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0041 OVERLEA ROAD - Health
t l Overt,�.a Drive ✓�. Hyannis A= 287 010 t / �`� r TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL aLX� ,� 1 'INSTALLER'S NAME&PHONE NO. :k a Vt ( 1 ';�C\\+C, S%V of q--) SEPTIC TANK CAPACITY �X"� IN-6 0 ur,L b®C.Ca LEACHING FACILITY:(type)\4 Esk\, (size) J NO.OF BEDROOMS OWNER y\ 01f PERMIT DATE: a COMPLIANCE DATE:Z M 1 �� Separation Distance Between the: / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility U Feet Private Water Supply Well and Leaching Facility(If any wells exist on II''p� site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within y 300 feet of leaching facility) ` / Feet FURNISHED BY V � ®S' laC • o nV� a r � � c LdLi cis t � J 6'' f q No. 45 'r l� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Mfiaposi ConstCULtion permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4( O s'e r l" F—A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ( J �P-1,hcrc( tc+ I roy (.� k J ve-les ct t-4 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C -local Sce1k Vrc.r\W kQ oLd Ycrr�Ok3 - �j %DAVID &060�'4vaioz, Ty P1S �� 1 �9 Cj 0�6 5 157, Gaur� etei- ��9 Soak r,V 6 C?�f U p of Building: Dwelling No.of Bedrooms Lot Sizes sq.ft. Garbage Grinder(04 Other Type of Building -k No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 6�� gpd Design flow provided (J 13•C� gpd Plan Date ►T�6'i `�t I Number of sheets Revision Date Title N.t+'Q. t'iYl PA/11 Size of Septic Tank S y_ Type of S.A.S. 4A w h yr.S t,,J Sl©q e Description of Soil I_ J:o p6p,�� S ob5p t(, Srl kl Nature of Repairs or Alterations(Answer when applicable) P0410 i Co 1 N p 5 e 4 I`. �]�/S t tl�i- S S, Po iy P Vie-,.v r 1(4#1 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 Health.Signed Date LA I,2 S' `pv Application Approved by �(b✓ ��l�� i5 Date Application Disapproved by Date for the following reasons Permit No. �.,���� « �) Date Issued07/ •� . .+ .+. —os."na.w :.yfj�=: `PK',v 14t..�`X"Mr`',.w.,6. 1b 'Z. - !' r ' No. �� (,� 1 Fee 00 t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWe N OF'BARNSTABLE, MASSACHUSETTS Yes ftPfitation for MisposdIOPttem Construction permit Application for a Permit to Construct Repair( Upgrade Abandon PP ( ) p (� pgr (' ) ( ) ❑Complete System ❑Individual Components Location Address or Lot No.4( O d P r ie j �A, 14 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � (0 fir K' (r°Y �l c)vP� eti t2. - A. Installer's Name,Address,and Tel.No.. Designer's Name,Address,and Tel.No. SGa!{ �rC.nVL t t 7 Otd Yc.r r-w0VV- qd t�AviD couGOAV6149, Rf SOS ¢ 47 j� 34Q D6 b� 15S Gkorl'c R-MPr, Rd Solt, Type of Building _ 1 e p .. ;r ' Dwelling No.of Bedrooms G Lot Size � t sq.ft. Garbage Grinder(no) Other Type of Building t y`A(.�4_ �` r 3 r 1' Flo j , No.of Persons Showers( ) Cafeteria Other Fixtures .�. o �"' r<•. �_ ,.. '• Design Flow(min.required) `Gy ' a gpd Design flow provided Plan Date kt 1 t �1, ?�oI f Number of sheets Z Revision Date gP Title S ew OA? I . S',o a h1 pI gh Size of Septic Tank Se Type of S.A.S. 4e-'4e m(1 PtS yj Sl oii e ` r Description of Soil t� O D5� i t S I/hS0 i 15g lM , Nature of Repairs or Alterations(Answer when applicable) PV 4i 9 i CO 1 jA A S e o �d � /S��b h Q- iqHkf�kt 11 h �o r1Pb,: AS np� �IGn 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 Health. ` Signed- r,...+r Date LA f /2S 1 IX Application Approved by ''NAy%.i(b. /'( Date ` / y Application Disapproved by Date / for the following reasons Permit No. Date Issued /rl ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of (Compliante THIS.IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�-°� Upgraded( ) Abandoned( )by_ C ��hy n,,AV�— at _'# ).&,r Ipr4 Vv, g r r�c - has-been-constructed in accordance- with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer 3C Cs 1A lam N/ c-c.�r �ll. Designer yI d C6wi'gnow r #bedrooms Approved design flow �" �.�. gpd The issuance of this permit rshall not be construed as a guarantee that the syste will f nc on a e"signed, ....., Date. /� f Inspector . ... ` — , ---------------------------------- ----------------------------- ------------------- ... No. Fee , .�- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( v)ooe ' Upgrade( ) Abandon( ) System located at Vft 1t, R kM A,,I n,14, gee . p and as described in the abov"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 musstt/be completed within three years of the date of this permit. r Date 1 _Q ~� 7� Approved by _'V. �!`r�( � 1 .?r�✓"7:��t°� iL Town of Barnstable t r Regulatory Services Richard V. Scali;Interim Director * RAMSTna[.E, MASS. Public Health Division i63q. ♦0 i°rFn nna�" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Sewage Permit#-.joSY Assessor's Map\Parcel 7—I 0 v, C_0% w, Designer: pw � Q�'1�Wh d Installer: �Cc� � /\A Address: i S Geode Ry4e r R� 4a��h Address: C>k3 C hq-t- 1m, vo 02G 3 3 r� �l s Mc- On CCC,/\V(__was issued a permit to install a (date) (installer) septic system at "� ( �V C'r � based on a design drawn by (address) D q V oa Co Ot� dated l ? „ (designer) - V I certify that the septic system referenced above was.installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above'was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. 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 constructe -\N of Mq ith the terms of the I\A approval letters (if applicable) �o� DAVID o D. COUGHANOWR No. 1093 :Installer's Signature) t' STelk SANI TARN (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc �* TOWN OF BARNSTABLE LOCATION c7Cj4,2 SEWAGE # c VILLAGE ®y'Q ASSESSOR'S MAP & LOT�� la INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size4O) /,&,vp NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 11�UIZIt£ Ps.%J/Z2,�dro DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� a v � N � �� e � �� o � �� � fi `�sz •i �M 0 V � ..a� \.�l 4r �� �� rl ` '1 f J LU-CATION SEWAGE PERMIT NO. emo VILLAGE 4 / -f - INSTALLER'S NAME A ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED T DAT E COMPLIANCE ISSUED , � �III -22' f 42 � �tcm GAL Pmopa P�Ta 55` VL In _ Town Office Bu-Nding No.... � Southft - i,JV1,A O.ZZ64 THE COMMONWEALTH OF MASSACHUSETTS , , BOARD OF HEALTH ' nl OF - Appliration for Diopoottl orko C rin-pt irtion rrrmi# Application is hereby made for a Permit to Construct' ( ) or Repair ( ) an Individual Sewage Disposal System at: Location- dress' or Lot No. ....... .�.... . � . .._ . � ................ .......................................•- . ....................._.. ........ Owner Address W Installer Address Type of Building Size Lot................ Sq. feet �-. Dwelling—No. of Bedrooms............. .........:...:..............Expansion Attic ( ) Garbage Grinder ( •) . Other—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria 44 - r fixtures Other .--••--••---•----------------------------- d _____.-----•--•-•--•-••-----------a........................................... ....._._... WW Design Flow............ Zj.:...................gallons per person per day. Total daily flow......4P__U_0.......................gallons. W, Septic Tank—Liquid capacity!_.��__�' gallons Length................ Width.........__..... Diameter.................Depth................ x Disposal Trench-No_____________________Width_..._...:r:._._.... Total Length.................... Total leaching area....................sq. ft. �..:_. Depth below inlet___ ......`_..... Total leaching area________________s ft. W Seepage Pit No.......... --_-_--- p g q•._ Diameter.__..__.__ 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........................ Test Pit.No. 2................minutes per inch Depth of'Test Pit.................... Depth to ground water........................ a =-••-=----.---•-•--••.......................•----••---•.....---•-••=---•----._...----•••------•--..._...--•-......---•----••--•-------•••-•--•....-- ODescription of Soil-----.......................................................................................................................................................•----••-_..... V --------•••-----•--------............................................................ U Nature of Repairs or Alterations—Answer when,{�applicable..... _ _ .___ �-0••..._... C �, :-•yam 1 ti J�`�-----..... t --- =1 fJ:�T ..: =c i1 _... _4 ....:...1.. `-T Agreement: The undersigned, agrees' to install the aforedescribed Individual Sewage-Disposal System in accordance with the provisions of TJITL2_ 5 of the State Sanitary Code— The undersig ther agrees not to place the sy ' stem in operation until a Certificate of Compliance ha - ued by the boar of health. igned........ ... ................. .................... ..... .... . -f5 Date Q� Application Approved BY - -- • •-•••••• �•'` Date Application Disapproved for the follo ng.reasons-.................................................... - - .................................................•••••••----•--•-•--•----•••-•• ---•--••--• ---'---...._...---......._....-----•-•-•--------------------_--------•------ • ..._...-•-•- Date PermitNo.................................... -=------•••--_.... Issued....................................................... Date ,' , a.uq,y +°J �L+" G - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for 14spuual Varks Tonutrur#ion "ami# Application is hereby made for a Permit to-Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: [ ii ` Location-Address t - •- G J� \ Y or Lot No. .r ! G_ ..`S ....-•••-•••........-•-•...............••--•.._..................._..... Owner Address W M Installer Address Q7i Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.. _......,.. ..............Expansion Attic ( ) .Garbage Grinder ( ) Other—Type of Building - No. of persons....................... Showers a YP g •----....-•--•-•------------ P ..._. (...>._— Cafeteria Other fixtures . ------------------•------- -------------•------- WW Design Flow........... ..--.-__--------.--gallons per person per day. Total daily flow.....-1r'.1A.-'Q___._--•-------------...gallons. WSeptic Tank—Liquid capacity!_4�.-.�_dgallons Length................ Width................ Diameter...... ..... Depth................ x Disposal Trench—No..................... Width..f_............. Total Length................. Total leaching area....................sq. ft. Seepage Pit No......... ........... Diameter..........--a-.... Depth below inlet..._......._...-- Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................,... fsr 'Test Pit No. 2..........._----minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--••-•--•-••--•••--•...............................••-•---••--•...-----••--•-•••--•--••--•--............--•--••-•--•.....•••-•--•----•-••-••••••..........-- 0 Description of Soil................................................................................................................................................ w U Nature of Repairs or Alterations—Answer when applicable_..-.. ��w!2G�aP�... ?_ ___ J.... . '._ __.no- ...... ;! ......•e. .._.. !!�i ------- '�^1c-------4X. Z>o....�!C- ��.�-=S`............a-�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE. 5 of the State Sanitary Code—The undersigned-further agrees not to place the system in operation until a Certificate of Compliance.has.bee--_i ued by.the boar of health. igne _ a_E - Application Approved By-•---•-----•. .._.... .(_.._. F" ..._... ". p ... r •----•----• ^ l Date Application Disapproved for the follo ng reasons:.............................................................................................................. ......................•--••------•--------......------------••••........................... ------..................•..•.....--•-•-•-•----•-•--........................... ......-••-•-••-- Date ' Permit No................................................... -- Issued....................a ....: Date................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Intif iratr of Toutplinna THISCERIFY, That the Individual Sewage Disposal System constructed ( ) .or Repaired✓'..'by........ "tall Q^ - •-• . .... .... •=••--- •-•-- �L Installs t J / at. .. ............� J1............--------.--•---.........._.._..........._:�t/>✓t� ...................................... has been installed in accordance with the provisions of TITLE _5 of The State Sanitary Code as described in the application for.Disposal Works Construction,Permit No.......1:S?'.. .1(?•r..0........ dated-------- F;,7................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM V11.1�I F U)NICT�N SATISFACTORY. �Ww DATE ....... ....... ............••--•--•--••..................--••-••... Itw9g o_r... --••-- --•--••••-••-••••-•--••--•-•---•-••--•--•-........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH (I u No.... FEE........................ � Permission is hereby granted_ ' >` __' t' A to Construct ( ) or Repair ( ) z Indrordual ewage Disposal System -T ...................................................... k as shown on the application for Disposal Works Construction Permit t1 o '_ ---- ted �� .� _. - •- --•-•-•..........•••.....--•- ,R.-� .� �� oa of Health DATE... `�--.:�.-�"._`.. I ill over(,��?- e Er cD Certified Mail Fee XS 10 r $ 0 Extra Services&Fees(check box,add fee as appropriate)', " (71 ❑Return Receipt(hardcopy) $ #- O 0 ❑Return Receipt(electronic) $ t W 1 0 �a C3 ❑Certified Mail Restricted Delivery $ NII (!_Me O []Adult Signature Required $ t []Adult Signature Restricted Delivery$ I�C3 Postage Ir (fs P S I r, Total Postage k v► $ ent To KILROY, BERNARD T TR O Sheet an --dA-pt-i. 41 OVERLEA ROAD _ _._... Ciry Stale;Zl _ HYAN N I S PORT, MA 02647 y- Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS(D-postmarked Certified Mail receipt to the ■A record of delivery Qncluding the recipient's retail associate. ` signature)that is retained by the Postal Service— Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Maii service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,It should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix It to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the'mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Farm 3800,Apra 2015(Reverse)PSN7530-02-0OPe047 t3 Complete items 11.:2,arid; l x- A. Sig turew. ! G Print your name and addre a the reverse X ❑Agent so that we can'retum the co you. ❑Addressee I II] Attach this card to the back of the mailpiece, B/1 eceived b ( nulled ryame C. Date of Delivery or on the front if space permits. 'c/'"r D. Is delivery address different from Item 1? ❑Yes If YES,ente&deli address below: ❑No O 1',NIS 6'0�0T KILROY, BERNARD T TR 41-OVERLEA ROAD " HYANNIS PORT, MA 02647 ! ?p7a II I�III01 ial I01 I II II II I I i IIIII I II ID I II I I I III 11 Servio T L , p Priority Mail press® ❑Adult Sign r• °�'•O Registered MaiIT"'Adult Signatu �tad:Deiiver-Y-., ❑Registered Mail Restricted 9590 9402 1933 6123 1781 56 Certified Mail Restricted Delivery �' �iu Receipt for ❑Collect on Delivery Merchandise Tiansfer_from_Service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation n-IncurM_Mail O Signature Confirmation 7 015 1730 0001 4987 6 9 6.4 1ill Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt I t USPS TRACKING# First-Class Mail Postage&Fees Paid Permit No.G-10 I 9590 9402 1933 L123 1781 56 jUnited States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 t�T Town of Barnstable Barnstable Regulatory ± Re ulatorY Services Department ADAmalcaCky &MtNSrnsU 1 MAS$. O 1639. Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6964 March 15, 2018 KILROY,BERNARD T TR 41 OVERLEA ROAD HYANNIS PORT, MA 02647 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located of 41 Overlea Road, Hyannis,MA was inspected on 02/15/2018 by Sean Jones,certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace.the septic system within the deadline period will result in future enforcement action. PER ORDER OF E BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V P Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\41 Overlea Road Hyannis.doc THE T, °* Town of Barnstable • � aiawcTlarr Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA*02601 Office: 508-862-4644 Richard Sca%Director FAX: 508-790-6304 Thomas A.McKean,CEO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-4-4 and Title V: 310 CMR 15,000) _ 'Au`x"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLEYE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool.within 50 feet of a private water supply well with no acceptable water quality analysis.'(This system passes if the water analysis ` indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER e Repair deadline: Q:�SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts a87 - 010 Title 5 Official Inspection Form Subsurfac w m e Sewage age Di sposal System Form - Not for Voluntary Assessments M y 41 Overlea Road Property Address K) Bernard Kilroy Owner Owner's Name information is required for every Hyannisport ✓ Ma 02647 2/15/2018 ' page. Cityrrown State Zip Code Date of Inspection �a -M 1 Inspection results must be submitted on this form. Inspection forms may not be altered in any -way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information c on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection, Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 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 2/15/2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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•3/13 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 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is H annis ort Ma 02647 2/15/2018 required for every Y p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -41:Overlea-Road. Property Address Bernard Kilroy Owner Owners Name information is required for every H Yannis ort p Ma 02647 2/15/2018 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑- Pump-Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): F ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ' r ❑ 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 i6 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every Hy p annis ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The.system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge-or,ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow - t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY P annis ort Ma 02647 2/15/2018 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. E] ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY p annis ort Ma 02647 2/15/2018 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? _ ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY P annis ort Ma 02647 2/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include-laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No , Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 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 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY P annis ort Ma 02647 2/15/2018 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY p annis ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1985 per town asbuilt Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 611 t5ins•3/13 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 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every Hy p annis ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" 31' Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid, levels as related to outlet invert, evidence of leakage, etc.): Water level even with outlet invert, tank was not leaking. Tank needs to be cleaned soon. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is H annis ort Ma 02647 2/15/2018 required for every Y P page. Cityrrown 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: F ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 41 Overlea Road Property Address Bernard Kilroy i Owner Owner's Name information isequired or every H annis ort Ma 02647 2/15/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 211 Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in paved driveway with steel cover. Box is rotted. Box has 1 inlet and 2 outlets, water level was uneven.in d-box with level even with 1 outlet and 2" above outlet invert in the other pipe. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systemt•Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information isequired or every H anniS ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ 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.): Both leach pits were video inspected fron d-box. 1 pit was found full into pipe with high level in d-box. 2nd pit was found to have water level 1' below inlet invert with signs of higher levels in past. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information isequired or every H annis ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is H annis ort Ma •02647 2/15/2018 required for every Y p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0i � 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Srey�t 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY P annis ort Ma 02647 2/15/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells . ' Estimated depth to high ground12'+water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Wria 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments, 41 Overlea Road Property Address Bernard Kilroy Owner Owner's Name information is required for every HY P annis ort Ma 02647 2/15/2018 page. Cityrrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 s Town of Barnstable P# 15-4016 Departitnent of Regulatory Services Public Health Division M � 2Dl Mom, Date)AM l t idle + 200 Main Street,Hyannis MA 02601 Z // m' Date Sc6edu16dt � J C�`'�#• �'� Ti'ma� � Fee Pd. Sa►rl Suitability Assessment for S age Dzsposa Performcd•By:_David Q, (`D ye ka a tyy, Witnessed By: LOCATION&.GENERAL INFORMATION Location Address l Uef te-1 P Owner's Name ge1-"rcj �1 YDy, it Address~ :' =- , a 4 y Assessor's Map/Parcel• 2 p 0 7/O yyEngineer's Name 04vi d' 1 . ,/ e NEW CONSTRUCTION' REPAIR � 1 (%' -�� Tele hono# 2, cC 3 Land Use• Slopes ' ~ I�'•�� A�' opes j96) �"� �p ,.:,Surface Stenos "�O H � a ,i t l' z �, �I Distances flnm: 0 on Water Eod ('00 '� (�t? ft Drinking Water Wall 00�' ft P 3 ft "Possible WdtArea Dralhage Way , 0-A ft Property Line IL+ ft Other ft MUM(Street name,dimensions of lot,exact locations of test holes&,per a testa,locate wetlands jn proximity to holes) � . r • . . l33zg� c , Parent material(geologic) 1' r6rVL'-QCl q 1 0V f WqA Depth t0 Bedrock y 6v� r Depth to Oroundwater. Standing Watcr In Hold' V\OVl e— "" ••Weeping ltotrl Pit Food h®h Estimated Seasonal High Oroundwater VWOfL `Fk�1/1 �'�(�>I yt DETF�RMINATION FOR SEASONAL'IIIGH WATER TABLE Method Used: De th Observed standing in obs,hole: In. Depth to toll rilottle1.. NonC.4f.I IN Ian• Dd th to weeping from side of obs,hole: In, 't,roundwater Adjustment ft, Index Well# Reading Datd:_ Index Well.leval _ , e Adl,•#hotor T—.Adl,f]roundwaten•Laval PERCOLATION TEST Date 3135 IS nme 44-5 Pht Observation Hold# ' r Time at 4" Depth of Pare Time at 6" start Pro-soak Time @ Tima(4"•6") - End Pro-soak Z'` Rate Min./Inch Nl 'a� 5 Lj x Site Sultablilty Assessment: Site Passed Sito Fallod: Additional Testing Needed(YIN) i F ' tq .'• .�+ Priginal:i,Public Health Dlvlslon Observation'Hole Data To Be Completed on Back .c **tllf percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least out(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC l- . DEEP.OBSERVATION HOLE LOG Hole# I Depth from Sall Horizon Sall Texture Shcl Color Sall. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stonci,'Boulders, tslatancy.% rival) 0- 11 l� - 6 AP �i�i 7�ihd U' IZ''l2 �enP ��iq�lP DEEP OBSERVATION HOLE LOG Hole# . Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. (� `ZQ 2.0 -�� Loony 4"d 10 9-3(2.- )tJc,ne r�&I ble Fr lei 54-14 C, �kk'ivyl Leo se DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldem. DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color 81311 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SSopcc Boulders, Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No r! Yes Within 100 year flood boundary No. Yes . Death of Naturally Occurring;Perylous Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorptibn system? If not,what is the depth of haturally occur ibg pervious material? Cer"tl-won �ca �.� I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me conslstgrtt4ylrl the required training cxpertl a and experience described in 410 CMR 15.017. E:��� OF•Mgss Signature Pal Dates DAVI D. � a ;i COUCH NOWR .;�0 �/CENSER �0 Q;WEPTIt_1PBRCPORM.DOC :> E VA L U P down cape engineering, inc. SIEVE SOILS ANALYSIS 41 OVERLEA ROAD HYANNIS, MA DATE OF REPORT: 4/5/18 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST srm 41 OVERLEA.ROAD, HYANNI LOCATION: DAVID COUGHANOWR TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 193.0 I SIZE :WEIGHT RETAINED, % DETAINED %PASSED --- .(sum.) . ---_ __.._ 9' - - - 1' 0.0' ---- 0.0% 100,0% ----- ------ ._.._. ...-- -------- ------ ------------------ 314" 0.0 0:0%: 100,0% 1/2 0.0? 0.0% 100.0% ----- - 3/8" 0 0-- ------------0.0-2: -----100.0% #4 0:0%;. 100.0°l0 ! ------------ --------------- •---- -------- -------- - •--._------- #10 = a--------------4 6% 95.4% 920 50 J 26 4% 73 6%0 ------------ '' -------•-.._.. ---- ------- --e._.._............. t#40 117.7, 61.0%; 39.0% ---- ---- - --- #50 152;0� -- ----- 7f3:S%; 21.2°fo rF80. 177 1: 91 8% - ------ #100 182 5; 94.6%• _____5.4% •-------------,.............................--------------------- ------ #200 189.7 98.3% 1.7% PAN 19'1 r5: 100.0% 0.0% 19 ._._ _ SAMPLE: 3.0, NOTE:TEST ON PASSING'#4 ONLY,0.5% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS.AASHTO A-'I-b(GRAVEL&SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE-: #4 100% (TESL'ONLY MATERIAL PASSING 14) OI< 05010110-100%o OK #100 0°/n-20°/a OK #200 00/6-5% OK SAMPLE MEETS TITLE 51FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL:CLASS 1<12`MIN.#IN. MATERIAL s DANIELA. NONCOMPACTED O.t11LA SOIL DESCRIPTION: MEDIUM COARSE SAND " CIVIL fi�a.�fi502 C9� Ca�4T t 1ONAt. ...,,,—.„..,,�- { a L Fee-4�-------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVe[r Congtruct ion Permit Application is hereby made for a permit to Construct ( +f, Alter ( ), or Repair ( )an individual Well at: 9------pvE2�E.¢ RoR� — --- 1o> �. 1-, - ------------ ------------------------------- ---- ----------------------------- Location — Address // Assessors Map and Parcel 1.44,2/F &)4�e C' .c/ -7,/ - - - ---------Owner Address 0455M nv L�/EGGJ�/LG ivy--Z L - 0 - �X -a 8 3 - �G� .vs-------------------- Installer 53 — Driller Address Type of Building Dwelling Other - Type of Building ------ No. of Persons----------------------------------------------------- Type of Well---�y`-SCho,°U G ��-- a = Capacity- Purpose of Well Il.V-------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed --- ------------------------------------------------ -- ------------L----------- date Application Approved By ---- - --- -- —- —--------- date— ---- -------------- Application Disapproved for the following reasons:-------—-------------------------------------------------------------------------------------------- --------------------------------------------- date PermitNo.- Issued------------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE certificate ®f �Lorup[iante THIS IS TO CERTIFY, That the Individual Well Constructed (fit), Altered ( ), or Repaired ( ) by--------- - - In ---------------------------------------------------------------------------------------------- at ---- - - ------------------------------------------------- has been installed in accordance with the provisions of theq own of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.V?K-1-2 --------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- -- ----- Inspector---------------------------------------------------------------------------- r Re Via► ''AArr qq i w No.Y --- i Fee-406------------- - BOARD OF HEALTH TOWN OF BARNSTABLE Appricat ion-*rVe[C Con0ructionpertmt i 1 Application is hereby made for a permit to Construct ( V11, Alter ( ) or Repair ( )an individual Well at: Location — Address ' Assessors Mapand Parcel �s_A Gk'/E &Ao�' P � — — -- — — —'S / OUE�'G i4 /��� A/✓N/5 OR — — — Owner Address Ce14-KI-5 /t.4 �Z65 Installer - Driller Address Type of Building Dwelling------✓--------------------------------------------------- Other - Type of Building ------------ No..of Persons-------------------------- Type of Well — BSc<� -- ����_ Capacity---o20?/1---------- - - ----------------- ----- Purpose of Well--------- '11r_ 9AT719/J------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance.,with the provisions of The _-Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to place the well in operation until a Certificate -of Compliance has been issued by the Board of Health. Signed -- - -- -- -- - -- --- — ----------------- ------------ date I. Application Approved By- ——=---= - :-------— - ---------- --- -------------- 1 date I� Application Disapproved for the following reasons:=----- -_. ------- ----------------------------------- -------—-------------------- ---------------------------------------------------------------------------------------------- date Permit No. — = - ----— --- Issued--- ------------------------------------------------------------------ k 'r` date .�.°:r -�:a'. .... ._. _ -. ..+..=,..+n....,rr....-. :ward, w+ri4rraw+„c �sw.n► �+:r4ra.+.m..��w, ., ,—: ., _.:�u*r.�:c +--�ua�: BOARD OF HEALTH TOWN OF BARNSTA:BLE Certificate Of. Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ('xl Altered ( ) or Repaired ( ) by ----- - - - - - - - -- Y- ----- ---- -__- Installer 1 at--------------- L1-------- —: — --- --- ---- ---------------------------------- -------`--- has been installed in accordance with the provisions of the own of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.V?Y ---------Dated--------- ------------ THE ISSUANCE OFfTHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- --—=------— - ----- - -- Inspector----------------------------------------------------------------------------- w- BOARD OF HEALTH TOWN OF BARNSTABLE well Con5truct ion Permit N9w 1_J1__�_ Fee--- �- -------- Permission is hereby granted---- - ----------------------------------------------------- to Construct (, ), Alter ( ), or Repair ( ) an Individ al Well at: No. - E— —��—` ——1 --. -- -- -i-- --- Strj as shown on the application for a Well Construction.Permit No• ------------------------ - — ---- --- -- — - Dated------- A_7'z-�---`t?9----- - ------------- - - ------ -- ----------------------------------------- . .-...._ , �oard of Health DATE----- — ---- - - -- --- --— - .vi � J �tj �1 00 22 0,00 g LOT 1.1 rr )FA MY s iiiii::: 9• lt7CJ7VTAIN 7 :/riiiiiii ' LOT s L0T SN. O c� �0.26'00„ 133:28 74' 35 � car ,�0"�'.• � . , ' _ 1 — N80.0B - NOTE.- OWNER OF LOT 6 HAS THE RIGHT PO DRESERPE`AND MAJN?AIN THE" GARDEN AND THE GARDEN W4LL ON .IOT 6 AS APPURTENAT TO LOT 5.-- SEE DEED ,FROM HORAN TO LAMPROS DATED 61161/rET RES.. Z0JVE,- "RF-1" This MORTGAGE INSPECTION plan `S For FLOOD zo�vs' ftnk Use On TO,Y F -777ZY OF- RZ--------------- REGISTRY OWNER: E--UDEjY,TId1,-hIOMZ_�LO�?T��6��' DEED;REF: --CTF,4fF-Q,9�'�9-----------BUYER: UR.II _EI._. '6R8Fhj-_ -- --- ---- -_- DATE: _J,?1-a1--8.4 PLAN REF: _1 Z3062- SCALE:-„ -F I, = T. I HEREBY CERTIFY TO �IIYCZP�Y.. AV1�Yr '_861YI ,-- -----�w----- �50r- _F THE FIRST A,VERICAN TITTLE PQ:Z, CO. TH.AT THE BUILDING itµ OF AW YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �.��``� CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ - CONFORM �. pAULK TO THE ZONING LAW SETBACK REQUIREMENTS OF THE C) MERITHEW 40B INDUSTRY ROAD TOWN OF ---BAR1y5"T,�_9LE,�______---_,_-AND THAT NO, 32098 ARSTONS MILE.,, MA 02648 IT DOES- 1V(J7'— LIE WIT14IN THE SPECIAL FLOOD HAZARD ,o p� TEL: 428-0055 AREA AS SHOWN ON THE H,U.D. MAP DATED—V-?. A,2-- FAX 420-5553 Co unit —Pane 0001-0011—D qh _ __ _ THIS PLAN NOT MADE FROM ENT 16140 GGY PAUL A P 5� SURVEY, NOT TO BE USED FOR F CEG, FTC. PTO � IFO � � TOT �� ' a L�LC�CINO scALE ! EC SEPTIC COMPONENTS OVERLEA 9 �. - R 1500 GAL o T E ECo qo m tABIE. GIS p � SEPTIC TANK® . LOCUS 5 A O N T pP U WACHUSSETT EXISTING EXISTING. S G LEACH PITS TO BE PUMPE D, ELEVATION O � FILLED AND ABANDONED IN PLACE. 53. 18 O LEACH PIT/ AVENUE CESSPOOL SLEEVE LINE WHERE SEWER AND T0p0F WATERG DISTRIsurloN aox® ,R„ING AVENUE ® WATER ER LINES CROSS PER TITLE 5. TEST PIT HYANNISPORT. MA L 0 C U S hWAP 0�� R _ L;LAL CALL ROoA1DR TO ATIONSO _G R RGROUND EFORE nsOTG FOR 3�8 4.15 ft M. (�\ 2 A OWED - d6l.05 _ I 58 ft bQ.60 / G >> 64 .I8 ft 66 J T J9 PA VED DRIVEWAY o \ PAVED E 1 DRIVEWAY THIS IS A COLOR / I 1 PLAN I USE COLOR PLAN ONLY 1 / 25 it FROM INSTALLATION 1 FULL DETAIL IS BEST I / IR IGATION WELT VIEWED IN FULL COLOR I 0 / 0 � I �0 0# / o VENT PIPE , cy 10 O 0 F2. N P _ 30 I 0 t _.. 2 � / / I PROPOSED SOIL ABSORPTION SYSTEM 1 / / -SEE DETAIL 1 / ON BACK IE / - I � I Q UTILITY POLE $ I WATER GA O TE ' \ I lJ WATER LINE 0 MINIMAL GRADING ELECTRIC AND PROPOSED TELECOM LINES GAS LINE ' 00n }) \ AREA = 58959 sf+- 135.74 ft l I LAND COURT PLAN 173081 D Q _ \ ASSR MAP 287 PCL 10 PLN bb 64 SCALE: 1 in = 30 ft 62 60 I O 30 60 58 56 133.28.ft a -- p 0 10 20 3° A PRINT ON 11 , x 17 in PAPER FOR PROPER SCALE ZN Of Mgss OF 414j P DAVID yGs o DAVID yGs D, a g D. COUGHANOWR N COUGHANOWR No. 1093 No. 461 ( u�pcTE SEWAGE DISPOSAL SYSTEM PLAN �FGIST PR VET - SITO SERVE EXISTING.DWELLING VARIANCE REQUESTED BERNARD T. MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. I �/I L p O 1 , T R. 310 CMR I5:221(7) - COMPONENT p. '' QWNER(S) OF RECORD DEPTH TO FINISH GRADE. 36 inES?Oo ) 41 OVERLEA ROAD MAX REQUIRED — VARIANCE TO THIS PLAN 15 INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM HYANNISPORT, MA 60 in OF COVER REQUESTED. DEPICTED ON IT FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING 155 Goo Rgdof Rd 5 PROPERTY ADDRESS PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS, OWNER Chatham, MA 02633 -' SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DOVIdCOU0HOtfT101LCORI DArE: APRIL 17, 2018 1508 364-0894 PG.ii2 JOB# ETE-4261 Inecoe i DATE: MARCH 30. 2018 SOL TEST LOG PERC# 15615 DESIGN CA LCCUU L'AQODM SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE #461 DESIGN FLOW: 6 BEDROOMS X 110 GPD = 660 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. I TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 660 GPD X 2 DAYS = 1320 GALLONS 2 MIN/INCH IN C SOILS USE EXISTING 1500 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 56.35 0-19 FILL DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. i 19-36 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: 36-52 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE T E F 52.02 HE LONG TERM ACCEPTANCE RAT OR A CLASS ONE 52-148 C MEDIUM SAND 10 YR 5l4 NONE LOOSE A SOIL WITH ';�, �•� 44.02 !� PERCOLATION RATE BELOW 5 MINUTES II PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. a TEST PIT 2 NO GROUNDWATER ENCOUNTERED THE 51 ft x 12.83 ft x 2 ft LEACHING GALLERY 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INCHES HORIZON TEXTURE (MUN5ELL) MOTTLES BOTTOM AREA = (51 x 12.83) = 654.33 sq. ft. 56.60 0-20 FILL SIDEWALL AREA = [2x(51+12.83)] x2 = 255.32 so. ft II T - OTAL AREA - 9 20-38 A LOAMY SAND 10 YR 3/2 NONE FRIABLE 09.65 s ft � p q 52.10 38-54 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE FLOW CAPACITY = 0.74 x 909.65 = 673.14 gal/day I' 4-144 MEDIUM AN 5 CSAND 10 YR 5/4 NONE LOOSE III li INSTALL A 51 ft x 12.83 ft x 2 ft GALLERY AS CONFIGURED 44.60 BELOW. FLOW CAPACITY = 673.14 gol/day WHICH EXCEEDS PERCOLATION RATE OF C LAYER THE 660 gal/dog REQUIRED FOR A SIX BEDROOM DESIGN. DETERMINED Y I 8 S EVE ANALYSIS. - / �00 G L ON 00' TIC TA K - I: USE SHOWY syl-9500-H-M DRYWELL 51 ft UNIT I in NOT � w TAPER Q TO (y) o 0 0 0 c' � y �r- SCALE CD Q o STONE 0 5 ft- 4 8.5 3 8.5 3 8.5 �3� 8.5 4 0 8 In ft ft ft ft ft ft ft ft ft 500 GALLON DRYWELL DIMENSIONS & DETAIL INSTALL ONE INSPECTION RISER TO WITHIN THREE /0 f t_ GJ INCHES OF FINAL GRADE 6 jn & INDICATE LOCATION ON AS-BUILT I INLET OUTLET 0 36 COVER COVER0000 in II' � - 7 a'i 3 IN DROP r AlFLOW LINE � UNITS �n RATED BU�DING )O in i4 TO 102 ,6 D-BOX i 48 in �!�. CROSS SECTION/ VIEW � LIOUID GAS INSTALL AN APPROVED GEIOTEXTILE -\ i LEVEL BAFFLE ' FABRIC OVER STONE I e o 6 in STONE BASE 28 314 in TO e E24 FFECTIVE _3/4 in TO. 1-1/2 in GRAVEL 1 112 in GRAVEL SEPARATION BETWEEN INLET & OUTLET in i DEPTH TEES NO LESS THAN LIQUID DEPTH CROSS SEC T ION VIEW 48 in 58 in 48 in 154 in II ALL STONE TO BE DOUBLE WASHED AND FREE OF IRONS, DUST AND FINES /N PLACE I NOT -INSTALLER TO OBTAIN DISPOSAL WORKS TO 16 in PERMIT BEFORE STARTING WORK. r SCALE -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF -� MASSACHUSETTS TITLE 5 SEPTICFROM �I -> O CODE (310 CMR 15). TANK c c TO -INSTALLER TO VERIFY LOCATIONSIOF ALL UNDERGROUND UTILITIES BEFORE O �D SAS T EXCAVATING FOR SYSTEM. -ECO-TECH ENVIRONMENTAL RECOMMENDS O THE INSTALLATION OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC 6 in STONE BASE PUMPING OF THE SEPTIC TANK.; -SEPTIC TANK NOT DESIGNED TO WITHSTAND 24 %� 2 CROSS SECTION VIEW VEHICULAR LOADING. DO NOT!PARK OR DRIVE VEHICLES OVER SEPTIC TANK. II IF L 0 W IP 0 F L Ej S j I t I TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO 4 in BE SCH. 40 PVC VENT EL = 73.07 +- b in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN ;'. PIPE 57.00 D=BO 5 USE MAX RATED E=TNG USE H-20 TEE 52.25 NITS I EXISTING 1500 OALLO PRECAST SCUP= TA 8.25 51.50 DRYWELL � 4 U 6 in o 0 0 EXISTING REFER TO DETAIL BOX SSOL ABSOGRPT O N + STONE 51.67 BASE `~ 51.25 -REFER TO w b In STONE BASE IF NE S Il STEIIVII u' EXISTING 174 ft 11-23 ft DETAIL ;BOX o a 49.25NO GROUNDWATER BELOW r - -_- 1 MOTTLING OBSERVED __ 44.02 �/ I SEWAGE DISPOSAL SYSTEM PLAN j�41 OVERLEA ROAD -_ HYANNISPORT. MA APRIL 17. 2018 � ETE-4261 PG 2/2 I