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HomeMy WebLinkAbout1016 PHINNEY'S LANE - Health 1016 PHINNEY'S LANE HYANNIS A = 252 - 053 r , I i i �I employees' foo pro ec io ce ificate_Cat-leas+ ^nP )edition,you must mail the: Please make the check payable to: Town of Barnstabl above. Allow up to four days for in-house processing. To get a food'permit application form, click here. have Acrobat Reader. Most computers have A automatically. If your computer does not have Acro to the Adobe website. For further assistance on any item above, call (508) 86 FEES: Bed &Breakfast Permit= $55;Tood Service Continental Breakfast= $30; Retail Food Store—Less less than 1,000 S.F. and Incidental to Business= 2 ; $30; Tobacco Sales Permit= $85; Additional non-re _ $100, Late Fee = $10 Back to Main Publi Q:\Application Forms\Foodappldoc ,a t ��# t f k$, `� Ready Rooter, Inc P.O.Box 371 Sandwich,MA 02563 SERVICE REQUEST: WO-30858 INVOICE 14ewe Bill to: Winery,Nadine Invoice Date: 11/5/2019 1016 Phinney's Lane Payment: Paid by:AR Centerville,MA 02632 Reference: From:Nadine Hinary Attention: Hinary,Nadine Site: Hinary-Centry 774-208-7224 1016 Phinney's Lane Centerville,MA 02632 Work done description: Jet Item Description Oty Rate Amount$ draincleaning Uncovered inlet of septic tank 6"deep.Used high pressure 1.00 310.00 310.00 water jet to free blockage in main line.Ran jet from inlet to house.Tested clear by flushing toilets in both bathrooms and ran the kitchen sink to confirm flow through the 2"line that carries the kitchen sink and washing machine.Found that the main line has backpitch and the pipe enters the tank pitched the wrong direction.Also the washer trap that _. was hooked to the kitchen sink line has no vent,there are two pro vents in the area of the washer.In addition the 2" sink/washer line runs 40'throughout the basement and- does not have enough pitch and it appears to be back itched in one section.No guarantee. Sub Total: 310.00 Total Amount Due: 310.00 Accepted by: Date: Printed Name: For questions please call 508-888-6055 Thank you for choosing Ready Rooter for all of your plumbing, septic, heating and drain cleaning needs! Please call us at(508) 888-6055. We're ready when you are! TOWN OF BARNSTABLE LOCATIONlh%6 A►%'Jhr YS zaH 0 SEWAGE#17-0iy' 7 rZ VILLAGE ASSESSOR'S MAP&PARCEL cl&;16 53 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1400 eor ,f fy !4 LEACHING FACILITY:(type) P OO �'/°l�t��4 �e) 2 NO.OF BEDROOMS OWNER AX7 4 1 PERMIT DATE: COMPLIANCE DATE: 7-12 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 10 7` 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 e �N No. ( � Fee "C./ -) Liz- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLAtion for MIsposal 6pstrin Construction 3pPrmit Application for a Permit to Construct( ) Repair(t� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or-Lot No. (/jlt� �1�,(J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel u,� e�y Installer's Name,Address,and Tel.No.4Zq ,��u f Q �f` Designer's Name,Address, Tel.No. B�eeyy I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) d gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank AX Type of S.A.S. �✓� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Iz c.-C a fi 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 oof to place t em,in operation until a Certificate of Compliance has been issued by this Board of Healt Signed ) Date Application Approved by _ Date Application Disapproved by, Date for the following reasons Permit No. to Z Date Issued Zo 1! 7f" .'+ n'n''}.t roe•1'1( r'�""'i'M Ar• i t .. r .�. a`,7" f1r ..s+ _i - :�,.,-.'XGt+'t}7. 1'No. �� . 7 - Fee n ,THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ApphLation for MispoBaY *pstrm Construction 3permit (, Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Add esss or Lot No.1bs( /Tr`/fX-e �,,(J Owner's Name,Address,and Tel.No. 1l Assessor's Map/Parcel ZS d CCl yi,r r Installer's Name,Address,and Tel.No. �6� 1�s<— y. Designer's Name,Address,agdTel.No. l � a � u.,•Q Diu`� .� 114 -�S 1 L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ;)• ' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other.Fixtures Design Flow(min.required) 3✓?0 gpd Design flow provided gpd Plan r Date Number of sheets; I Revision Date Title ' ;` / i Cr G� � dSize of Septic Tank /�t� jC' J1`, Type of S.A.S. c rr. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) { e. r "�4 ( n�e/ Date last inspected: Agreement: } t -- 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 an&n6t`to_pla�ce the system in operation until a Certificate of Compliance has been issued by this Board of Health.,/'' r; SigneB ) Date Application Approved by a/' Date' /r{ Application Disapproved by Date` r 1j for the following reasons Permit No. to i Ti 7"5 Date Issued ------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS eeftifitate of Compliance THIS IS TO CERTIIFY,that the On-site Sewage Disposal system Constructed ) Repaired(;p) Upgraded( ) Abandoned( )by �,tf•� t �,r,> ,��`'�- --� r/l. hoc;4.- CC / L � at 0 // has been constructed in accordance with the provisions of Title 5 an ,he Pr Disposal System Construction Permit No.&I-i-25Z; dated �9raea Installer "GA&-e //, Designer #bedrooms Approved design=flo X3 v gpd The issuance of this permit shall not be c nstrued as a guarantee that the syst m will func"on as desi :ed. ' Date /l — Inspector r - - .- -q----------- ----- - ----.-- _ --- — - -- -_-.------------------------------------- ---- ----- No 2m 19 — 2�2 Fee#`Q0 CV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposat 6pstem ConstrUrtion Permit Permission is hereby granted to Construct( ) Repair K.) Upgrade( ) Abandon( ) System located at A✓F7 A'n M'C Yx G 4tx e. 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:C ns ction must be completed within three years of the date of this permi. Date ��� �� Approved b r - »..�—v� ,�. ,„.�.�. ""--, -T, �.0 �� -. 1 :/ 'y y�.,; �- M T'o� n o �;�rr><stithitlr oFtrtE tp y , tin Regulatt�rcr S:e�-�r>lces ' Rlchal d V Seal►, In,ttt rni I}ii;ecty �ASRNSTASLE - q? i639 :�� Public, ,I.1tl),D"' *-" ATFD MAi t+ J ' I bbnias?1=)Lliean,Drrect.�►t; w ?OQ llaan Sti eef,H�.iainls,, btA 02f01 c cilY gab 8b2 tva-t 1 at SUS 7rlt)G,14 Installer S DesigiTer Certiflcakion Forirl Date.; iLt Serxfage Fermrt# Z j Assessor's 1tiIaplPareei '� Pam+ c- m c Cam, , ., lles>gtser c ,:v�� —4 c s vc i LY �� Inst..11uiti �cr Sew-��- .�.t~ < ,; Address j �1�, �r'us5i��f �2cR ,,t.� � f LL � ) r� Addt ess � .� ,.`I v 1 �Y C �. w ,.. - .. !C 1 �C u� .. , �717 ", , vi, e � V',S [SSUCt1 al I7Ct!'-111t TU lilSI'tll a tdate} al'z (.irsst , r suptia5xstemat _�� �h:rtvt�' S C (addle�5 - �°t bawd an a dusigri drata n by C �� r'nyc btl� �<� fr gated �( (deli taer � g ) I certify t11at the suptiu system rcfeleric cd aboxe,.was lristalled substanti� r7 fly '<tGCO dilly [0, Che CIeS1�TD, xX17'.7 Cir May Ih ,,,it e minor"apprbVea.Ghhtlocs sbthr aS lateral.rf IOCattOil Ui•the; dlstnbutlon.boa andror septic tank S"trip otu (�;f reclulled} �j inspected arcl the still, ��reie found satrsfao or , �x 3 Inc', �'"', that thu3se ttc S- _tr' Tti referenced abox e lx{as installed.xvltl� i7i'v)or c.l an es T(.i grealei thaa� 1`t}' later<al relocattorr of the S3S of airy xrertialalelccatiorl iJf and,compotcnt of the sp c system)'but In accordance xxirh Stan;&'Local R��ulattoi�s,; Plan;:rears on.of catrtl ed S 1i lilt by;; lesil;u�i tosfo-ll`o x Si;1p out,_(iftccltt-i cd},ryas inspecteci.ar>d thz,suds,. lucre:found:,atisfa,ctoiv.. I Lci ttfy that=thu �ystel �T,ci uncurl, ibox e nras cvnsti u.cicd ut x�ttn the turi>ts " o{tltu T A al3pro ettC c:,abl�) t�of µass Q�� �" j/j (Installci's S7gnatulc. : �� .. Mc�N ctvtL NO'.35}dg r� ' gF01,Sf'E'_'�� finer s Signatul c) � . (Afti� Dc_sibne ere) s PLESI' R]CTURI�I TCJ BARNS TABLF,' I'UBI IC IFIIaAIT,,H Di�r'I"SION. .C'ERTI�ICA T I OF CO IPLI, I E r 1(3T 1E:,ISSUI!D LII�TTIL .BCIT i THIS FOR;VI ANI3 AS ',' 7 L , c J1R It>✓CZI'4�ED`B� I FIF B .: s1'A. E PLTBI,UC .IIEAL PII .D..f tSi:O'v 1}Ili trk C; r >: C fI 5tpr�ra�es,�ner Genificeuon Eoiiii R�� 3 1} i,do ., Engineers note 7 s Certdre�don is bm led lc an as b, i'n pe ,inn of ys m i emnoner us cisiaHec pnor+obacitSiEi'she enq Iii tlid..Pt super`nse,conslruction of he.sys em he.'in,ailer iissumes responsib''rr cr'I rut ncls ror�.rnr"r` r to spe ified grades;wiiM Proper compaction and setting i er covers:,,as s iown on ti e day fin plan s,!P co itin� I . . . . . a�v No.2 I�—� �`J' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS fipiication for Misposal *pstrm Construction Permit Application for Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System Q46gividual Components Location Address or Lot No./6/(, �'lj...r�cf5 Lc,�e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J v,, .kf�Ld Sslt`ld�A69 E2 Installer's Name,Address,and Tel.No. �25� f/ s`�� Designer's Name,Address, d Tel. o. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �j Q Ok7 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r1 f/. )I? 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 a -to tem in operation until a Certificate of Compliance has been issued by this Board of Hea g gne -a Date Application Approved by Date ✓� J �0 r Application Disapproved b Date for the following reasons Permit No.�,pJ J Date Issued Fee No. +G Y / + 00 " l - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:%Yes Yes "PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS - ftplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System D.nd'ividual Components Location Address or Lot No. /G �li H I+� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel G� G7 �j j �� 1 'I Y r - t Installer's Name,Address,and Tel.No. 3�S/ r S-�? Designer's Name,Address, d Tel. o. n � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ' i• Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maimen�nce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and t to pl kre system in operation until a Certificate of Compliance has been issued by this Board of Health ne Date Application Approved by L, Date Application Disapproved b Date for the following reasi ns Permit No.gbi i" ?5 Date Issued 5h 5J g --------------------------------------------------------------'------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS �� C f( BARNSTABLE,MASSACHUSETTS J Lk I Certificate of Col pliantP S ' / n � f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired 1( Upgraded( ) c)/ Abandoned( )by 1A Ito i/t[1 at has been constructed in accordance j \ with the provisions of Title 5 and the for Disposal System Construction Permit No. dated `a' 7QI �f^' (/ Installer / H a ✓ -t/ a(,j 4;J& Designer i #bedrooms Approved design flow ' -- gpd The issuance of this ermit shall not be construed as a guarantee that the system wil fun o designe I Date Inspector 1 (4 n --------------------- - - - _ - _ - a.w - - - --- - -- ---- - - No. — Ft . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstern Construction Permit Permission is hereby granted to Construct( ) Repair(,� Upgrade( ) Abandon( ) Systern located at ^�- P I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co traction must be completed within three years of the date of this permit. Date T Approved by I Town-of Barnstable a BARNSfABLE, A 6 9 Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 j Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE 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. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: 0:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc t►E T�," ,Town of Barnstable Barnstable , fill-ftwea w MAS Board of Health Dmf s639. ♦0 Alfu+�►�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program February 15,2012 Policies,Procedures,and Guidelines Septic Systems Documented as Failing to Protect Public Health and Safety and the Environment by a DEP Approved System.Inspector Later Documented-to have a Passed Inspection for the Same System Conducted by a DEP Approved System Inspector#2012-01 [Section 15.305 of the State Environmental Code, reads as,follows `if a system is failing to protect public health, safety, welfare, or the environment as set forth in 310 CMR 15.303(l)or 15.304(1), the owner or operator shall upgrade the system within two years of discovery unless:(a)a shorter period of time is set by the local Approving Authority or the Department based upon the existence of an imminent health hazard;or(b)the continued use of the system is permitted by the local Approving Authority in accordance with the provisions of an enforceable schedule for upgrade.J The Town of Barnstable Board of Health will consider permitting the continued use of a septic system which has been documented to "fail" to protect public health, safety, and the environment but later documented to "pass" an inspection by an approved System Inspector conducted in accordance with 310 CMR 15.302 and local Health Regulations. To consider such an extension, the applicant is required to provide the Board two passing inspection reports conducted by two independent or separate DEP certified inspectors. The two independent passing inspections shall be conducted at least six months to one year apart. The following procedure shall be followed for consideration by the Board to grant an extension or to overturn a failed septic system inspection report: 1. The applicant shall submit four copies of the failed and passed inspection reports to the Health Division Office (200 Main Street Hyannis Ma) at least thirty days before the established deadline to repair the failed system. These documents will be forwarded to the Board members for review prior to and during the next regularly scheduled public meeting. [NOTE: At properties used for seasonal use, inspections should be conducted during periods of heavy usage] 2. During the public meeting, the Board will determine whether or not the application would qualify for an extension. The Board will also determine whether or not to require or recommend another septic system inspection which shall be conducted six to twelve months after the first passing inspection. The Board may require the additional inspection(s) to be conducted during a specific time period(i.e. during summer months)at seasonal properties. 3. Immediately after the third inspection is conducted (six to twelve months later)the applicant shall provide the Health Division four copies of the third septic system inspection report, regardless of whether it's a passed or failed result. The Health Division will forward the documents to the Board members for review prior to and during the next scheduled public Board of Health meeting. At that meeting, the Board will determine whether or not the application would qualify for any additional extensions and/or determine whether or not two passing inspection reports would overturn the failing inspection originally submitted. Wayne Miller,M.D. Junichi Sawayanagi Paul Canniff,DMD Q:\POLICIES\FailedSepticSystemsW ithPassingReports.doc 0153 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 ?k 1.101 t S fw.z.e ' Property Address , EXCEL BUILDING SYSTEMS COMPANY, INC Cyr Owner Owner's Name y information is required for every Hyannis Ma 02601 5/14/19 i page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on thieform. 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. Inspector Information 13811 on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane � Company Address Cotuit Ma 02635 City/Town State Zip Code Boos 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/15/19 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form m l� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is Hyannis required for every Y Ma 02601 5/14/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:, ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1,000 Gallon septic tank as well as a concrete distribution box and concrete leach pit. Septic tank is leaking at the seam. Leach pit was opened and has a hard stain line up 22" of the bottom. Contrary to the previous inspection report system is NOT in failure. 2) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7126t2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 �u Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. CityTTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): Septic tank needs to be sealed at seam. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts qi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is Hyannis " required for every Y Ma 02601 5/14/19 page. Cdylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health and Public Water Supplier,� pp , if any) determines that the system is functioning in a manner that protects the public health,th, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No `❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No - ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d NA Vacant 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form ie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 Cit /Town page. Y State ZipCode Date f Inspection o ns ection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 3 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 C Commonwealth of Massachusetts -, Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Original to home Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s 1016 LJ Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: V Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts rp Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityfrown State Zip Code Date of inspection- D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level:` Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert - Level and at normal level 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Concrete leach pit. Pit is functioning as designed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 C� Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 u� Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1016 �V Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is Hyannis required for every y Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 5/15/2019 Assessing As-Built Cards G / TOWN OF BARNSTABLE LOCATION IQ�l0 1,Iv�trf5 `.c,..-� SEWAGE W "'4g6 VILLAGE ASSESSOR'S MAP& LOTZ 2__e� INSTALLER'S NAME& PHONE NO.__ SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_ �I/�c-+C/�S? P� (size) �& .} NO.OF BEDROOMS�_PRIVATE WELL OR BLIP C W_ R BUILDER OR OWNERr�� ,i-- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:__ VARIANCE GRANTED: Yes No I e CAo f- JOCID 5?, � https://townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=252053&seq=1 1/2 r Commonwealth of Massachusetts Title 5 Official Inspection Form ht Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Test hole data on file Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 e Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1016 v Property Address EXCEL BUILDING SYSTEMS COMPANY, INC Owner Owner's Name information is required for every Hyannis Ma 02601 5/14/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 t Town of Barnstable Barnstable Regulatory Services Department 1 i639 Wca j 9 AnFtivsrnst,E. ""` . Public Health Division Gb 1� p�FO MA�� 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0329 May 8, 2018 ONEIL, DENNIS A ESTATE OF C/O OCWEN LOAN SERVICING LLC 1661 WORTHINGTON RD STE 100 WEST PALM BEACH, FL 33409 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1016 Phinney's Lane, Hyannis, MA was inspected on 04/18/2018 by Jason Haskell, 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. Distribution box is overloaded and badly deteriorated. Leaching pit shows signs of failure. 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 THE BOARD OF HEALTH ��asean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1016 Phinneys Lane Hyannis.doc Er •. • r,w m 0 Ca 7__,, q] $ertified Mail Fee 4.��o' °��ry" 01 n- Extra Services&Fees(checkbox,add fee as appropriate) A ❑Return Receipt(hardcopy) $ -, O ❑Return Receipt(electronic) $ IMA1y; A ❑Certified Mail Restricted Delivery $ Here r3 ❑Adult Signature Required $ ❑Adult Signature RestrictedDelivery$ l7 Postage -- m $ Total Po; O'NEIL, DENNIS A ESTATE OF $ t.n Sent To C/O OCWEN LOAN SERVICING LLC O Slieefarti 1661 WORTHINGTON RD STE 100 WEST PALM BEACH, FL 33409 Ciiy;�Stafe Certified Mail service provides the following benefits: a A receipt(this portion of the Certified Mail label)' for an electronic return rgceipt,see a retail Is A unique identifier for your mailpiece. associate for assistance.To receive a duplicate a Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A,record of delivery(including the recipient's retail associate. 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 a 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 7 a Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with,CerUfied Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the a To ensure that your Certified Mail receipt is d 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 a 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 heed 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, :+-5 complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece;" IMP®RTANE Save this receipt for your records. Ps Form 3800,April 2o15(Reverse)PSN 7530-02-000-9047 I SIERRA#191" o Complete items 1,2,and 3. A Signattye ® Print your name and address on the reverse X ❑Agent so that we can return the card to you. 11 Addressee ® Attach this card to the back of the mailpiece, B• ived by(Printed Name) C. Date f Delivery or on the front if space permits. v delivery address different from item 17 M Yes f YES,enter delivery address below: ❑No O'NEIL, DENNIS A ESTATE OF C/O OCWEN LOAN SERVICING LLC 1661 WORTHINGTON RD STE 100 WEST PALM BEACH,'FL 33409 II I DIIIDI IDI Ial I II II II I I i IIIII I 11111111111 IIFlt 0AduNlce Type ❑Priority Mail Express® Adult Signature ❑Registen:d MaiITM W❑ du Signature Restricted Delivery ❑Registered Mail Restricted NW Mail® Delivery 9590 9402 1933 6123 1777 53 ❑Certified Mail Restricted Delivery f Retum Receipt for ❑Collect on Delivery Merchandise ❑Collect on Delivery Restricted DeliverySignature ConfirmationT 'n—A,Hnlr-Ni!innher_LTransfer-from_service-label)—_-_c� III ❑Signature Confirmation 1 7 015 1730 0001 4988 0 3�t Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02 000-9053 Domes t R i USPS TRACKNG# First-Class Mail Postage&Fees Paid Perms No.G-10 9590 9402 1933 6123 1777 53 r United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service%— _ q Town of Barnstable Health Division •� 200 Main Street Hyannis,MA 02601 � IE • - ��ram, . Town of Barnstable - i AI AN�TIAi C T Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Off= 508-862-4644 Richard ScA Dircctnr FAX 508-790-6304 nomae A McKean,CEO Feb 6,2007 Rev. 5111116 DEADLINES TO REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ 'An`-Z'marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE 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 �tatic liquid level in the distribution bo bove outlet invert due to an overloaded or clogged SAS or cesspool � e ❑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 wafer quality analysis.'(This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q SingleCesspool ❑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 Repair deadline: _ w.sEPTICOEADLINES TO REPAIR FAILED.SYSTEMS.doc 1� JI 6 S3 Commonwealth of Massachusetts Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1016 Phinney's Lane Property Address �y Ocwen Loan Servicing LLC Owner Owner's Name information is {'* required for every Centreville ! &An d MA 02632 04/18/2018 w page. City/Town State Zip Code Date of Inspection U11 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 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Jason Haskell use the return Name of Inspector key. All Clear Septic&Wastewater Services VSLA Company Name 102 West Main Street Company Address Norton MA 02766 City/Town State Zip Code 508-763-4431 S113520 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: a ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority Qo.r` 04/25/2018 Inspect 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 b� VS Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 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: Septic tank, distribution box, SAS. Septic tank is leaking. Distribution box is overloaded. SYSTEM FAILS. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): . ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/rown 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 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 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. ❑ ® 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.doc•rev.6/16 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 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. CitylTown 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Forn 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 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. CitylTown 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: Unknown 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): 15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 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: 11/18/1994 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"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.): Joints are good. No evidence of leakage. System vented. Septic Tank(locate on site plan): Depth below grade: 8"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: 8'3"x 4'3"x 4'9" (1000 gallons) Sludge depth: 6" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. Citylfown 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 25" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 30" Distance from bottom of scum to bottom of outlet tee or baffle - 4 Tape measure How were dimensions determined? Rod&Ta p Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank found to be leaking. Liquid level is at 33". Baffle and tee are good. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness I Distance from top of scum to top of outlet tee or baffle III Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: . gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 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 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 2 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 overloaded and badly deteriorated. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No` Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Signs of hydraulic failure. 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.doc•rev.6/16 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 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville . MA 02632 04/18/2018 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: See below 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: High ground water elevation to be obtained during system replacement. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1016 Phinney's Lane Property Address Ocwen Loan Servicing LLC Owner Owner's Name information is required for every Centreville MA 02632 04/18/2018 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I . . All-Clear Septic Wastewater Services AA cr a E I 3 Oct 5 Trji 102 W. Main St. Norton, MA 02766 Office: (508) 763-4431 Fax: (508) 763-4168 www.aliclearseptic.com .. ' Commonweafth of Massachuseft Title 5 Official Insertion For Sttbsfttrface age Disposat System#F?Wm-Not W Vdu€rtary Assessmerft 11W fiNnneys lam, SLOG 3 Property Address Arbor Terrace owneesName 'nomm f"isevesy Hyannis MA 02601 4� .. citytrown sty Zip Code Data oft fa Inspection results mast be submitted on this form.inspection forms may not be altered in any way.Please see completeness checklist at the end of the form, 7m b Men en utfb4f1 A. General Information 19 N OF 4gS%4Z4 an the computer, case t zits 1. I€ e '�p2. .Wx ui - on = JAMES :R,' tt:e neurn .latmes 17 5sa€s d SEARS key- mum of Wap"tor Capewide Enterprtses,LLB ��'of ��•'o�.�' 1c 3 nOty Nam7lm fC 1 S. �����i�,��"5 m N S" \V`��` CompanyAftess Mashpee MA oms CWTOM state 508-4 -SM S1623 TeteFhone t4urnber license Numiter B. Certification 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 se*We disposal systems.1 am a DEP approved system Inspector pursuant to Section W40 of Title 5(310 CMR 15.000).The system: 0 P 0 Conditiaflly Paste 0 Faft 0 Needs Further Evaluation by the Local Approving Authority _. 4-17-12 CD >'s Signature [Fate �,� The system inspector shalt submit a copy of this inspection report to the Approving Authtii y(Bc* of Health or I3EP)within 30 days of completing this inspection. tftie system is 0 shared s it has a design flaw of 10.000 gpd or greater,the inspector and the system owner stall submit ft report to the appropriate reWatoffice of the DER The ofigurat StwUtd be sent to the system owner r and copies sent to the buyer,if applimble,and the wing;auftnty. report only describes eonditions at do tim of burr and under de conditions of use at that time.This inspection does not addiness how the system will p;erforn In the future under the sane or different conditions of use. t5frrs•11110 TO 5 Ol"frrspecgM FOW Subsurface Sewage f)ispo W System•Page 1 of 17 Colmmoniea of eht� Title 5 Official Insertion Form Suhsutfce Sewage flhWosal System Fem-Not f"Voluntary Assessments I 1W Pis to SLOG 3 Proped y Addiess Arbor Terrace iaiomi f Hyannis MA 02601 4a 16�1�9.regt►sred for every C�tyrrt�n Page. State zip CO& Date of hmpewon Iron Summary:Check &B C;D or E I ahwys complete all of Section D i have not found any irdarrnation whirr indicates that any of the failure in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure€riteria nut evaluated are 41dicated below, Comments: I B) SYSWM C 0 One or system components as described in the"Conditional Paamne section need to be replaced or repaired.The system;upon completion of the replacement or repair,as approved by ffm Board ofHeaft Oteck the box for W,gild"or aim d mirwd"(Y,N,ND)for the following statements.U"not.. determined,"please explain. The septic tank is metal and over 20 years oW or the septic tank(whether metal or not)is str udurally unsound,exhibits substanfW Mit ativn or exfii€ration or tank faiiure is imminent System will pass inspection if the existing tank is replaced with a implying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and 9 a Cute of Compliance indicating that the tank is less than 20 gears old is available. 0 Y ❑ N 0 ND(Explain below): •,,710 Tithe 5 OW60 Sty 50"P DI POW SYMM•PaP 2 Of r7 I Cemrltoteattt of saaciaft Title 5 Official Inspection For Subsurftw3ffr.MeWwpmW3ysteml for Vokint ry Assessments 1160 Ph*Meys LA ELM 3 Propft Arbor Terrace infomudion-is for Hyannis AAA 02601 cityrrorarcl state zip Coft Date of ir�an S. CerMcation (cont) B} System Condlltonally Paste(cont): 0 Cbservafion of wbreal€watortugh sWic vmWWve1 m thedaftiAm bcKdm 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 rl Y ON 0 ND(Explain below)- 0 obstniction is removed 0 Y ON 0 ND(lain belowy disftution box is level or replaced 0 Y 0 N 0 ND(Bcplah lamy [ The system required pumping more than 4 times a year due to broken or obstructed pipe;).The System Will pas avoection if(Mth approval of ft Board of Reamy 0 broken ems)are replaced 0 Y O N 0 HD(Expkm bekw 0 obsbuc5on is removed 0 Y 0 K 0 l y C) Further Evaluation is Required by the lard of Health: 0 Conditas exist which wire further evaluation by the board of filth 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 Cl 15-J 11)(b)that the"stem Is not finning In a ma mrier which wffl safety and the environment: Q Cesspool or ptq is wiM 50 lid of a she wad Cesspool or privy is within 30 fleet of a bordering vegetated wvetland or a salt marsh I',M•I vio 7m 5 omw Tit Fw:MMWftM SMP MPOW Syst M•P2P 3 ff i7 i Title 5 Official Inspection Foy Subsufftm Sewage Wisposal System l Mary Assessaients I Ln, BLDG 3 Propeft Addrew Arbor Tetra OMW Ownees Nam infoffnfewAf d fN Hyannis MA 02601 CWrOWn state ZIPCO& Date of hwection EL Cefffikadon (cont) 2- System will ftfl unless the Board ofH(and Public Suppuff.it ) determertes that the system is functioning in a manner that protects the public health, ate e €tma 0 The system has a septic tarok and soil system(SAS)and the SAS I 100 feet of a surface water supply or tributary to a surface~water supply. The system Im a sqft tanko SAS and SAS fs wOh a Zone 1 of pgft-mew supply- 0 The system has:a septic tank and SAS and the SAS is pia 50 f ma of a private water supply wa 0 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 weir*. Mew two to t dam_ "This system passes if well ate,pry at a DEP oerfilied lab�ory,for fecal coliform bacteria indicates aunt and the presence of ammonia nitrogen and nitrate nitrs W is equal . toor less#m5W%provided o#ware ftWW.Aar be attached to this form. 3. � ID) System Failure Grp Applicable to AD Sys: Your RK111cale"Yoram to each oft _ Yes No 0 ' g ", Backup of sewage into facility or system ccsnporwt due to€verb or, clogged SAS or cesspool 0 Discharge or ponce of effluent to the surfaces of the ground or surer wad due to an overloaded or clogged SAS or cesspool o z Sty"level in the dis�r tx above oust iffmt due to an overfoaded or coed SAS or cesspool 0 0 Lmud depth in cesspool is less than Tbelow wfwt or avail voltme is less than day flow tea+11110 T&t5 R%PeMA FOW&MWTAW SeWW VAPOW SystW-Pan 8OTTf Commo#twmM of Massachu"ft Title 5 Official Inspection Foy Srrbsuft"Sewage flisposal System i=o _ For Voknfty Assessffients 1160 Ph€reys; Ln, SLOG 3 Property Addrew Arbor Terrace C `s mum m dfo quir Hyannis MA 02601 4-16-UL page. City1T-OM zip CO& Date O hwecam $s Ceftffication (cont) Yes No Required pumping than��pu the last year MOTdue toobruct + um times Any pin of the SAS,cesspool or privy is below high ground water ovation. 0 0 Any portion of cesspool or pit is with 100 feet of a surface waW sum or tributary to a surfa0e water supply. Q Any Portion of a cesspool or privy is win a Zone 4 of a public mil. 0 0 Any Portion of a cesspool or privy is within 50 feet of a private water supply welk Any ports of a cesspool or pdvy is lei t IOD iee taut greater ffm W feet from a pie wrier supply well with no acceptable wad quality analysis-tThs system passes if the well water analysis,performs at a DEP certified laboratory,for ftc-d crl'rfmm back4a€rt €tes absent and dw press 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 the fora D M The system is a cesspool suing a facility with a design ter of 2000gpd- 10,000gpd. The system falIEL l heive detenP&M that am of nwe of OM abM faffm 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 MOSSMY th MnUl the fa*ft E) LaW Ste: To be considered a Large syste the syMem ##serve a facility with a design flow of 10,000 gpd to 15,M 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 0 the system is within 400 fleet of a surface d cing water supply 0 0 the system Is within 200 feet of a tributary to a surface drk*"vim►supply El 0. the:system is located in a nitrogen sensitive area(grim Wellhead Protection Area—11Nd A)or a maps Zone 11 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 O above the large system has flailed.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. twa•11110 Tale 5 DAtU MWeCUM Form:Subs MAW Sewage Disposal System•Page 5 of 17 I Commomsmeafth of Massachtmet Title 5 Official Inspection Foy &*ate Sewage Msposal System fast-Not for Voluntary Assessmertts 1 M Ln, SLOG 3 Praperty Ate Arbor Terrace ownerintoru °s . ffo a egWt d Hyannis MA 02601 4-16AA�_ pace. cayrrom she zip Code oaL-O C. Checklist Cheat if the following have been done_You must hmlicale p or$W asloesch of the Bluing: Yes No 0 0 Pumping informs was provided by the owner,occupant or turd of# ldx 0 0 Has the system received normal flows in the prevkKm two etc Have large vokones of water been introduced to the systern ray or as part d this inspection? ® Were as built plans of the system obtained and examined?(tf they were not available note as WA) J@ ❑ Was the facility or dwelling inspected for signs of sewage back up? Was the s d e`Inspected for ski of tmt out? 0 0 Were all components�excluding the SAS,located on site? 0 Vftre ft9q*ct&*marft1es unemmd,apemW,mid ftWwWof tM tat* Inspected for condition of the bafflkm at tew materW of oonstruc#on, dimensions,depth of liquid,depth of sludge and depth of scum? ® n Was the facility owner(and occupants f different from owner)provided with informatin on the proper maintenartm of subsurface sewage disposal systems? The size and ration of the Soil Absorption System(SAS)on the site has been mined based on: N 0 Existing informa#km For ems,a plan at the of Health. 0 0 Determined in the field(if any of the Wure afteria Mated to lit C is at approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Fkm Condili Number of bedrooms(design): $ Number of bedrooms(actual): DESIGN how based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins-11/10 Ptie 6 Otitdei kq)Wm Form:Stbawfam Swap Ofsposai System•Page 6 of 17 f ' Commonwealth of Massachusetts Title 5 Official Inspection Foy Subsuftm SMW Cam#System form-Not for Voluntary Assess"tertis 11W W"s Ln, SLOG 3 pAddm Arbor Terrace omm owneesNRM � is � , Hyannis MA 02601 416-1� ram. cayrrown state zip Coft Date Of fivPecom EL System Infomma(m Description_ Number of current residents: NA Does residence have a garbage grinder? 0 Yes 0 No Is laundry on a separate she system?[if yes separate inspection required] 0 Yes 0 No Laundry system irk? 0 Yes N No seasonal use? 0 Yes Water meter readings,if available(fast 2 Years usage(gpd)): Shared Watar ureters Sump pump? 0 Yes 0 No Last date of occupancy: r ate CommyeerciaVindustria,I Fleur Conditions Type of Establishment Oesign 1bw(based on 310 CMR i$20ay Gaf ns perdW W . Basis of design flow�seatsfpemonslsq-ft_,etc.)- 0 Yes 0 NQ irtdustrW waste holding tank present? 0 Yes 0 No unitary waste dWwged to ft Tift 6 system? 0 Yes 0 No Water meter readings,if available tins• tli0 T e S OMU msoeoia+ is SMsurrace SewageDispow system•FW7ofi 17 Commonwealth of dohUsefts Title 5 O iciai inspection Foy Sub suftx*Sevm spasm] for\k*mtary Assessments 1160 Phim� gin, BLDG 3 PropftAddfaw Arbor Ten aoe owner m oimatian Hyannis MA 02641 4-16-1j , gage. CdtyTCo>�n safe zip Date of b"Pecon D- Systm Itfomiation (axt) LaM date of<ccupancyluse: Bate 00w. (describe ice; Wkdbmww- Pumping Records: Source.of W- 9-MMOOM 1226-11 was pumped as part of the mispe n? 0 Yes 0 No ff gallons How was quark pumped mined? Reason for pumping: Type Of System Septic ta*distri�lox,soil absorption n system its ampoof overflow Cesspool 0 Plivy Snared system(yes or no)cif yes,attach previous` rids,if any) IrmovetwWAlterimVve tedwuftp.Attach a copy of the curmt operatfon aid maintenance contract(to be obtained from system owner)and a copy of West inspection of the I/A system by system operator under contract Tight tank Attach a copy of the 9EP approval. 0 Ottw( y 13(tNs•it/i0 'f�3 oi�2l t�F�tt:� i1i�088F�Y •P 8 tX77 Commonwenfth of�!lassarc#t ids Title 5 Official inspection Foffn SuWmrftw Svm" Systm Fo loot for VoWrfty Assesan is 1160 PbWm" Ln, MDG 3 RapeftyAddms Arbor Terrace mqulf dfo a Hyannis MA 02601 Cityrrown s zip Coft date of It ion M Systm 111formMon {cont} . ' App "wmate age of all meets,date costa �jf Mom)and source of n13Fmmtion: 2009 Perna# 2000- 386 Were sewage odors deter wh arriving at the site? 0 yes 0 NO Dew below grade: 4W Material of construction: 0 rat iron 0 40 PVC 0 oar(explain)- pwate Water supply Well or aim WW few Comments(pn condition of tents,venting,evidence-of leakage,etc.): Pipeing at T-4' rP mg 4-'soli 40 pvc Septic Tanis(locate on site plan): Depth below grade: Material of construction: rrcrete fl.metal 0 fiber9 s 0. 0 other jpogn) If tank is metal,list age: yeals Is age cws rme-d by a Cerftae of Coroixm?i(aftach a copy of e) 0 Yes- 0 No . Dirrrertsiorts: 2000 Gal H-20 1000 Gal H-10 Sludge depth: 1� ISM•1111U �3 1 �t111;$i�BWf�E �Sy812111•P8$8$dITT C mmumwealtr of Massachusetts Title 5 Official Inspection Fob SubsuffAce SeWW flftpmW System fo -NA for lfolurfty I1(W Ln, BLDG 3 Prapft Address Arbor Terrace information Hyannis MA 02601 4-16-1� Pap-P ` C frd" state To Code Date of Ln-Vection a Systm Infonmifi ( ) Septic Tit ) Distance*=top of sludge to bonom of*Aet tee or balft NA Scum thickness Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottorr of outlet tee or baffle NA How were dimensions determined? Asbuilt-Tape-Plan Commeft(an pumping r9cwmnendations,Inlet and out tee or bsfffe Condit ,shwWW Wdeg t liquid levels as related to outlet invert,evidence of leakage,etc.): Two Tanks-one 2000 Gal H-20 with inlet Tee and steel cover at Grade, Tank at 4ir Below Grade, Tank a t working level out let Tee Tank Two, 1000 Gal H-1 Q at 42"Below Grade with mover at 9*, In and oid Tees, No sign ofover t!2ft Grease Trap(locate on site plan): Depth below 9aft teed Material of construction: 0 0 metal 0 01km 0 Dimensions: Scum thickness from top of qWn to top of outlet tee or bAe Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping, Date OU-I W0 TM 50ff=M8PGCWFW SUb&Mft5ewwUWWsystem•PwsoofiT Commonwealth of achusetts Title 5 Official Inspection Foy Subsurfum SwNvV DftpDsa Sysftm F -Not for Volti Lary Assam 1160 Phinneys Ln, BLDG 3 Property Address Arbor Terrace OWW OWFW48 Nam f';W�every Hyannis MA 02601 416-1 Pap. WrMn StMe 230coft Date Of M Syston Information ( _) Comments ion pumping recommendations,inlet and oft tee or baffle oonditim,sMucl integrity, liquid levels as related to cutlet invert,evidence of image,etc.): P -_-or.HoWing fink tic must be pwnpeif a1 OM Of`, - ) PMn)- Depth below sue: p con ete O metal O RWOM 01olye� 0 Oth" Dimensions: Design Float: 999m W day Am 0 yes 0 Alan level: Alarm in 0 Yes 0 N l Of W Pump kV. Date Comments{condition of alarm and float svitiches,etc.): `A#tach copy of amerg pumpmg con t( aired).is copy ate? ❑ Yes 0 No !ems•t trio Twe 5 otridai ftwemn sm:&twKaoe Sewage O mPow Symem•Page t t of 17 t Conmonweafth if Mass h 1 Title 5 Official Inspection Foy suurfa SewvWDhWo9a1SysftmFoxn _Not for Vdun1cy Azsmmertts 11W ftku*W Ln, SLOG 3 PropeityAddnms Arbor Terrace OwmWs Nam intomatfequ1mfd Hyannis MA 02601 4-16-19�,- . Wrown state zip Coft Date of hwecwn M System Information (conp DWWbuthm Sox if present must be opened){lot;ate 13n site plan): Depth of Rquid WM GtxnrneAs(note it box is level and distribution to outlets equal,any evidenm of solids ever,any evidence of leakage into or out of tux,etc.): 0 Box is 5C fiebw Grace +/arver at 47, and s s of tom' or sabd tarry over, Five lines out Pump Chamber(locate on site plan): Pumps in working order: 0 Yes ONO Alarms in working order: 0 Yes 0 NO Gt !mft(awe ay4ibon of pump ,condfta of ' ), So#1 Abwrption System{SAS)(locate on site plan,excavation not required): if SAS not WcaW4 e*m why: tSMs•17%TU Tide 5 0WW i McMon Form:&i UMM sev W Disposal system•Page 12 of 17 Commom"afth of M a chuseft Tile 5 Official Inspection Foy - Subsufftwe SeWW Dis�sySftm ftm-Nat for Vduntary Asses 1160 Pays Ln, €LOG 3 Arbor Terraces o i q m dfo Hyannis MA 02601 i Pap- oAYrram shite zip Coft Date Of hispeeftn M Syston 1111f 'lll (conL) Type: 0 number 0 leaching chambers number: so 11 leaching galleries number. 0 leaching trenches number%length: Q leaching%ids �,dimensiom- 0 overflow cesspool number Trrameof : Comments(note condition of soil,signs of hydraulic failure,WM of ponding,damp sod,condition of vegetation,etc.): LLeadwq is 50 No Caps tfmd Augw Be side tg and camem km C Sm and back km vent Pipe, lVa sign of over loading or solid carry over Cesspools(mil must be pumped as Par#of inspection}(late on site plan): leer and - Depth—top of liquid to inlet invert i Depth of solids la�w Depth of Scm layer 0hrsions Of cesspW Materials of construction ution Indication of groundwater inflow Q Yes [ No Oft fe•I V10 T ft b bffi*W MspWw Fow&ftwtaw Sewage OWPOsai System•Page 13 Gf17 ' I i Commonwealth of ��� Title 5 Official inspection For Subwrfmw Smage DbposM Sysf m i Not fbr V0kMtWy Assessffmnfs 1 M Phirmeys fin, SLOG 3 Propeft Arbor Teffaoe intoffMbon is Hyannis MA 02601 f OwAred for ewy page. Citylrown State Tip Code Date of hupection M System In#ormatkM (cont) Comments{note conditm of sON,signs of hydraulic Ukue,level t#per,wxhbon of vegetatim etc.}: Pfivy(locate on sb ptan)= 1Vterials of construction: Depth of skids Comments(note c crxlition of soil,signs of hydraulic failure, level of pondinig,wridiffon of vegetation, SM.f Itio TNe 5 OffW f Uspeethm Form:Subsurface Sewage U(sposa(Salem•Page is of n l ` o f s:ach } Title 5 Official Inspection F -ft Nbw Two M =01 CW S � '._.:. }}M�'RVAdO Z b,,t a R� ,S x. ... .- t'�,. "" ''.mot -Wff M*S of Lammte --4mv vAftwmwSw*enwm �_ -am Rom': '' 0 hand-afttC11 ka &mw"afte-md Sews" ,g. 2 f02 D t 3` e , 31 F £ � - 7 ` i Tliiii�liiWe !oa Ct Title 5 Official Inspection Foy Subsurfm Sew"e Disposal Sim fti MA for Voluntery Assess I M Phi LA, MDG 3 Propst#y Address Arbor Terri !fir ownees Nam infortnatiion is for:rwy Hyannis MA 02601 4-16-1� Pap- city/Town State zip code Date of tr> n D. Spy Info nar'#tl (k.). Site Exami_ 0 Check S 0 Surma water a 0 Check aWar r 0 Shaw wells rnated depVt to high ground waW. 2OW feet Please indicate all rrre#w&used to dew ft ho gmund elevahon: 0 Obtained from systern design plan an€ecm If tamed,date ofdesign plan mmwed: fists observed site(abufting pi OR W P Checked with focal Board of HeaM-explain: Cif with focal ex vMors,ftstallers-tadach mmtti Acoesmd USGS - : You must dubs how you estebimhed the high ground water elevation Per Past Report BLCC 2 Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5Tns•1 trio ?lobe 6 o1fiew tnwemnfom.&mwuts sv*� —aoow system•Page is or 17 Co m onweafth of Massachuseft Title 5 Official Inspection Form subsuffm SvwaV so Nt for Volur"AsSess-me life Phi Ln, am 3 Proms Air Teffwe . infnrrnation Hyannis MA 02601 416-1�LL Pap- City-MOM state zip Code Date of hmpactwn F. Port ComCheCkW 0 Inspection Summary:A,S,C,D,-or f dhecked 0 inspection Summary D f5yslem FaffureCffteria AppUmble,W AN SyM3 oompleted 0 System Iftmmatim—5sft4ted nth to huh gmurdwater 0 Sketch of Sews"Dim"System drawn(m page 15 or aftached in separate as gins•1 t/,U Title 5 OBietat mspewon-Form:Subsurface Sewage IIi9p W System•Page 17 of 17 No......... .. Fxa............................. �. THE COMMONWEALTH OF MASSACHUSETTS BOARD ® HEALTH f Appliration for Elispvii al Works Tatutrurtion firrmit Application is hereby made for a Permit to Construct or Repair ) an Individual Sewage Disposal System at: ........�. �[�.. .._f.... y! .......................... Z G' ............--•--._..... •--•...................•...........------ ;� Q �/ ,or-ation-Addrr ss / /►� Lo ....---•--/`--`---f_.�G.r.. ._.f..�6 :L^ .......................... 3.T)-----:�-J.!T!..e.V'...:5.� .._.t.l _ O r Address W ------•----•------- ---•-----•-----••-•------- � Installer Address U Type of Building Size Lot_1 f..C,_3k..Sq. feet Dwelling—No. of Bedrooms__________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------••------•-••-•-••-••----------.._...•--•-•-•----•-•••••••-•-....-•---•-•.....-----•.....----... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity d jQgallons 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... ..&eeu�.ez....._ .. Date._..._��Ilxx �/.... Test Pit No. I....___:_ __minutes per inch Depth of Test Pit--- ____._ Depth to ground water......11.................. 4 Test Pit No. 2... >..minutes per inch Depth of Test Pit../_ `'. Depth to ground water.........-'::.___. O Description of Soil---. --#/x - � _ /f W / ....__ ............•-•-----•---•........... �q it Q----IYZZ faa.u� U N /� .� J�'Tfv Agreement: 13�)'/-- jz%�"1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI ITIYLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee/is d b the board of health. Signed -------------•--------•------•-•-•----••------ _ ..1 Application Approved By.............-,.... -:,�% Date Date Application Disapproved for the following reasons:.............................................................................................................. .................•--•--------•----------------------------------------------•----•------------•--•---------•---•------•-•--------•-----•---.......-•----••............................................. Date . PermitNo......................................................... Issued--.......--•----•--- Date No.. FEB.. THE COMMONWEALTH OF MASSACHUSETTS BOARD Ott HEALTH : .................OF............-..... .!�.1�7-146._.4+............................ Appliration for Biipusal Works Tnmunrtion Vamit Application is hereby made for a Permit to Construct (>44!b,or Repair ( ) an Individual Sewage Disposal System at ........�- �'.. �f,��/� � ...,�� .............• -- --------............-•-•--•---•....._. cation A dr ss Lot O Address Installer Address Type of Building Size Lot_ �''i_c- ._Sq. feet U Dwelling—No. of Bedrooms..................................Expansion Attic ( ) Garbage Grinder ( ) J a Other—Type of Building ..................... ------ No. of persons............................ Showers ( ) — Cafeteria ( ) 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 nk ( ) , f /*� "—" Percolation Test Results Performed b __--. G � d" Y . ..... ----•---... ---- ------•-------- Date •--- �,:.:....... Test Pit No. 1....5:- •..minutes per inch Depth of Test Pit.. Depth to ground water........................ PL T _est Pit No. 2_.___-. ..minutes per inch Depth of Test Pit . ..... Depth to ground water...................... P4 ---•••---.......................... O Description of Soil.... Q ,y is .-. �,►"" +' T ,lt + '� Sa �y.!u►a+r UNat re o r era ions nswer e aip�ile-.-- � 4 ' . . J � .-- le Agreement: "^ '41.4 /'`f° The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti:'I: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee f, d b the board of health. � � Signed •----- - --------------••--. ---------•••--••- •-•-----•-------•--�•� Application Approve d B _.. --•--- -` ................................... D Date Application Disapproved for the following reasons_.................................................____................................. ................. --•--------------------------------•-•--••-------...-------------•---•---------------....•..----•---------•------------•-----------•--..............................••---•-•----.._ —......---• Date PermitNo......................................................... Issued....................................................... Date i THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH ............O F...� w .�, .,,..... .............................................. Currtiirtt#r of Tuntltnrr THIS IS TO CERTIFY, That th I, dividual"n� isal System constructed ) or Repaired ( ) .----• -• .................... -•.... ......... ....... ••---- --- by es�-r f ' ; at .. ......•-• ----....... • � � ` -----------•----------------•------------------- 47 has been installed in accordance with the provisions of TI 5 f The State Sanitary Code as described in the. application for Disposkl�Vorks Construction Permit No... `... �................. dated----............................................ THE ISSIJ E OF THIS CERTIFICATE SHALL NOT BE CONS AS A GUARANTEE THAT THE SYSTEM WI // FICTION SATISFACTORY. DATE..... .1.. Inspector........ -••.-•--- ---•--...-•-•-------•--------•...-•--•........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No� . .. ..... -- FE ►i �r� 1 rhii TP&spos ar#ion rrntii Permissi Whereby granted--••- •... ��..................----- ------ -----•------........................................................ �. to Constr ct epair an dndiIdual Se ge System' atNo. ...... 4r '" --------- ............................ Street as shown on the application for Disposal Works Construction.,P-umitt No............. ..... Dated...................................... Jy �� �: ........ .. .---- -----------------•---...----•--•--...... $a of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y- L 0 C A IOh _• SEWAGE PERMIT. N0. >. Itsw IIS ,C,eL�/ c � VILLAGE 'INSTA LLER'S ' NAME R ADDRESS SuILDAR OR 'OWNER �'R£L- Slat £L�,S DATE PEIt Oil T ISSUED DATE C0 MPLI. ANCE ISSUED tpul e°l� r �1 the '33 j r C,r H 46 ` - 1 Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS \BOAR® O�HEALTH 0`T -OF........ ~.. .... . Applira#ion for Diapatial iv ork,5 Tian,itrurtion frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location.Addres or t No. ,....�' .0..t � _.1 . .. .....-••----••....._ .....•-•-• ' er ----•-------•-----•-•--•--------Address Installer Address / U Type of Building Size Lot.1�l�r.G-S�_Sq. feet 0-4 Dwelling—No. of Bedrooms........ ...................:.:..__......Expansion Attic ( ) Garbage Grinder ( ) ' Other—Type T e of Building ' No. of ersons____________________________ Showers G1 YP g ---------------•------;-=- P ( ) — Cafeteria ( ) Other fixtures ---•-•--•-----• •-•-•••./----•-•--•---••-•-•--.....- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity Pe lAallons Length.............•.. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No----------a-�'�. ....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( )/'I �p ~" Percolation Test Results Performed by.... / , .1 ............................ Date---- Test Pit No. 1.....:..........minutes per inch Depth of Test Pit---j_��'... Depth to ground water------------------------- 44 Test Pit No. 2. ___minutes per inch Depth of Test Pit---14.`.�_.... Depth to ground water..........:............ -•..... .................. . . ------------- •------------------------------------------------ --•---•------•----•--•------•••--•------------•---.----- O Description of Soil..TR9 .0."6?... .......................................-310.9f. ---p-"-�.........--t -s.M..................... -----••-------------•-•-••---••............•---•- -(R.'$;; .......��rt' SPA SD.-----......-----•--------------------•-----� =���---- `?11.-Ty ���-? W -----•... dam._-.t l�. r_ .a? �----S ------------- ---------3a-' 141- 1K _�c�:�2S�.... g�,-►D ------------------------------------------------------------------------------------- Agreement: ,a a -• 14.4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issu by the board of health. Signed. ...•••--•• •.... �✓ ��8 Dat Application Approved By-••--•-- .. ;-•-..... ....................... -••••/�� - -�--•-- Date Application Disapproved for the following reasons:..................................................................... ...........-•---••--••-......---•--•-----•---•--•-•-•----------------•-•-----------------------•----•---------------......--•--•......-•--..._.....J�----------••••---------••------•--••........... Date Perms No. -----------.--------- ...... Issued_... .. Date F>ms........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O I-IEALTH !''?.......................OF......... "i .. ..................._........ Apli ira#inn for 11iiipnnaf Works Tonstrnrtinn 1hrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at :' J. Location-Ad es .............................................................. ............................. � _....1 i .... .No..0 . .... Qw• r Address W /f� Insta 1ec 40 Address U Type of Building Size Lot. '?2�,.G�0 '_.Sq. feet Dwelling—No. of Bedrooms---...... ----------------------------Expansion Attic ( ) Garbage Grinder ( - ) Other—Type of Building No. ofpersons............................ Showers — Cafeteria Q' Other fixtures . - ----------_------------ W Design Flow............................................gallons per person per day. Total daily flow..............................._.........._.gallons. WSeptic Tank—Liquid capacityc�allons Length___............. Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......+A------- .Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z "Other Distribution box ( ) Dosing ,tt nLk ( ) '—' Percolation Test Results Performed by._ ? il Date. A �7 . _ a Test Pit No. I...............minutes per inch Depth of Test Pit 1 �r _. Depth to ground water------------------------ Test Pit No. ...minutes per inch Depth of Test Pit.../.f. ..:`l"'r... Depth to ground water........................ 9 _ ._....-- ................................................... --- ................................. O Description of Soil..F '" �- ` -- » 4�F ( .-• -••----•-••------------ --f -�- - i- *�Gx ��J�1vv1 i� t.r.lfltz 30 - )41 lIy cos 5� W ------------------------------------- - . --•------------- Ua i s or era ions—Ar"f SWheri a p ... Agreement: 3 o _ .+_4 4 °;r ' ? The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with provisions of the p 'TT :,.,E 5 of the State Sanitary Code: The undersigned further agrees not to place the system in optrA tion until atCerti sate o Compliance has bee isssi e by the board of health. Signed------.-- --- .............� V-...."---------•)-- Date Application Approved ffy----•`N ..................... ------- ...........---•--.............. Date Application Disapproved for the following reasons-.................................................................................----•--------•--•------••--•• •-•-----------------------•-••------•-----•-•--------------...---------------------------......----------I---------------•---•-------••••-•-----•--•-•-•-------•---------••-----••-----••-------......_•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH AJ / Trrtifiratr of Tnnt fittnrr THIS IS TO CERTIFY, That the Indi idual Sewage Pisposal System constructed ( ) or Repaired ( ) by--•-•--• --•-•------ ......................................•----.....................•-••--•--- a er at � L ........... --------------------------------------------- has been installedo in accordance with:the provisions of TITLE j of jhe State SanitaryCode as described in the application for Disposal Works Construction Permit No. _' _____________ dated _..._.._._..____.___.__._.........._._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM WILL,FU/ACTION SATISFACTORY.' DATE....._.. .//-...?f.�.................................................. Inspector....... ......--------•-------•--...---------------•------......_..........---••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD�_QF HE�� _ /.c •...........OF..P:.:........... .........__....r..: �. No.fC?�..._::��.. FEE. :.-............ Disposal VnF4.v Ton Sinn Vrrmit Permission is hereby granted to 'Constr ct or Repair ) an,IndividuE,� wage Di?,osal -a ...... `" Street as shown on the,application for Disposal Works Construction Permit No..................�' D ted....--.._................................. tr oard of Health f i. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou fnr Diripn3ttl Wnrk,i ( omitrurtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ('1,-ran Individual Sewage Disposal System at: A- L...............d �... ...: . ... = ---.......•........... ...----------------.------•. . .._ f o ,ton-Address r Lot No. V ._. �%1!!!iyG�=� - - ----.-.-•-•---- -- OwPX*)--t.... .............(a.... Lddr s Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.--_-_�-•---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtur ---------------------------- - - W Design Flow.._...__.. ________________________gallons per personp day. Totall aily flow......��� ---------------------gallons. WSeptic Tank-4 Liquid'capacitygallons Length________________ Width__....._._______ Diameter_.------------ Depth--------------_ x Disposal Trench—No_ ____________________ Width.................... Total Length.-...______......... Total leaching area....................sq. ft. Seepage Pit No.-..--/------------- Diameter..../-cam:____.__ 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-.--_------______-_-.-.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------------•------•----------------••-••---.......---_.............................................................. 0 Description of Soil........................................................................................................................................................................ U ----•••••--••-------•-------•-•••--•---•-•-•••------•------•---.......-•-----•--••------------•----•-•--•--•------•-------------•-•-••----•........................................................... ----------------'---------- -----------------------------------------------------------•----------------------------------------- ----•--------------------------- U Nature of Repairs or Alterations—Answer i a hcabl _.__..\_.�0.._�...P&_ir; __L - _._.�- ,._........ 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 Complian t o d health. - ---- -- --------------------- -----� 1�...�`.....Sign ....... - .. ... to � ..:. ...........:............ = � Application Approved By ... ....:: Date Application Disapproved for the following reasons- -------------------- ............. ----------------------............------------------------------ ......................................................................................... ------------.........------------------- ---------------.................--------------- --------.----------------*....-------' Permit No. _...L.. .'`..`............... __ Issued ..... ...... ........ Date } t � 5v�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,c ppliration fur Di-n1j'wial Worbi Cnowitrur#iutt rami# Application is hereby made for 'a Permit to Construct ( ) or Repair (lam)`an Individual Sewage Disposal System at:' r Location-Address / or Lot No. 1 `• ....... ✓\........ ......`.......... ...................... .•----------------­f_ f ti-��t...:d�.=- •�......................................... Owrier I f •-----•-•...................... .. •-- -------•------•--------•-•--.......... .. . _...................................... 1.4 1 Installer Address Type of Building Size Lot. ..................Sq. feet Dwelling—No. of Bedrooms........�J._..•...........................Expansion Attic ( ) Garbage Grinder ( ) a 'Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Pa Other fixttres ------------------------------ W Design Flow......__.____..: ........................gallons per person er day. Total daily flow..__.. __._......_.__------------------------------- Ions. WSeptic Tank 1 Liquid capacity! _gallons Length_.�....... Width-�........... Diameter................ Depth........ . x Disposal Trench—No- -------------------- Width-------------------- Total Length--___-----�-__-____ Total leaching area_...................sq. ft. Seepage Pit No.---.-;-__._.---... Diameter.._..1.._r).------ Depth below inlet_..Gl........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-_-_--_______._- _ Depth to ground water-..___---.-_____--_----. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pr ........................................•-.............•••-•.._.....--•---•-••••••••.........--•---..........---••-•---•----•----••-•--•-•.....--•---•....... 0 Description of Soil........................................................................................................................................................................ x V ....••••-------•--...----••••••••••-•-•....----•------••--•-----•-•-•--••----------•-•-------•------------•-.....•••-•-•--•-•••--•-•••••-•------•---•----•----•••...............••--••--•••............. W -------•-----------------• .........................--•• ---------------------------------•••....... -••••--•----------------....•----------•-----•--•-•-••--••••••-----•-----•--..................•- U Nature of Repairs or Alterations—Answer when applicable.._.__?. .�-N.s?�._1_- _,:�1• c _ �'1- i ` --- ..-•-•---•--...------•----------------------•-•'•...., ,/ a 1— [.. ,I Agreement: 1 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-beeti issued-by the board of health. Signed--------------...... �....................... ......... Date Application Approved By _ CG.:- ----- ------------------------------- /... 7 --- Date Application Disapproved for the following reasons: ..... .................. ------------------------------------------------------------------------------------------ Date Permit No. ,l'� --------- Issued - /�5 -` ----r...... Date _ --______________,—_____—__,__.___________—— _——__————_.—— —___________ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of Cnomplianre THIS IS TO CE TIFY, That the Individ'ual�Sewage Disposal System constructed ( ) or Repaired .. by ------------------------------------- -- 7 ' ( ,.-.. .�.. �� C`. L- - "sriuer at .. O---- _�2`f ---- has been installed in accordance with the provisions of TITLE of The Stat Environmental Code as described in the application for Disposal Works Construction Permit No. ... ..... � . -a �j dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE/CONSTRUED AS A GUARANTEE THAT THE f SYSTEM WILL FUNCTION SATISFACTORY. DATE...... -` ------ p Ins ect+ �' �- _ -- ...... ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ........................ FEE..a sj>--'--..��.22 Displatial ork �ua� rti n erntit Permission is hereby granted....._. ��(.�,n.....�.. ... ..`..�C.1-�i ---_-�..........•••---------•••••••-----••--••......•............••. to Construct ( ) or Repair (t')an Individual Sewage Disposal System atNo. ------------------------ Street�� as shown on the application for Disposal Works Construction Permit No----------__.__ ated.__.��"'........................... �/� = Board of Health DATE------••-----------------------•----------.-- ---- -------------••------ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS LO CJA T�IION jS EJ/MI A G'.E PE KNIT N0. VILLAGE � kS.TALLEWS NAME i ADDRESS i UhLDR OR OWNER D K T E PERMIT ISSILED DAT E CO_MPLrANC-E ISSUED�I f i 393 I TOWN OF BARNSTABLE ;LOCATION f(,�`lp �1�� ,�5 G�%�--- SEWAGE- VILLAGE ASSESSOR'S MAP 6i INSTALLER'S NAME & PHONE NO. ��.1-.4o_4 �cg�7Tdc_ SEPTIC TANK CAPACITY S r(t LEACHING FACILITY:(type) � .� T ! �� (size) . NO. OF BEDROOMS PRIVATE WELL OR�IC WA - R BUILDER OR-OWNER.. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Na n V� tiy. { ��• � •; h `_ � � W R • r s � � + . � s �r � V f R _ _ _. _N _ Q _ _ -� T f - .r {., � � �, � C. -1-- :_��.: _, ` '�;: ��;�q tti i4 EXISTING CONTOUR --g8-- N x 100.98 EXISTING SPOT GRADE —W EXISTING WATER SVC. ✓O'''e y —e.F�W OVERHEAD WIRES wOy TEST PIT BENCHMARK LEGEND ° u £z Q aw � A 3 0 Q� cT qve �cc� LOCUS MAP Z0 NOT TO SCALE PHINNEY' S LANE CATCH BASIN CATCH BASIN 100.76 edge of pavement 101.36 101,89 R=85 . 48' A=1 6. 09' x 100.48 EXISTING S.A.S.100,43 ry TO BE PUMPED, FILLED :.1Qfl..51:: ' 4� - x 101.6 W/SAND & ABANDONED 12.8--{ 99. 8 �" :---1 x 100,51 + 0 .7 100.11 O P-1 ul STP— b. :. . x 101.17 tom: ;``,�•� PK SET 100.8� '�, �� �'��� rii.r it 100.00 O 01.39 i is cn 32 Z m '+ BM/ORANGE D T :4 :'..".._V.. 100.50 101.20 _ WALK EXISTING SEPTIC TANK [j (TO REMAIN) ".: .1'... ...,. : .::.`'V ' ::.`: TOP OF TANK, EL.=100.86f 99.57 100 35 : 1N = f 0 10173 _101.4 V.(OUT) 99.50 0 100,68 EXISTING BENCHMARK ~ --W , HOUSE 1016 �� ) � ORANGE DOT/COR. WALK IJ 100177 T.O.F.=102.3t/ :R EL.=101.20 QCIP DECK I�ALK+ 101.21 ' 99.17 x 100.53 -tae--- `� LOT 3 lee-- 18,000±S.F.(RECORD) x 99.54 18,946±S.F.(CALC.) SHED ' 89.81, 98.96 Or Mass9�yG PARCEL ID: 252-053 PETER T. s PROPOSED SEPTIC SYSTEM UPGRADE PLAN Mc N 1016 PHINNEY'S LANE, HYANNIS, MA � CIVIL CIVIL No. 35109 Prepared for: DiBuono, Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 SI B OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. EXCEL BUILDING COMPANY, INC. Engineering Works, Inc. 1"=20' P.T.M. 206-19 8 JAN SEBASTIAN DRIVE, SUITE 9 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. SANDWICH, MA 02563 (508) 477-5313 7/1/19 P.T.M. 1 Of 2 ° NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=97.0 /FFzFOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & WATERTIGHT PROPOSED S.A.S. COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=102.3t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=101.7t F.G. EL.=101.4f F.G. EL.=100.8t F.G. EL.=100.6t MAINTAIN 2% SLOPE OVER S.A.S. • • /IJAYA • . iN/A17J7�7 L = 5' L = 5' S=1% (MIN.) © S=1% (MIN.) 2" LAYER OF 1 8 TO 1 2 4"SCH40 PVC 4"SCH40 PVC s'' DOUBLE WASHED STONE A LL1io"I "' as $ as (OR APPROVED FILTER FABRIC) 14. 6 6aaaa9a aaaaaaa �3/4" TO 1-1/2" DOUBLE EXISTING 48" uqulD WASHED STONE LEVEL GASABAfFLE� 4' 4.8' 4' INV.=97.72 PROPOSED INV.=97.55 EFFECTIVE WIDTH = 12.8' . . �. INV.=99.50t D-BOX EXISTING INV.=96.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONIC. ELEV.=97.6f 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=97.00 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=96.50 eases 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE Raw aaaaaaaaaaa aaaaaaaaaaa ON A MECHANICALLY COMPACTED SIX INCH CRUSHED BOTTOM ELEV.=94.50 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' 2 x 8.5' = 17.0' 4' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4 0 PERVIOUSLLY MATOERIIAL RING EFFECTIVE LENGTH = 25.0' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W., EL=88.1 LEACHING SYSTEM SECTION - SEPTIC SYSTEM PROFILE GENERAL NOTES: / 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL /EXISTING BOARD OF HEALTH AND THE DESIGN ENGINEER. HOUSE(11016) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS T.O.F.=102.3f OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �� M FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. A36 SS 1 - -5. ALL ELEVATIONS-BASED-ON--AN-ASSUMED-•DATUM. -- 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF co HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. _ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. ��•6�9• 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. ;;a 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS IN AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. ' 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY D THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 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). SEPTIC LAYOUT 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND SOIL LOG NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC DATE: JULY 1, 2019 (REF#TPT-19-61) SYSTEM COMPONENTS NOT SHOWN ON THE PLAN SOIL EVALUATOR: PETER McENTEE PE(SE#1542) WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH 100.7 A 011 100.6 A 0" SANDY LOAM SANDY LOAM DESIGN CRITERIA 100.1 B 10YR 4 2 7" 100.1 B 10YR 4 2 6„ SANDY LOAM SANDY LOAM - NUMBER OF BEDROOMS: 3 BEDROOMS 98.0 32" 98.1 30" C1 10YR 5/6 C1 10YR 5/6 SOIL TEXTURAL CLASS: CLASS I SANDY LOAM SANDY LOAM tO 5/4 10YR DESIGN PERCOLATION RATE: <2 MIN IN (BOULDERS) (BOULDERS) DAILY FLOW: 330 G.P.D. 96.6 49" 96.6 48" DESIGN FLOW: 330 G.P.D. C2 C2 PERC GARBAGE GRINDER: NO-not allowed with design M-C SAND M-C SAND 50"/68" LEACHING .AREA REQUIRED: (330) = 445.9 S.F. 2.5Y 6/6 2.5Y 6/6 .74 88.2 150" 88.1 150" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PERC RATE 2 MIN. 5 SEC/IN. "C2" HORIZON PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-20 RATED NO GROUNDWATER ENCOUNTERED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 1016 PHINNEY'S LANE, HYANNIS, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: DiBuono, Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 206-19 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD (508) 477-5313 7/1/19 P.T.M. 2 Of 2