATOR IS 30 /EFFECTIVE HEIGHTS 2 3. 8ackfil shout be clean a g stones over 3": in size:' 4. This s stem Is ub act to inspection during installation Y 1 P 9 - 'Environmental a ices Inc., by,Carmen E..ShayServices,, 1 `i ll this system in accordance 5. The contractor shall nsto s r; plan with Title V of the .Massachusetts`state code' the approved a PE0 T10N TEST PP P R LA . and Local Regulations. n, an, 6. tf ;dunn installation the contractor `encou tars • 9_ Y f rc #on t October 30' 2003 Date o_Pe Colo I Test: soil conditions or site >Condittons that are :different: Y R.S. C.S.E.CARMEN E. SHAY,Test Performed B y . - from those shown on-the ..soil to or m our.desi n - B. .H, 9 9 ne s B :WAIVER per Barnstable0 _ , Results t s Witnessed W ( P ) ,., INC. _installation must halt '& imrnediate notification be HAY ENVIRONMENTAL-SERVICES l C S E 0 , it nm 1 ervi es Inc. Than MPt 040 _ made to CarTnen:;E. :Shay,,!--,. Em a enta S c , Percolation`Rate. ;:Less an 2 v r machine' shall drive over the 7. No vehicle o heavy ►Y - septic stem unless noted as H 20 septic components. e n ,L. Marcha t Y P NFHIe n .,. n itoutlet..tat ends. 8. install Tuf Tite as baffles or equals o a �--- LOT 40 g q _ f 'Test Hole # _ 9. Al( Distribution Unes ,shall :be 4 , diameter 'Schedule 40 NSF.. PVC. pipes. 1 ,, P P % 2 2 d -� .. 1 II rpiping, i in #ees :dc,flt i s shall be 4 diameter 17 0. A solid p p g. t rig DEPTH SOILS ELEV. w ter tight Ot- Sehedule 40 NSF PV(:.:pipes with a t g t 1 nts : 7 , 4. s 9a5o 5 . . , , 0 0 ' n Abutting Loam 1 1.:Municipal Water is Connected to ALL OF The Residence o d , in . Properties With. 150 'Feet San -----_- - ---- ""-- 10 YR 3 2' 98 p� ,. __, - TH 'PROP RZY LINES. ARE APPROXt TE:ANp ., __ E E MA 0 $ A 97.75 �` O p _-_��__ I H SURVEY PLAN GENERATED BY ___98 COMPILED FROM THE EY Sand s .-.,. Y . . . .-. ED K LL G C E. OF'OSTERVILLE `MA Loam f .. E O . -SUBDIVISION OF LAND IN HYANNISPORT MA - 'PROJECT BENCH MARK ENTITLED VtS , ivrRs � O s • • DATED QECEMBER .26 1962 TOP OF FOUNDATION .. , -..- � 8 $ 40 . 95.25 . �j 0 - . -. �. �. � ,_. AND IS NOT INTENDED TO 8E.A SURVEY PLOT PLAN ELEV. = 10000 Assumed Medium ( ) O TEST HOLE #1 5- IT SHOULD BE USED FOR NO 'PURPOSE OTHER THAN .Sand �' � . : Failed O �V 98.5 ELEV. 0 D I3ax �. : TH SEPTIC SYSTEM INSTALLATION.,. . 2�r T -LOT #39 teach Pit E /a ,- So 40 144 2 LEACH `PIT TO E PUMPED OUT AND EXISTING L C B EXIST. 1000 I. EX go FILLED IN PLACE AND OR REMOVED. _ Septic Tank HA _ NOTE. ANY STRIPPED OUT SOIL 'CONTAINING LEAC TE ------ --, T T N CH P T B DISPOSED r FROM HE' CiS I G LEA IT: 0 E 0 - DECK ,. , 1 'SPECIFICATIONS. t OF AS PER;60ARD OF HEALTH F --WI N 0— F THE_PROPERTY - NO,WETLAND, ARE PRESENT THI 24 O I I , Pere 1 ASSESSORS MAP 267 `PARCEL' 154 LOT #4 , P -4 to 58 Depth to . arc 0 s _ EXISTING Pere Rctt Less Than 2 MPI e I I . . LEGEND No Observed 'ESHWT 3 BEDROOM _ Observed 0132 ,... 1 No Groundwater Ob e MOUSE _ .� > I AS I DENOTES PROPOSED lIEs4 I I t t74X 1 DRIVEWAY SPOT GRADE 1 i . LOT 38 - i 1 1 ` r 1 DENOTES EXISTING F t; X 104.46 SPOT GRADE -------------- -- --�__� _ 1 ,w_ _r P 99 _._-.-` LOT 5 �,. .'. 1 , � , # t7 PROPEf�TY `.LINE , 1 I - __I `1 XO 690 Square`Feet + _ PROPOSED CONTOUR a / 96P - -- 99 ____ I; _ 118.00 --__ _ 97 EXISTING CONTOUR 4 N 31d 10 30 98 EP TEST HOLE & DE E H L PERCOLATION TEST,, LOCATION TYPICAL 1000 GALLON SEPTIC TANK OI J? TO N R AD E E L C 6 FOOT STOCKADE FENCE . NOT,,TO_SCALE 0 0 E N 2-tB'dAU. ACCESS MANHOLES 40 FOOT RIGHT OF WAY REV., 11 4 03 per BOH - .:Design caics an aank<location revised. / I • >: � „,;� 1 - �i . �-tee �f r,„�� ,. b _t.: . _ � � � � .- .-� P EA_ N �� . � i 7g e.3b k:.'. �fYi kr. Tr ".' r.. ,: '• .... . ,:103 �y-,�+� ,,�T � �. � �- .�,� � .SYSTEM UPGRADE ADE Our ET OF PROPOSC SEPT R a ; PREPARED .FOR THE ACCESS COVERS FOR THE SEPTIC TANK. , r WS11bBU110N 80x AND LEACHING COAIPONEN .. ... .: �- --T �. ... r-:-. - - -, .•, ;s£r o�roe THAN`e.u�s eaow f,�sHm �"' NELSON ��S O IJVE Ill GRAVE HALL BE RAISED >n rrtnlw s of .. GRAM CONCRETE srEa �.uvroRGED��cxsr +cONc AT FINISHED IMStALL TUF-1ITE GAS AFFLE5 OR EQUALS N ,-VI -W B :Pia E 34 - OLD TOWN ROAD THEREFORE DWELLING IS LIMITED TO 3 BEDROOMS 4•' v" � .. NOTE: SITE IS LOCATED WITHIN 'A ZONE fl, EREF WEW - ,; 3-2 ItE►10 ABLI:COVERS . .� /- T. _- �YANP RT MA _ .. SEPTIC SYSTEM OVERDE5lGNED:AT OWNERS RE4UE5 l %-14* r> Desl n Calculation9OFmin.'deo►arw:e �hf E A D 6B• 2'mW, .anrf to au . , _ � -SEwLEr 1. a c��. Number. of"Bedrooms. 3 Existm ,;E utvalent to 330 'Ga DaOUTET Gar a Grinder.',No CC bag �, ro : ,. Mina Per Title c� h Capacity Proposed: 30 Col.° Do Minimum . . ,- � _ Leaching Copa y rap _3 / Y ( � VE � U Septic Tank.>Exist., 1 OOb GAL S ' ., Septic.Tank 2 x 330'Gal. Oa 660 USE - Y INC.:rNVI 01VMENTAL SERVICES, N r, th 0 20 4 _ R i percolation rate of Q min. inch _�r SOIL AREA: , Using e c o on o •,,,. s . i • - ", .; 7 f x 4 0 ft. -, 296gallons, <... Bottom Area.:. .0. 4 al s t. Cl s :. o . �. _ 9 / 9 q 6 P.O. (}X 27 8 ,. _. ..f 48.00:. allons'... .:, ,. r.. Sidewall,Area. 0.74' ./s `ft. x '200 s t. 1 .- . . .. ... .. - � . ..., , EAST-FA MOUTH MA 0253fi � .Y .- >. �-Provrdm -_,444.00 allons '' . S N � L. , .. -....... 9 9 A 'FZ�P 8 0 . NI ; r .: a f _ TE FAX . _SOs ,54;3 _.a7§6 SCALE 2 — , HAVING`•A EFFECTIVE N S CTI N INFILTRATOR ERs G 2 E E �D E O Use. . 5 HIGH CAPACITY Fit OR.CHAMB A f1 i. CROSS SECTION ( ? .> ;.. ~ �— � RAW B�. . AT : OC OBE 30 _ 20 ' F STONE,.ON -TH SIDS , . _:.SCALE. 1 20 __ D N CES E D WITH 3 0 WA SON E E ND 4 W x 7 L . O BE SHED A ( 7 ..:. END . �' �, M SDSO P1�:7WG SHEET 1 OF . �. 2 5 OF WASHED STONE ON THEE PROJECT SD500. EILENA E. 0 , - .,..... , ,. ".. :e .. .'. r .:,. F.": f :. . r ....,:,, :.,..:. .. ..:.;- '..:., a .,.... .: ... •