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0055 PILGRIM LANE - Health
a 55 Pilgrim Lane A = 311 059 Hyannis ,� /i ,R �, I f 1 I i 1� l II t I TOWN OF BARNSTABLE LOCATION \C4 f SEWAGE# :2 0161 VILLAGE e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.`[ A ,� S nI C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) "(size) NO.OF BEDROOMS OWNER_�Gt 1r� r I PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: N n.9 p pN<oV J Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Ck3 r e1c 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 gffacility) � Feet FURNISHED BY Ck \Jc®t- . �Z CO 0 C) oo [O �. n � � iv 1 glLDoao- -W/ AN FeeNo. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes i� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS I AppY1tAt10I1 for VepDsaY 6p8tP111 COttstCUttIDII PeCllltt Application for a Permit to Construct( ) Repair(0 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ?a 1 5, a L,, #Y4#k n wnerxn�,� s� ,d �1� 1" D ��y� Assessor's Map/Parcel �`�-� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. i�. t�a.r51a� i� '�3er�.�nsa"Cnac SOFT-c/O�U-7i55 �'.,.s,...�t>-.:v5 ct�c.vvitS SC��~y7`7�S�f� Type of Building: Dwelling No.of Bedrooms Lot Size e7 sq.ft. Garbage Grinder( ) Other Type of Building L1 y us-r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ;IL;t C) gpd Design flow provided 3 gpd Plan Date 2 - 1 1 ci Number of sheets ;Z Revision Date Title Size of Septic Tank 1'5-00 Type of S.A.S. f SC.Z'j y Ge/)a ev C ACC Description of Soil Nature of Repairs or Alterations(Answer when applicable) ZN 5 Je, �� I C7C� Gt- -/ Z2 Roy Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gne d Date ' 'Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �' Date Issued No. D 3 Fee THE COMMONWEALT46F MASSACHUSETTS Entered in computer: 1 PUBLIC HEALTH DIVISION - TOWN.OF.BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(M Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S S p, r M L f%) ,Owner' e Address,and T No. 5 d � � -/Ol�(�� Assessor's Map/Parcel .. S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. `J',,S\o s h 'C3 rv�na'I nx SOU-yOU- 7/SS �'•Yg,Nro r,;,s Gvc�✓'/t5 5U¢3-H77-S�/3 Type of Building: Dwelling No.of Bedrooms ;Z Lot Size `7 sq.ft. Garbage Grinder( ) Other Type of Building 0 us Y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow.(min.required) gpd Design flow provided 2 y 3 h gpd Plan Date 2 - 1 - 11-I Number of sheets Revision Date d Title Size of Septic Tank I SOU Type of S.A.S. / s,co G do r h 4y"6 p✓ ." Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1-,v it /SGU ,.� / �iV day ` ""o0 ctrt � IGro t-1A InP/ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by This Board of Health. Si'gne _ y 1:0 /11l Date Date Application Approved by A _ Application Disapproved by V Date . for the following reasons Permit No. / Date Issued y ti ---.------------------------1------------ -- ------- -------- - - - -- ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( $Upgraded Abandoned( )b c a A -13 (r,w i n1C at 5 .,. L ro has been const ,cted in acc d. ce with the provisions of Title 5 and the or Disposal System Construction Permit No. D/ /ted Installer, Designer J #bedrooms Approved design flow a 2 e / Algp'd r The issuance of this permit shall not �be/cotYsttrJued as I guarantee that the system iI+ ,n/ctJijor�j as d('esyigVped.y% C Date Inspector /� r p / - — - ,.// - t• , V 1 - - - - ------------------------------------------------------------------------------------------ V No. /"J Fee--- ��-�� / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Vsposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 5 1 e d, ,x N FA A 4 u..,ri 15 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co`tructi,n m7/� c 'pleted within three years of the date of this permit. c { Date roved A b PP Y 04/04/2014 14:05 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Richard V. Seali, Interim Director 9 `$ ~ Public Health Division Thomas McKean, Director Zoo Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-794-6304 Instalier & Desiener Certification l"orm Date, �j. l Sewage Pern1it# ;2D I �d 29z Assessor's MaplParcel 1 ` �Pd rf J rani-ea P Installer; 3,�,_Vr% (VI c Designer: � Address: t Z W. s Ate.I Lzrj Address: 9 0 . - t�—,��Q.ta Yam' c�2[o�I y C�.�.�rc•+V��lac M,(� 4�3z On L PA ` -(a-J'L ik was issued a perrr}it to install a d e (installer) P septic system at .��� 00" CtM J used on a design drawn by (address) ?�-&�--e e dated b — (designer) I certify that the septic system referenced above was instaLed substantially according to the design, which may i,elude minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I cerdfy that the septic system ref=nced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if req=ed) was inspected and the soils were found setisfactory. I certify that the system referenced above was constructed in compli ith the terms of the 11A approval Letters (if applicable) ��fi� PETER T. McENTEE to er's Signature) CIVIL rro.30106 6?kesl�pees Signature) ix Designer's P EASE RETURN TO BARNSTABLE PUBLIC REALTH DIVISION. CERTI LATE UF C4M2I ARE R CExVE BY X BARN ABLE PiT)3LIC HEAD ILT XVTSION. BUILT CARD r THANK YOU. Q:1Septic\Desiper Ceitificatior.Form Rev 9-14-13.doe f Don=i s 24O s 129 02-06-2014 ,.12--16 BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION WHEREAS,Juan Marichal,of 182 Pitchers Way,Hyannis Massachusetts 02601 is the owner of 55 Pilgrim Lane, Hyannis (Barnstable County) Massachusetts 02601 (hereinafter referred to as "the Property") and,being shown on Subdivision Plan 11519-G (sheet 2) dated July 23, 1949, drawn.by Joseph Selwyn, Civil Engineer, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 71, Page 19 with Certificate of Title No. 10599 and said land is shown thereon as LOT 232-W. WHEREAS, Juan Marichal, as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restrictions as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environment Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environment Code Title V Minimum Requirements for the Subsurface Disposal of Sanitary . P Sewage,and authorizing the issuance of a building permit for the construction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this documeni; NOW THEREFORE, Juan Marichal, does hereby place the following restriction this above referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title; 1. 55 Pilgrim Lane,Hyannis, Barnstable County,Massachusetts may have constructed upon the lot a house containing no more than two(2)bedrooms. Juan Marichal agrees that this shall be a permanent deed restriction affecting the Property located on 55 Pilgrim Lane, Hyannis, Barnstable County, Massachusetts and being shown on plan recorded in Land Registration Book 71,Page 19 with Certificate of Title No.10599 For title see Deed recorded with the Barnstable County Registry of Deeds as Document No.. 1,229,214 and Certificate of Title No. 201238. x Property Location: 55-Pilgrim Lane,Hyannis Massachusetts 02601 WITNESS my hand and seal this�f day of �2LolQcr4 2014. J a ichat COMMONWEALTH OF MASSACHUSETTS Barnstable County,ss: On this _,S f day of - , 2014, before me, the undersigned notary. public, personally appeared Juan Marichal, proved to me through satisfactory evidence of identification,which were_ Y11%Pr (i csa ,is ,to be the persons whose names are signed on the preceding document, and acknowledged to me that he signed it voluntarily for its stated purpose. Notary Public My Commission Expires: MANE C.McPHEE iVH O YASMAS COMYubric ONWE,1lTH OF SCHU$ETT8 My C,�xnmissian E�ires Awrd a;20tc Property Location: 55 Pilgrim Lane,Hyannis Massachusetts 02601 BARNSTABLE REGISTRY OF DEEDS a. Land Court Index Abstract-Search Results Page 1 of 1 BARNSTABLE LAND COURT REGISTRY DISTRICT JOHN F. MEADE, REGISTER Land Court Abstract by Document# Search Document*: 1,240,129 , Database searched: Land Record Gtor/Gtee Index thru Feb 06,2014# 1,240,157 <Previous Next> Show Print Cart DOCUMENT ABSTRACT Doc#: 1240129-1 _ = Recorded: 02-06-2014 @ 12:16 Address: 55 PILGRIM LN Pages in document: 2 Group: 1 Type: Restriction Descr: 232-W 11519-G Town: Barnstable Doc date: 02-03-2014 Ctf#: See parent list Parent doc: 1,229,214 1 DD Ctf: 201238 Grantor: MARICHAL,JOAN (Gtor) Grantee: BARNSTABLE TOWN OF(HEALTH) (Gtee) Recording Fee: 50.00 State excise: .00 Surcharge: 25.00 <Previous Next> Show Print Cart HOW TO USE THIS PAGE To see an abstract of the next sequential document, click on Next>. To see the previous panel displayed, click on <Previous. To view an image,click on the document icon with "DOC". Please note that if the icon "DOC" is not shown, that means the document image is not available. To view an abstract of a referenced document,click it's hyperlink. Most images you will view and/or print will not have marginal reference notations on the image. If you are interested in marginal reference information for a particular instrument/document, check and optionally print the abstract for it.There is no fee for printing abstracts.To print the abstract,right click on the abstract side(not the left side)and, for Internet Ex lorer select"Print". https://72.8.52.132/ALIS/WW400R.HTM?WSIQTP=LC09A&WSKYCD=D&W9RCCY=2... 2/6/2014 ti3 fi 4�f y; N in -,c,` ,..'s L N � -OFFICIAL I cc Postage $ f Q 6 N � Certified Fee 1 N POstmarkl C3 Return Receipt Fee KHe a C3 (Endorsement Required) MA� W Restricted Delivery Fee r (Endorsement Required) r-9 p Total Postage&Fees $ CQS N C3 Juan Marichal F 182'Pitcher's Way Hyannis, MA 02601 Certified Mail Provides: �( o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: q Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Win ' ry .off`✓?ri. e Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent a Print your name and address on the reverse X n i ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date f D ivery ® .Attach this card to the back of the mailpiece, a � or on the front if space permits. D. Is delivery address different from item 1. Ye - 1. Article Addressed to: If YES,enter delivery address below: No Juan Marichal"". 182"Pitcher's Wa`' " y 3. Service Type Hyannis, MA 02601 ❑Certified Mail El Expressail ❑ Registered ❑ ceipt' ❑Insured Mail ❑4. Restricted Delivery?(E2. Article Number (Transfer from service Iabeo 7012 1010 00001 2 PS Form 3811,February 2004 Domestic Return Receipt 1 UNITED STATES POSTAL,SERVICE First-Gass Mail I Postage Fees Paid USPS Permit No.G-10' ° Sender: Please print your name, address,and ZIP+4 in this box • I Town of Barnstable Regulatory Services Department � Public Health Division F 1 200 Main Street Hyannis, MA 02601 r • �t Town of Barnstable Barnstable Regulatory Services Department AFAROMCM * ' � Public Health Division Q D "1s Mai n in Street, Hyannis MA 02601 2007 Office: 508-862-4644 SECOND NOTICE Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 2521 March 5, 2014 Juan Marichal 182 Pitcher's Way Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 55 Pilgrim Lane, Hyannis, MA was last inspected on 5/16/2013 by Raymond Dumas, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. There is evidence of carry over from cesspool to pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH as McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\55 Pilgrim Way Hy Jun 2013.doc r - Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 41 (AlfJ, 'r exns�ssari r_� � Logged In As: Parcel Detail Tuesday, March 4 2014 Parcel Lookup Parcel Info Parcel 311-059 � ) Developer LOT 232-W ID Lot Location 15�5 PILGRIM LANE �) P r i ----- Frontage Sec OTIS ROAD ' Sec(30 Road Frontage' Fire Village jH NAY NISITYANNIS District' Town sewer exists at this Road 21j 46 u -� address No Index '� Asbuilt Septic Scan: Interactive `` � 1 3110591 Ma p s ,, Owner Info Owner MARICHAL,JUAN � Co- Owner I Streetl 1182 PITCHER'S WAY ( Street2l — City;HYANNIS �—) State MA Zip'!E-6-01---j Country Land Info Acres 0.15 Use;SingleaFam MDL-01 ] Zoning jRB J Nghbd 10104 Topography 11-evel Road Paved_ Utilities All Public _ + Location Construction Info Building 1 of 1 Year1950� � Roof Gable/Hip Ext iWood Shingle Built Struct— Wall Living 880 � RoofiAsphlF GlslCmp ACiNone Area Cover` Typen Be ' r Style Ranch ,V1/allDrywall1 Rooms 12 Bedrooms " _...._._�.. Int; Bath Model residential Floor Carpet ( Rooms 11 Full a, Heat ,_ ___ __. Total Grade Below Average Type Hot Air Rooms5 Rooms - to --- Heat Found- Stories 1 Story Fuel.Gas ation Typical Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 3/4/2014 v ft'1 co :.yx.. ra ra F I ( Lrl CO rru Postage $ �yp,N N 1S p Certified Fee / p 1 Postmark R Receipt Fee 1� p (Endorsemsem ent Required) / �!.(ire 0 ON Restricted Delivery Fee 1t p p (Endorsement Required) O Total Postage&Fees &sp� ru r qT' 1=1 Juan Marichal a 182 Pitcher's Way Hyannis, MA 02601 Certified Mail Provides: n A mailing receipt w o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required: t e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". 'I a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and.present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 n Complete items 1,2,and 3.Also complete A. Sig ure item 4 if Restricted Delivery is desired. X ❑Age ® Print your name and address on the reverse dressee so that we can return the card to you. g e ved by(Pri ed Nam ) C. Date of Delive "m Attach this card to the back of the mailpiece, L or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1 Article Addressed to: If YES enter delivery address below ❑No LHyannis, an Marichal I 2 Pitcher's Way 3. Service Type MA 02601 ❑,Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 Article Number( nsfer from r a service label) { 7 012 1010 0 0 0 0 2 8 51 18 8 3 � PS Form 3811.February 2004 Domestic Return Receipt 102595-02-M-1540 I I UNITED STATES POSTAL.SERVICE First-Class Mail Postage&Fees Paid. I USPS Permit No,G-10 M Sender: Please print your name, address, and ZIP+4 in this box' I Town of Barnstable I Public Health Division 200 Main Street I Hyannis, MA 02601 I i f i Town of Barnstable Barnstable IFE Regulatory Services Department `"teKAMr Public Health Division �j fo 39.y a 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 1883 January 27, 2014 Juan Marichal 182 Pitcher's Way Hyannis, MA 02601 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 55 Pilgrim Lane, Hyannls, MA was last inspected on 5/16/2013 by Raymond Dumas, a certified septic inspector for the State of Massachusetts. The inspection of the septic system-showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. There is evidence of carry over from cesspool to pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH • Thomas McKean, R.S. C e_.. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\55 Pilgrim Way Hy Jun 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 21 62a Pa eui�ciAtile :1 I m, v Logged In As: Parcel Detail Tuesday, )anua2014 Parcel Lookup Parcel Info Parcel Developer CLOT 232-W ID" Lot Location[55 PILGRIM LANE ) Pri FrontageSec Sec J30 Road�OTIS ROADrv_.__ Frontage�0 Fire Village FHYANNIS ( District IHYANNIS Town sewer exists at this Road -� address No Index Asbuilt Septic Scan: Interactive 311059_1 Map Owner Info Owner;MARICHAL,JUAN Co-IF - Owner Streetl 182 PITCHER'S WAY ( Street2{ �? Zip Country Land Info Acres F0,15 UseSingle Fam MDL-01 Zoning Nghbd[0104 TopographyjLevel Road) aved Utilities[All Pu Ib c Location Construction Info Building 1 of 1 Year ---�"'� Roof Ext r- - --: �1950 Gable/Hip iWood Shingle Built Struct Wall ' Livin Roof AC FAsp g880 h/F GIs/Cmp lNone �' Area Cover Type Int �_` Bed __. _. _. € StyleIRanch Wall Drywall Ro0 ms;2 Bedrooms 1 e r Model Residential Int Carpet Bath 11 Full� � `' "� � `` Floor Rooms i Grade Beiow Average Heat Hot Air Total 5 Rooms • F—� Type _.__._ __.___ _.i Rooms ( Stories 1 Story Fuel Heat`Gas� - Found-ation Typical Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 1/21/2014 � r ru ru .. o 0 OFFICIAL - . Postage $ U11S ru Certified Fee 0 Return Reoelpt Fee C3 (Endorsement Required) O Restricted Delivery Fee(Endorsement Requ.rl ` M Total Postage&Fees $ I rq ru o Mr. & Mrs Howard Bearse % Juan Marichal 182 Pitcher's Way Hvannis. MA _n26n1 Certified Mail Provides: ! o A mailing receipt ti • A unique identifier for your mailplece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.'To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. 1 o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the art!- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 , i, miel :. AIM M Complete items 1,2,and 3.Also complete A. S�ignre item 4 if Restricted Delivery is desired. ❑Agent X © Print your name and address on the reverse ❑Addressee so that we can,return the card to you. ece' d kyj Printed Nai Date of Delivery M Attach this card to the back of the mailpiece, or on the front if space permits. - ^ D. Is delivery a�d Jress different-'-.m iter.0 ❑Yes 1. Article Addressed to: If YES,enterdelivery addrerss below ❑No Mr. & Mrs Howard Bearse � % Juan Marichal ' 182 Pitcher's Way 3. SecviceTyp M I i ❑Certified Mail ❑Ex�ess Mail y H annis, MA 02601 ` ❑Registered ❑Return Receipt for Merchandise — — — ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number Ili i t i l i 1 I l i f., 3, } (Transfer from service label) 7 012 1010 0 0'0 o 2 8 51 0 0 2 2 � PS Form 3811.February 2004 Domestic Return Receipt, 102595-02-M-1540;, r VICE RJ' I UNITED STATES (6k[ - E , ce S m° I Stage es P Sender: Please print your name, address, and ZIP+4 in this box I I A � I Town of Barnstable Public Health Division I 200 Main Street I Hyannis, MA 02601 I I �l+ill'Ii,��ll�l��'i'IIil�jililllFllli,�I�lillili�I�lll,�Iellriil i f table Town � Ba rn S Barnstable THE Tp� Regulatory Services Department ;efia Cft i M I+ IARNbTABLE. ;A 9 Public Health Division 2007 TEA" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0022 September 6, 2013 Mr & Mrs. Howard Bearse % Juan Marichal 182 Pitcher's Way Hyannis, MA 02601 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 55 Pilgrim Lane, Hyannis, MA was last inspected on 5/16/2013 by Raymond Dumas, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. There is evidence of carry over from cesspool to pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER O-F THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\55 Pilgrim Way Hy Jun 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 /,F/ y{ • pew;{ 11 f �y2dY! J P,� ....�.u..e�^^^fx 3M' 'R �:I`[;at�tisimlt�r-�:I } • -�'s: ;� . •„„ � g �'� ��+rrr '� ��• ;i34 �a�a f- � �"� �� �` -�"� � � 'tea Logged In As: Parcel Detail Wednesday, September 42013 Parcel Lookup Parcel Info Parcel 311-059 — —I Developer LOT 232-W ID` Lot Location 55 PILGRIM LANE Pri 30 Frontage' Sec OTIS ROAD Sec Road I Frontage Village JHYANNIS Fire HYANNIS District Town sewer exists at this Road 1246 address No Index Asbuilt Septic Scan: Interactive 311059 1 Map1 �` Owner Info Owner(BEARSE, HOWARD A& LINDA J ( Co Owner I%MARICHAL, JUAN Streetl 1182 PITCHER'S WAY _ / Street2 - City.HYANr NIS ' State(MA Zip�02601 Country Land Info Acres 0.15 Use Single Fam MDL-01 Zoning RB Nghbd 0104 Topography ILevel i Road Paved Utilities All Public ' Location Construction Info Building 1 of 1 Built 1950 �SRoot Ext (Gable/Hip � � Wall Wood Shingle Living 880 Roof IAsph/F GIs/ AC None d Area Cover Type Style Ranch Wall Drywall Rooms 2 Bedrooms cask Model lResidential Floor Carpet �I Rooms 1 Full Grade"Below Average Type Hot Air Rooms 5 Rooms Total Stories 1 Story J Heat iGas Found-1 q Typical Fuel" ation Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 9/4/2013 f Free people search and contact details for H... http://www.whitepages.com/name/Howard-A-Bearse/Hyannis-MA/4p5m5fm WhitePages Send Howard A Bearse's details to phone Your number Message Howard A Bearse 508-778-5626 55 Pilgrim Ln Hyannis,MA o2601-5620 Send' There was an error,please try again later.close Thank you,your message has been sent.close See What Howard Bearse's Home is Worth L.dcna Howard A Bearse 45-49 years old Phone number 508-778-5626 Address 55 Pilgrim Ln Hyannis,MA 026oi-5620 People Howard may know Barbara Bearse Linda J Bearse April N Bearse More results at PeopleFinders.eom ©2013 WhitePages Inc.-Privacy Policy and Terms of Use 9/4/2013 k` 1e m U.S.POSTAGE>>PITNEY BOWES Town of BarnstablePublic Health Division BAR"5f"BLE. 200 Main Street O O ZIP 02601 Hyannis,MA 02601 z 02 1 VV oo6.1 �y 000138.3424 JIJN.�26.,201.3. 7012 1010 0000 2650. 9347 Howard Bearse 55 Pilgrim Lan,e,< _ .T Hyannis, MA: 026Q1 h • _ _ . ;— , .• __ -�R=TURNI TO SENDER W F� .>r fia yyf ' sue. c: � 'S C: 0 2gg'�77>8.33�..�q' 7q,9���qqa^yy yy ii �'8�8 t9t�d'a-k.9 2 48q 3'0g y4.!L�.���t�g�aa, :'�'�r ;�544S " "4 •f 9 9 9:4.Y`i 9,i��T4; 4t�i 9.19�T�74fl I9�B �i94T 99 vry u95'ae6 :3.�e.e a .iv "I' r>�'•:''s;'�y ����� �-_��x«t�tn�,�1H "��iyr``"i.4,na�'1i�''.-+. �•�lr;:�>r�sr�u.;.i.+wFroa'.*af y�p�Rll_._._ - - - 33 - ■ Complete items 1,2,and 3.Also complete 7Signatureitem 4 if Restricted Delivery is desired. ❑Agent. ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. (Printed Name) C. Date of Delivery s I ■ Attach this card to the back of the mailpiece, or on the front if space permits. I _ D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: I If YES,enter delivery address below: ❑No I , I I j =..Howard Bearse 55 Pilgrim Lane I Hyannis, MA Service Type 1 3.�02601 ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise I ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes �� I 2. Article rfroms 7012- 1010 0000 2850 9347 "\,�� umber (Transfer from service.labeq �- _; i; PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540; J n m rr o0 F F I 11C I A L U CO Postage $ 5 d S n ru Certified Fee C3 Qostmark p Return Receipt Fee �UGHerer �' p (Endorsement Required) 2 M Restricted Delivery Fee 9 (Endorsement Required) O �Q 1\4 V W S\� . p Total Postage&Fees rl ri -Howard Bearse_ 55 Pilgrim Lane Hyannis, MA 02601 Certified Mail Provides: e A mailing receipt i o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: n. Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when,making an inquiry, PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 - S r Town of Barnstable Barnstable �t� Regulatory Services Department `OCK IARNSfABLE. MASS.. Public Health Division i639 ,� • �f A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9347 June 25, 2013 Howard Bearse 55 Pilgrim Lane Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system.located at 55 Pilgrim Lane, Hyannis, MA was last inspected on 5/16/2013 by Raymond Dumas, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. There is evidence of carry over from cesspool to pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\55 Pilgrim Way Hy Jun 2013.doc i Town of Barnstable Barnstable �r Regulatory Services Department KAS& Public Health Division �• 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9347 June 25, 2013 Howard Bearse 55 Pilgrim Lane Hyannis, MA 02601 . ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located of 55 Pilgrim Lane, Hyannis, MA was last inspected on 5/16/2013 by Raymond Dumas, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. There is evidence of carry over from cesspool to pit. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\55 Pilgrim Way Hy Jun 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26031 h ti B.A17.'\St4tiLE. ' as .. 4a y dAi`y Logged In As: Parcel Detail Monday,June 17 2013 Parcel Lookup Parcel Info Parcel ID 311-059 I Developot LOT 232-W I Location 55 PILGRIM LANE ---I Pri Frontage 130 Sec Sec Road JOTIS ROAD Frontage 30 Village HYANNIS Fire District HYANNIS I Town sewer exists at this address NO — . I Road Index F1246 __....__ ._._..-._____—_ --j • � a Asbuilt Septic Scan: Interactive jo 311059_1 Maps Owner Info Owner BEARSE, HOWARD A&LINDA J' Co-Owner Streeti�55 PILGRIM LN Street2 i I City HYANNIS State AMA ZipFO-26-011 Country J Land Info Acres 0.15 use Single Fam MDL-01 h Zoning RB Nghbd 0104 Topography Level Road Utilities All Public � Location r�-.. �._..-...w...�__._._�,......_....._.. �� Construction Info Building 1 of 1 Year 1950 Roof Gable/Hip 1 W Wood Shingle) Built Struct .Wall 11 _ Living 880 1 Roof Asph/F GlslCm AC None Area 1 Cover p Type Int a Bed 12 Style Rnch D Wall rywall Rooms Bedrooms i � s Model Fesidential . Carpet Bath 11 Full e< Fl000rr Rooms Grade Below Average Heat Hot Air Total 15 Rooms Type Rooms Stories 1 S story Heat Gas Found ]Typical Fuel ation Gross(880 Area Permit History http://issgl2/intranet/propdata/ParcelDetai1.aspx?ID=26031 6/17/2013 A / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim-Way 01 a� Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Raymond Dumas use the return Name of Inspector key. Dumas Landscape Const. A Company Name 564 Old Stage Rd. Company Address Centerville Ma. 02632 City/Town State Zip Code 508-778-0249 S1437 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/16/2013 Ins pe is gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. bt6 71 3 t5ins-3113 Title 5 Official Inspection F v bsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: 5 ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 ;.r�� Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 e r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 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•3113 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 ." 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3(13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts vTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �z 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1 Old Cesspool and 1 overflow pit Number of current residents: 3 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: 2012 34500 gallons 2011 33750 gallons Sump pump? ❑ Yes ® No Last date of occupancy: occupied at time of inspection Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Cations per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s y< 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityrrown 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: Barnstable Sewage Treatment 9/13/2005 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): Cesspool and 1 overflow pit t5ins•3113 Tale 5 Official Inspection Food:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: pit installed 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: approx 4 ft 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) no tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4 Distance from top of scum to top of outlet tee or'baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Evidence of carry over from cesspool to pit Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 55 Pilgrim Way Properly Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityfrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. City/Town State Zip Code _ Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no d box Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 1 cesspool and 1 precast pit 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is Hyannis Ma. 02601 5/16/2013 required for every y 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•a113 Title 5 Official Inspadion Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Pilgrim Way Property Address Howard Bearse owner Owner's Name 'Mannalk is reqaired for n everyHyannis Ma. 02601 5/16/2013 Me. CihrRown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: [] hand-sketch in the area below ® drawing attached separately i tFM•3h3 Title 5 Official Inspection forth:Subsurface Swage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is H required for every y annis Ma. 02601 5/16/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record - If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: Water contour map You must describe how you established the high ground water elevation: usgs data base Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 5� r 55 Pilgrim Way Property Address Howard Bearse Owner Owner's Name information is required for every Hyannis Ma. 02601 5/16/2013 page. Citylfown 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 r h® g p y p g o attached In separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# l Department of Regulatory Services ? Public Health Division Date Z3 13 t63 200 'n Sheet,Hyannis MA 02601 Date Scheduled Ub)xl.��-Time Pee Pd. A 6 ut Gd Soil SuitabilityAssessment or Se 's' o i ,M C? .f //Jb ///J� Performed By: /2C K., f `C h witnessed Ey: �' / "/ ,� LOCATIONY&GENERAL:INFORIVIA Location AddressOwner's Name tN 't�C� -r}��"� lam; b C &V 1..;. Address �AyAvlvt-%a H y v►a :ti /vtP, 67-6 01 ` Assessor'sMap/Parcel: .�t) 5-i,/ Engineer's Name (j( NEW CONSTRUCTION REPATR, 7� F Telephone# f 5 0 6p 73 7- _I 7 VVW Land Use Slopes.(%) Surface Stones Distances from: Open Water Body ft 'Possible Wet Area ft Drinking Water Well. ft Drainage Way - ft Property Line ft Other ft SIMTCH:(Sweet name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) 2 � J tl r - Parent material(geologic) -k V U 7-11��Y _` Depth to Bedrock' Depth to Groundwater: Standing Wstar in Hole: IIV Weeping from Pit Face Estimated Seasonal High Groundwater Y DETERMINATION.FUR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date - Time Observation 0 • Hole# �T-4 -1 Time at 9" r- Depth of Pero iCJ`U 7{� -G t I Time at 6" Start Pre-soak Time Q Time(9"-6') End Pre-soak L l J M n s Rate Min./Inch Site Suitability Assessment Site Passed_- Site Failed: Additional Testing Needed(YIN) Original:Public Health Division Observation Hole Data To Be Completed on Back— -- If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:4SEPTIC\PERCFORM.DOC DEEP OBSERVAT'ION:HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil' Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency- el L37- -g' T DEEP OMER`°ATION ROLE LOG Hole# '— Depth from Soil Horizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistena.° d—�, da � co ✓1 4 G-S 2' rY DEEP OBSERVATIONROLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) .Mottling (Structure,Stones,Boulders. Consistengy.° v i y f ' i[^ } DEEP OBSERVATION HOLE LOG Hole# ,•` } Depth from Soil Horizon Soil Texture Soil Color .Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.° e Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi us material?. Certification I certify that on � atc)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required trai'm g,g ertise and experience described in 310 CMR 15.017. Signature Date �! L Q ( ( Q:\SEPTIC\PERCFORM.DOC DEEP'OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil- Other Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulders. r_ Consisten el �y,,?L Gf C S 2�5YG1` DEEP OBSER ATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. C n isGravel) 4 LS 2• rY DEEP OBSERVATION HOLE LOG-— Hole Al Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ` ,(Mansell) ,. Mottling (Structure,Stones,Boulders. 1 onsistenGravel) iI t 4 � DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muttsell) Mottling (Structure,Stones,Boulders. Consisten %Gravel 1 i I r , Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes_ Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ' ' If not,what is the depth of naturally,occurring pervi`us material? Certification I certify that on q4' h6 e)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required Ir ukK,7L1Apertise and experience described in 310 CMR 15.017, Signature Date ll L q (� Q:\SEPTIC\PERCFORM.DOC r B l Town of Barnstable P# Department of Regulatory Services i s Public Health Division Date flZA 13 t 200 'n Street Hyannis MA 02601 't Date Scheduled '� .+� Time ! " JJ Fee Pd. �t0-0 ' Soil Suitability Assessment for S s o Performed By: Oe K-,— M C- Sv-4--r M Witnessed By: LOCATION&GENERAL INFORIVIA ON Location Address , Owner's Name a CA>y�tQ r�e 1,5 uS�(,% Lin Address I g- �`t�1�►in l It./q�►�►:s MCA- c e Assessor's Map/Parcel: i S Engineer's Name,OR r r�j7�(C G'�{—�•C NEW CONSTRUCTION REPAIR ' Teleph /one# ����' 3 7 — t1 Land Use Slopes N Surface Stones Distances from: Open.Water Body ft 'Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line f ft Other ft SKETCH:(Street[tame,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t 2 � N 1 J 11 w C7 Rr ,9 r A CT � Parent material(geologic) Depth to Bedrock- - "A. Depth to Groundwater: Standing Water in Hole: IIV I /�'_ Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE = Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs,hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# ,�(" Time at 9" Depth of Perc Zt1 G Time at 6" Start Pre-soak Time @ -`U Time(9"-6') L l JAM'n End Pre-soak Rate MinAnch Site Suitability Assessment Site Passed_� Site Failed: Additional Testing Needed(YIN) Original:Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICTERCFORM.DOC LOCATION SEWAGE PERMIT NO. VILLAGE 1117AV 62-6p/ INSTALLER'S NAME - &� ADDRESS fS, hj0 lv"l S I U I L D E R OR OWNER DA T E P ERMIT I S S U E D ( DATE COMPLIANCE ISSUED 9 �� �/ Rc zo� c VIN No................_....... Fss........�..I..�...�_.'..la�.. THE COMMONWEALTH OF MASSACHUSETTS V •ter BOARD CY HEALTH -. ....I'- .........O F.......... a--144:.. ---------------•--------------•--------•---• . Appliration for Ditipm l Works Towitrnrtion rantit Application is hereby made for a Permit to. Construct ( )i Repair ( ) an Individual Sewage Disposal System at: ......---- '�'�,� ��'� G/'� --------------------------------------------- Location:Address or Lot No. > 2' •-------------------------- --•------- Own r - Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity...--.......gallons Length------_------- Width................ Diameter................ Depth..... ....... x Disposal Trench—No..................... Width.................... Total Length_................. Total leaching area....................sq. ft. Seepage Pit No..........:.......... Diameter.------.------------ Depth below inlet.....................Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) (Idw ����� Percolation Test Results Performed by-----•-•--•--•-•-•----•••--- •--------•••......-•-•--••-•••......• ate------. _j Test Pit No. 1................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........................ R+ -------•--•------------------------•-•-•----------•----------•--••------•••--•••---....----•-_....-......................................................... ODescription of Soil........................................................................................................................................................................ x U ••--•-••-•-••---•----••••••---•••--•-•••-•-•••-••••-••-•-•--•---••-•-••-••--••••••••--•-•---•--------••••-•-----•--•-•••--••-----•-••---•.............................................................. W ------------------------------------------------------------------------------------------------------------------------=----- -------••----••••-•••••....••--•--•-••••--•••......--•-•---•--•--•---••-- VNature of Repairs or Alterations—Answer when applicable................................................................•................_.............. -••----•-----•••----------•-•...-•----•..•--••--•-•••---••-•------••---•-----•-•----•••••-•--........--•-----••••---•-------------------------•---••-.....•------•••-•-•-•----••--••--.._...-••••-•••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T T;. y g g p y 5 0£ the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has b issopl by the board o},health. Signe / `� ��� Da e ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons---------------••----------------------------------------------------------------------------••-•••----•-----••-- ---•------•----------•-------------------••-----------------------------------------.........•••-•-•-•••- (�' Date Permit No......................................................... Issued...... ... :-.j d--.... ------------ Date No......................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ..- 1. --.....O F................... t:. `.-----------..................................... Apli iratiou for Uiipu,5al Works Tumuurtinn Vernfit Application is hereby made for a Permit to Construct ( ) r Repair ( ) an Individual Sewage Disposal System at: ......_r ._.� .. -- __............. ____________•-.--............-_._----....... Location-Address or ALot No. A'e-"'-i '_ - --'-------------------------------------•------•--------..... .......... ----- ................................................... aOwn r -------•••----•--•-•-•-••Address............................l�" t'' �' f ------------------------------------- ------....------- Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. W Design Flow............................................gallons per person per day. Total daily flow......................................._....gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ ............ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) omoel v(Idw, ��� '"' Percolation Test Results Performed by.......................................................................... Date----____ . Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (X Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. ----•-----------------------------------•----------•----•--•----------------•---•-------------------........................................................ 0 Description of Soil................................................-........................................................................................................................ x U W ---•--------------------------------------------------------------------------------------------------------------•------••-------------...----------------------------------------------------•------ U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. --------------------------------------------------------------------------------------------------------•------------------------------------------------•----•---•-----------•------•---------•------•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE:'?: . p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bpep issir by the board health. j Signecl2 �..-� __�.�-_ I1040P'!J-•----_. ` / Date ApplicationApproved BY.................................................................................................. Date Application Disapproved for the following reasons---------------------•---------------------------------------------------------------------------------.....__.._ ••-------------------------------------------•---•-------------------•---.....------------•--•----------------•-----------------•-------------------------•-••--•-•--•------------------•--------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ` ' .....oF............ m_......it'.. . ......................................... �rrtifiratr ,af f�nr3n li �tre r TH S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..•.._ ------------------- t ................ ...... ._......- r...................... Installer ` a has been mstalld in accance with.the provisions of > of he State Sa-Vary Code as described in. the application for Disposal Works Construction Permit No..:...___.....y 1_ ______________ dated__.f:_...f t__:`_. ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS-A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATIt... Inspector .' - ' '>".!-�. x+ ����' �'�•_�/'X,�"''r..' -: �- � t�d�,.w.�,�t"� ^'rim��.r�� �' r:J x4 't•. k' THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ......... f�".f1.......... ..OF........... �� �................................................. No..... `.. .. FEE ............ Zan Permission is hereby grante -�� , ......---to Constru ) or Repair ( In Ivldual age Dispo�treet stem �� as shown on the applicati for Disposal Works Construction Pm N ..._ Dated..___' _ ............... ------....�/� _ 1� _ ;------- �_G (�_ ---•.......................................... Board of Healtdi� DATE_____*2 G �^__.. VV FORM 1255 HOSES & WARREN. INC.. PUBLISHERS - ' - a —Q9 ——EXISTING CONTOUR ��'� AIRPORT N x 100.98 EXISTING SPOT GRADE LOCUS ROTARY 97 PROPOSED CONTOUR Ro�TE ZB R W EXISTING WATER SERVICE ogre 2s G EXISTING GAS SERVICE —e,H. W—OVERHEAD WIRES Rods Ro �o G TEST PIT LGP j1519 $ BENCHMARK z ° Y 2 Q C NCP LEGEND 100,90 STOCKADE FENCE 99.89 `'' LOCUS MAP _ NOT TO SCALE 40.7 1' �/TP-1 100.53 O x -I -T. .�,. ���^ GENERAL NOTES: ,PROP. '%.5 .Si 1_�� 7BM-2 I,.: I:� OUTSIDE COR./BOTT. STEP 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SHED I'. O "I ni EL.=101.09 1 BOARD OF HEALTH AND THE DESIGN ENGINEER. I - I 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS L 100�1 ` �� OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE EXISTING CESSPOOLS LOCAL RULES AND REGULATIONS. TO BE REMOVED `—' 10 3� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR (SEE NOTE 11) 412' O a 00.10 N �� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE li cJ'; �p �\ DESIGN ENGINEER. 171,01.05 � � � 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING XX\ CK �� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN EXISTING CESSPOOL �L TO BE PUMPED, FILLED (D �� E SUppORTS ��\ ENGINEER BEFORE CONSTRUCTION CONTINUES. W/SAND & ABANDONED v 50 OT 100,38 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF SEX/STING i HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �u I HOUSE(#55) 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. I ,T.,0.F.=101.3E x �.. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. U I CRAWL SPACE'EL.=99.4 100,96 ;.: 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE x " DIRECTED BY THE APPROVING AUTHORITIES. 100.64 '. \ 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY O .., .. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ,,,� � •• CONSTRUCTION. LOT 232W 100,51 10 . 5 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS x M L 311 -59 100.09 REPLACE WITHIN THE AREA BCLEANH AND FOR 5' ON SAND AS SPECIFIED IN N SIDES3110 CMR THE 255(3).S. AND � 5429 f SF � ' 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 18.42' U 51 5B, �;ry 4 _ INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. R=120'0 7BM 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 100.19 \ PK NAIL SET NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. avement EL=100.00 edge Of F F 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC .28 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 100SE 100.30 \ ' 15. CONTRACTOR SHALL VERIFY THE ALL SEWAGE FLOW IS CONNECTED TO r M LA k 0.00 THE PROPOSED SEPTIC SYSTEM. OF MASS 1 y" 100.00 UH'W MAG, AIL M PLAN PETER T. PILG PROPOSED SEPTIC SYSTEM UPGRADE McENTEE Q 55 PILGRIM LANE, HYANNIS, MA o CIVIL No. 35109 I Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 �'FGIS E� Engineering by: SCALE DRAWN JOB. NO. FS NG OWNR OF RECORD 1"=20' P.T.M. 227-13 n BEARSE Enineeri HOWARD A & LINDA J g g Works, Inc. 1�{ 182 PITCHERS WAY 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 2 1 14 f 2 Z � P.T.M. 1 0 01 13 HYANNIS MA 026 508 477 53 1 ( c � V, NOTE: TO PREVENT BREAKOUT, FINAL GRADE -16.5'-�{ SEPTIC TANK SHALL NOT BE AT, OR BELOW, E'=97.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE PRO OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX OF THE PROPOSED S.A.S. SHED i ~j i o0 CRAWL SPACE FLOOR INSTALL RISER & COVER PROPOSED S.A.S. ^� �$. S.A.S. 1 EL.=99.4f SET TO 6" OF GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND 24.4____ 1 v' T.O.F=102.2f SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=100.1f g,0 24.4' F.G. EL.=100.2t F.G. EL.=100.1t F.G. EL.=100.1t ^o DECK L = 20'(MAX.) 3'(max.) � L = 8' L � 5' ' ® S=1% (MIN.) ® S=1% (MIN.) ® S=17 (MIN.) 4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" RTS DOUBLE WASHED STONE NOTUBE SUPP 0 to"I 6 aaaaSa®a (OR APPROVED FILTER FABRIC) SO 14" aa6aaaa INV.=97.15 48" LIQUID aaaaaaa --3/4" TO 1-1/2" DOUBLE LEVEL ADD INV.=96.77 PROPOSED 4' 5.2' 4' WASHED STONE .EXISTING GAS BAFFLE �O� INV.=96.60 EFFECTIVE WIDTH = 12.8' HOUSE(4155) INV.=96.90 ,T.,O.F.=101.3f 3 OUTLETS INV.=96.50 CRAWL SPACE'EL.=99,4 PROPOSED SEPTIC TANK 1-500 GALLON LEACHING CHAMBER SURROUNDED WITH STONE AS SHOWN CONNECT TO EXISTING SUITABLE SEWER PIPES AT HOUSE, AT OR ABOVE, INV.=97.55 H-10 RATED TOP CONC. ELEV.=97. SEPTIC LAYOUT BREAKOUT ELEV.=97.00 Baaa NOTES: INV. ELEV.=96.50 eases 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaeaaaaB®a INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.50 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 8.5' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 16.5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0 Ea E3 Ea Ea 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL.=87.9 4 ®®®®®® ® ® ®®® 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE ►- 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR-EQUAL. � w ® N Z ®LZ®®®® ® ® ®®® SEPTIC SYSTEM PROFILE 102" SOIL LOG DESIGN CRITERIA DATE: DECEMBER 5, 2013 (REF#14,171) 4" KNOCKOUT SOIL EVALUATOR: PETER McENTEE PE(SE#1542) 20" DIA. COVER NUMBER OF BEDROOMS: 2 BEDROOMS WITNESS: DONNA MIORANDI R.S. HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I (EFFLUENT LOADING RATE=0.74 GPD/SF) ELEv. TP-1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN 99.9 0 q 0'. 101 q 0" DAILY FLOW: 220 GPD SANDY LOAM SANDY LOAM DESIGN FLOW: 220 GPD 99.4 B 10YR 4/2 6„ 99.6 B 10YR 4/2 6" 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (220 GPD) = 297.3 SF 97.1 10YR 5/8 34" 97 1 10YR 5/8 36„ 500 GALLON CAPACITY, H-10 LOADING GPD/SF.74 C1 C1 PERC CHAMBERS PROPOSED SEPTIC TANK: 1500GALLON CAPACITY 36"/48" COARSE SAND COARSE SAND N.T.S. PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 2.5Y 6/6 2.5Y 6/6 USE 1-500 GALLON LEACHING CHAMBER SURROUNDED 93.9 72" 94.1 72" PROPOSED SEPTIC SYSTEM UPGRADE PLAN WITH 3/4" to 1-1/2" DOUBLE WASHED STONE-ALL SIDES C2 . C2 SIDEWALL AREA: 2(12.8' + 16.5') x 2 = , 17.2 SF MED. SAND I MED. SAND 55 PILGRIM LANE, HYANNIS, MA 2.5Y 7/1 2.5Y 7/1 BOTTOM AREA: 12.8' x 16.5' = 211.2 SF Pre pared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 in TOTAL AREA:.................................................I............328.4 SF 87.9 132" 89.1 132" Engineering eering by: SCALE DRAWN JOB. NO. .i En ineerin Works, Inc. N.T.S. P.T.M. 227-13 PERC RATE: < 2 MIN./INCH ("C" HORIZONS) Engineering DESIGN FLOW PROVIDED: 0.74 GPD/SF(328.4 SF) = 243.0 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/1/14 P.T.M. 2 Of 2