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HomeMy WebLinkAbout0394 PITCHER'S WAY - Health 394 Pitcher's Way t Hyannis / A = 290 015001 l `e h� r o29D-o/5- onl Commonwealth of Massachusetts p Title 5 Official Inspection Form { Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is required for every Hyannis (/ Ma 02601 10-13-2020 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 filling out forms A. Inspector Information SI *r H (o�" on the computer, use only the tab Breft Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code rno (508)477-0653 S113747 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 Brett HickeyDigitally signed by Brett Hickey Data:2020.10.16 11:53:15-04'00 10-13-2020 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. t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts A ----_------- ..... Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y 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: The system was in working order at the time of inspection. 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 ears old is available. P 9 Y ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y St page. City/Town ate 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): ❑ 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 ,: - _-,I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town 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❑ p p y g g a salt marsh b. 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. c. Other: it III 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes. No ❑ El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 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 �u-- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town 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 ❑ Q 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: ❑ E 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. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ 0 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. i 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 11 of a public water supply well t5lnsp.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 iSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y 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 E ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ 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? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components,excluding the SAS, located on site? 0 ❑ 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? ❑ El 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: El ❑ Existing information. For example,a plan at the Board of Health. ❑ El 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.cloc•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 394 Pitchers Way � . Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example110 gpd x#of bedrooms): 333/GPD Description: 4 Number of current residents: i Does residence have a garbage grinder? ❑ Yes 91 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 I■❑ No information in this report.) Laundry system inspected? ❑ Yes '❑ No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2019-449/GPD (only year available) Sump pump? ❑ Yes ❑■ No Current 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 - Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis ' Ma 02601 10-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 9-21-2020 Was system pumped as part of the inspection? ❑ Yes ❑■ No f ,es volume pumped:y p p gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection' Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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 infor'mation: 2005 per plans Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): 11311 Depth below grade: feet Material'of construction: ❑cast iron H 40 PVC ❑other(explain): Town water 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 c � Commonwealth of Massachusetts So Title 5 Official. Inspection Form _ i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 394 Pitchers Way Property Address Raymond A Marshall' Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3„ Depth below grade: feet Material of construction: ❑� concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 211 Sludge depth: 3411 Distance from top of sludge to bottom of outlet tee or baffle 0n Scum thickness G11 Distance from top of scum to top of outlet tee or baffle V 1711 Distance from bottom of scum to bottom of outlet tee or baffle measured 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.): The tank was in working order at the time of inspection.'The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 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): NA 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 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F' ,? 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town 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): 0" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is required for every Hyannis Ma 02601 10-13-2020 page. City/Town 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.): NA * 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: ❑ leaching chambers number: ❑ leaching galleries' number: ' leaching trenches number, length: 15'x30' 0 leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5lnsp.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 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town State Zip Cade 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.): The SAS was in working order at the time of inspection. No evidence of past back up was observed when viewed. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 1 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts +n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town 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 a , r j< 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is required for every Hyannis Ma 02601 10-13-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑M Check cellar f ❑■ Shallow wells Estimated depth to high ground water: No GW @ 136"feet Please indicate all methods used to determine the high ground water elevation: R Obtained from system design plans on record 2-10-2005 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: A plan on file at the local Board of Health was used to determine high groundwater. 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 i Commonwealth of Massachusetts == Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 394 Pitchers Way Property Address Raymond A Marshall Owner Owner's Name information is Hyannis Ma 02601 10-13-2020 required for every y page. City/Town 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. ❑E 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)completedI 1 ❑■ 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TO�R OF BARNSTABLE SEWAGE # Udr- LOCATION { `rII,LAGE ,����� `ASSESSOR'S MAP &LOT;ZS'O O/S•�� INSTALLER'S NAME&PHONE NO. Kam' SEPTIC TANK CAPACITY E a LEACHING FACILITY: (ape) p (size) NO.OF BEDROOMS - . BLUDER OWNER C.S .. PERMIT DATE:—..... COMPLIANCE DATE: r Separation Distance Between the: Feet Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Well and Leaching Facility (If any wells exist Private Water Supply Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching fac' Furnished by ii X t� r i i j7 � .�dl - . . Commonwealth of Massachusetts W " Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 394 Pitchers Way Property Address ���� - Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use only the tab key 1. Inspector: to move your ��D O 1 �d Robert Paolini t cursor-do not Name of Inspectors use the return key. Capewide Enterprises,LLC :all Company Name fh -s t� P.O.Box 763 C, Company Address t•,3 `;r Centerville Ma. 02M2 r e7� City/Town State Zip ode 1' t (508)428-4028. S14454 Telephone Number License Number B. Certification _ l 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 t Title.5 (310 CMR 15.000). The system:- ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 2/27/2008 Insp ctor's Sig ture 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 DER 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. 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. ' 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check. A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: ❑ 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 ❑ obstruction is removed 394 Pitchers Way-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts " W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System,Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 C 0 obstruction is removed ND Explain: 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 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. 394 Pitchers Way-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 ,M 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page.. City/Town State Zip Code Date of Inspection B. Certification (cont) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a:DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to,or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® 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 El ® Static liquid level in the distribution box above outlet invert due to an ovehoaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less El than Y2 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. 394 Pitchers Way•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 394 Pitchers Way Property Address Wellington Scares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page., City/Town State- Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ®- 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 1 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 El ❑ 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. 394 Pitchers Way<12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is Hyannis Ma. 02601 2/27/2008 required for y every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped'out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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 El ® approximation of distance is unacceptable) [310 CMR 15.302(5)] 394 Pitchers Way-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a� M 394 Pitchers Way ^ \ Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bed rooms.(actual):.` 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ®, No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006-08:17,700 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occ 2/27/2008upancy: 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: Last date of occupancy/use: Date Other(describe): 394 Pitchers Way-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 394 Pitchers Way Property Address / Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information } Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system'own'er) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed.(if known)and source of information: system installed 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way M Property Address _ Wellington Soares ' Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: t ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 4" Depth below grade: feet Material of construction: ® concrete ❑ metal. ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon - Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle ` 29' Scum thickness 1 7, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined?' Measured 394 Pitchers Way-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: . ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness .t 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.): 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): 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 ' f Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: . I Capacity:,, gallons Design Flow: gallons per day l 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.): I , *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑'No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has three outlet laterals with equal distribution.No evidence of solids carrryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 394 Pitchers Way•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ° M 394 Pitchers Way Property Address .Wellington Scares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances,,etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields_ number, dimensions: 15'x30'x1' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No-signs of hydraulic failure.No ponding or damp soil. 394 Pitchers Way 12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 .. every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 layer Depth of scum la p Y 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.): 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.): 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 394 Pitchers Way P rope rty.Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. 1 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 394 Pitchers Way Property Address Wellington Soares Owner Owner's Name information is required for Hyannis Ma. 02601 2/27/2008 t every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: Bottom of leaching 15', feet Please indicate all methods used to determine the high ground water elevation: ❑ r 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: As-Built Card ❑ Checked with local.excavators, installers- (attach documentation) r ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations.USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 394 Pitchers Way•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 1HE l0� Town of Barnstable • ' OF Regulatory Services BAMSCABLE ; Thomas F. Geiler,Director ArFo39�A Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Town of Barnstable P# Department of Regulatory Services ,AMMAM& : Public Health Division Date I b y KAM a 200 Main Street,Hyannis MA 02601 16jr d Date Scheduled Time Fee Pd. � � � . Soil Suitability Assessment for Sewage isposal Performed By: l-�tia�5 - - Witnessed By: vt LOCATION & GENERAL INFORMATION Location Address Owner's Name P1 A 01 X Address Assessor's Map/Parcel: a Gl O_O i S-0v Engineer's Name �%j NEW CONSTRUCTION --&- REPAIR REPAIR Telephone# r Land Use Va ca o,T Slopes(%) 2—0-4 Surface Stones 0 Distances from: Open Water Body 0 ft Possible Wet Area i �1 ft Drinking Water Well (M Xll ft Drainage Way V,.V*dl ft Property Line 7 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) �2 I 54` 1 s� P17cNFO-S WAS Parent material(geologic) w�S� Depth to Bedrock _. t Depth to Groundwater. Standing Water in Hole: IZI4/ � ► �� Weeping from Pit Face Estimated Seasonal High Groundwater __ - DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: CCL Pxwt A -- t,, - U S G S K AIA Depth Observed standing in obs.hole: _ In. Depth to Soil mettles: ._tu• Depth to weeping from side of o s.hole: io, Groundwater Adf ustment B Index Well#k W_ Read- Date:. Index Well level Adj.factor,_Z Adj.droundwater Level 1� �Iyle EY PERCOLATION TEST bate P ( . Time 12;00 Observation Time at 9" Hole# Depth of Perc [�r Time at G' Start Pre-soak Time @ 0•O o --- 'rime(9"-6') --- End Pre-soak 1"T,.0o Rate MinJlnch 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:\SEPTICIPERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent % ravel 3 -9 A Ioye— 3/3 1 vX 4- `/-4 -13� G F/IvtS 2 Hy4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel b- 2 p Ale LS 10 Y2-:3/-? 0 -24- O Yam. 5/6 FIMS 2-,fY 1-A N zo 1 12-9 y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ravel Flood Insurance Rate Man: Above 500 year flood boundary No r Yes Within 500 year boundary No-2 No Yes- Within 100 year flood boundary � 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 pervious material? Certification I certify that on 7 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date 6 D Q:VSEPTIC\PERCFORM.DOC Commonwealth of Massachusetts _ _Title 5 Official Inspection Form Subsurface Sewage Disposal System Form= Not for Voluntary Assessments �M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every. Hyannis Ma. 02601 4-28-14 . 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. i Important:When A. General Information- - filling out foRns on the computer, .. I use only the tab 1 Inspector: key to move your . _.. cursor-do not Matthew F.:Gilfoy use the return key. Name of Inspector B&B Excavation _. _.. Company Name .14 Teaberry Lane Company Address a��& . Sandwich Ma.: 02644 City/Town State Zip Code (508)477-0653 - S131640 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the j 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 15000). The system: ® Passes. ❑ Conditionally Passes ❑ _Fails Needs Further Evaluation by the Local Approving Authority 4-29-14 Inspector's Sign ture I Date I -. The system inspector shall submit.acopy 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. - ��jj - `✓ ° I t5ins•3/13 Title 5 Official t pe, on Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are Indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 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-3/13 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 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 Y2 day flow t5ins-3/13 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 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. CityfTown State Zip Code Date of Inspection Bo 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- 1 0,000g pd. ❑ ® 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of.Massachusetts f Title 5 Official In pection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 394 Pitchers Way - M 5... Property Address:. - - :.. David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. Cityrrown State Zip Code Date ofinspection 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: ❑ M 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 Ias built plans of the:system:obtained and examined?(If they were not.::::. ® available note as N/A): M El 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? EJ 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): „ 333 t5ins•3713 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2-11-05 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 10"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20 feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): 2" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required.for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):. At time of inspection septic tank appeared to be in working order,Tees present no sign of back- ' up.Liquid level equal with outlet invert. 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 �M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. Cityrrown 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 0 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.): At time of inspection d-box appears to in working order no sign of deteration, or carryover. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town 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: 15'X30' ❑ 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.): At time of inspection leaching appears to in working order no sign of hydraulic failure.Water level in d-box at invert. System working properly. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Sub'surfacwSewage Disposal System Form - Not for Voluntary Assessments 4 3 .Pitchers:Wa 9. y Property Address David-Baker Owner Owner's.Name information is required for every Hyannis Ma. 02601 4-28-14 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 wh46publicwater-supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached.separately . I I I I t A -W t5ins•3/13 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i Site Exam: ® Check Slope f ® Surface water ® Check cellar Shallow wells Estimated depth to high ground water: 129"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record perk date aug-18-2004 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: El Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °7M 394 Pitchers Way Property Address David Baker Owner Owner's Name information is required for every Hyannis Ma. 02601 4-28-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 © NOV TOWNIJF BARNSTABLE LOCATION 94 P/ r -e✓1 Q!�,e SEWAGE #"206:57-5-5 VILLAG ASSESSOR'S MAP & LOT V-qQ OILS•tldi INSTALLER'S NAME&PHONE NO. \ ke SEPTIC TANK CAPACITY LEACHING FACILITY: (type) c P (size) NO.OF BEDROOMS BUILDER OWNER PERMIT DATE: COMPLIANCE DATE. d Z63 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa c' ' Feet Furnished by N r P d� . r r l No. Fee 15® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppiication for 30i5pont Opgtem Con.0ruction Permit Application for a Permit to Construct X Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 39,4 '' vkc'v1 S WA Y Owner's Name,Address and Tel.No. (_0��� Assessor's Map/Parcel }fieq0"n S Installer's Name,Address,and Tel.No. .a Designer's Name,Address and Tel.No. ��/—ti c7l'lf►� LI�UI�bOJM��11`l`—rJ�C.S . 39 - T17(Q(P Type of Building: Dwelling No.of Bedrooms Lot Size_31o,aE�S sq.ft. Garbage Grinder(/VV - Other Type of Building No.of Persons �_3 Showers( t/S Cafeteria Other Fixtures L+tj y oz , kc."yG!\G1 n,,,►i-- LAu wDgY Design.Flow 2:)O gallons per day. Calculated daily flow gallons. Plan Date a I\b DS' Number of sheets Revision Date eLZQL Ct31 . �nJt> � L oC►4'i\Dt� Size of Septic Tank isoD Type of S.A.S. IS X'3O ( AC," Description of SoilP fl^1 Nature of Repairs or Alterations(Answer when applicable) E � "'C`s3'?l►f�N 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 provision f Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue his Boari of Health. SigAed, Date Application Approved y Date o'Z 1)16--5 Application Disapproved for the following reasons Permit No. ® 0 Date Issued �2 THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS' �Y 0[pprication for 30i.5po�al.-Spotem Construction Permit n 7 Application for a Permit to Constructp<)Repair( )Upgrade( )Abandon( )IxComplete System ❑Individual Components Location Address or Lot No. 39 L� ��-�C�rt r S WA Y Owner's Name,Address and Tel.No. 4 i M 1-1ya rJ,J t*� Lop—\1IC)cn--'cac� SoweG5 S Assessor's Map/Parcel U�,l G(�h 1 =oQt `� 414SIi Installer's Name,Address,and Tel.No. t/ Designer's Name,Address and Tel.No. ,�" �Gf�� �HflY C-�ut��.I►,nc�r�t- .,JCS , Type of Building:Dwelling No.of Bedrooms Lot Size G.I_AP��- sq.ft. Garbage Grinder( V�1� Other Type of Building L)CN'r. No.of Persons Showers(;/5 Cafeteria(VI) Other Fixtures 1. K\)Azot Design Flow �,' )C) gallons per day. Calculated daily flow gallons. Plan Date `1 h l C.S' Number of sheets Revision Date " Title k�ms�c. � �'-)o c-)-4 i c Sc x S� Lt.<A-TA-1)bs , Size of Septic Tank_ 1.ScD c�.�\\uc , V Type of S.A.S. I V tCi .(1 v Description of Soil Nature of Repairs or Alterations(Answer when applicable) FCC "tom�4 ( AN z ' 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.provisionvf Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this Board of Health. Signed .:AA A . _ L Date Application Approve by Date Application Disapprove for the following reasons Permit No. �' U' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertificate of (Eam fiance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed (,Z )Repaired( )Upgraded( ) Abandoned( )by VIP at 7 Q"(- k has been constructed in a,cordance with the provisions of Title 5 and the for�Disposal System Go: struction Permit Novi 5 65Q dated _ I I d Installer !� — ' _ r Designer The issuance of 06�rrm' tii shall not be construed as a guarantee that •he yst it nction as designed. Date �d"5InspecCr No.AnD S -J.5 Fee /`5 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mig;poaf *pztem Construction Permit Permission is hereby granted to Construct(,,/)Rep it( )Upgrade( )Abandon( ) System located at , t t 4 2 fin. &An r S _" J >, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the d Ce f'this-permit: Date: --II /c),5 Approve by j 5 Town of Barnstable Regulatory Services _ � o Thomas F. Geiler, Director * BARNSTABLE, + MASS. ��� Public Health Division rFD NIP' A Thomas McKean,-Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 5/20/05 Designer: Shay Environmental Services, Inc. Installer: �\�-k�'� Cc�nC -syc�k%r� ' Address: P.O. Box 627 East Falmouth Address: MA 02536 On. 5/10/05 was issued a permit to install a (date) installer) septic system at 394 PITCHERS WAY, HYANNIS, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 02/10/05 (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. XX_ I certify that the septic system referenced above was installed with major change"s'(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. OF Mgss�c '�" o� ti� ```•� n CARMENsta ler's Signature) E sfi SHAY No:'1181 GISTs (Cas s �•` ( esigner's Signature (Affix Deg Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF•COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form r " �1 YOU WISH TO.OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission,to operate.) Business Certificates are available at the Town Clerk's Office, V FL,367 Main Street, Hyannis,MA 02601 (Town Hall) DATE: . Fill in please: APPLICANT'S YOUR NAME: V����I IJ d� RA BUSINESS YOUR HOME ADDRESS: 3�l ��' M TELEPHONE # Home telephone Number :5O NAME OF NEW BUSINESS �I.I.I IJ �. ES EI,EC P IC.IA14 TYPE OF BUSINESS r"L6C71M MAN' i�P�NEV�I A-N IS TI•II51:HDMIw OCOUPAT[ON? YES NOS slave you>2een given.approval from.th build n .' �iisiort?. f NO ADDRESS OF BUSINESS P S A MAP/PARCEL NUMBERJ' When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S CE This individual has bee ed of an�rmit requirement that pertain to this type of business. uthorize Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been'nfo ed of the permit requirements that pertain to this type of business. Au orized Signature* COMMENTS: Ct on e 1 S -"" n kk7 a-+tw 1 - 3.- CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: S /as TOWN OF BARNSTABLE ' TOXIC AND HAZARDOUS MATERIALS` i ON-SITE INVENTORY NAME OF BUSINESS: y� U1W r dN R- SQWES �I�CTRI61P7V BUSINESS LOCATION: N4 PITCH MS Wh INVENTORY MAILINGADDRESS: ���5U01 TOTAL AMOUNT: TELEPHONE NUMBER: O % 4 CONTACT PERSON: VVIEWN610N I2 SOk EMERGENCY CONTACT TELEPHONE NUMBER: 15( 09 95 154 MSDS ON SITE? TYPE OF BUSINESS: Em"TR.I cim INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum ( I Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants i Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers 8 A'Z P4k -&e an S (including bleach) ` Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS t . , . , , . .: .. :. 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FAMILY 1n � ,n � R38 INSUL 1 N i NII ® 1= �-K :— + ? 1X3 STRAPPING 2X10 a fit I6 O G. i NII S2 I rll ,, r{• I �� 5r8" F.C,WALLBOARD I rll GARAGE � I x I NII 4' THICK 2 s !GARAGE 2X4' �a1�16" OLLBOARD w CONC,SLAB � 6'-0I'4" 2'-8' 3'-b" 21-411 31-1011 181-0" - - - - - - - - - - NII > ci - - R131NSULATION ' 9 �-- 2X10'e* *0 orc, O O 1/2" PLY.S14EATH NG * NII �- -1 a'o' co. 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REV1510N DRAWN BY PACE 6GALE , n JOB ADDRE55= MR $ MR5 WILLINC�TIN 50ARE5 DESIGN CUSTOM COLONIAL STYLE HOME 01-15-8005 # JB 1/4 1'-0" 394 PITCHERS WAY FM- HYANNI5 MA, 1 PURCHASE OF DRAWINGS LEAVES PURCHASER RESPoiISIBLE FOR COMPLIANCE WITH ALL 2 EXACT SIZE AND REINFORCEMENT OF ALL CONCRETE FOOTINGS 3 ALL FOOTINGS SHALL EXTEND BELOW FROSTLINE VERIFY DEPTH. LOCAL BUILDING CODES AND ORDINANCES,J B DESIGti 6 MAY NOT BE HELD RESPONSIBLE MUST BE(DETERMINED BY LOCAL SOIL CONDITIONS AND ACCEPTABLE 4 VERIFY STRUCTURAL ELEMENTS FOR DESIGN t SIZE WEST BARNSTABLE MA.0266$ (508)315-0930 FOR SITE CONDITIONS OR FOR THE USE OF THESE DRAWNGS DURING CONSTRUCTION, PRACTICES OF CONSTRUCTION,VERIFY DESIGN WITH LOCAL ENGINEER. 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I I � �", I I I I I I I,I I I I I 1, .1,I 1 I I I I , - �, I I I I I I I I I� " 1� .I I � . I � I I I I � , I I I I I : I I � I I I I " I I I- I I � I , I I - I I I I I I I I , - . E�L �: I I I � I I I il I,, I I I 11� I: I I I I I 1, I I - I I I v I I iI I I I I I " 1 I I I �I I -I I I I I I I I ,, I I I I I I I I I I I I 1� I I ! I � I I I 11 " � I I I I I I I� I I I , I 11, I � I - I I I � � � � :�I I I I I I I I il I I I ,'l , I � , I, I I I I , I I : � � I � I I I I � I � � I I I � I � I I I I I : I I 11 I. I : I � 'I, I � � :I I� I I I I I I 'I I , I � I I 1,I I", " ,�, I �,,I 1- I I I . I I � ; I I I I I i I I I � I � I 11 11 I I �,I- e i I I I I I 11 I I I� 11 I � I I I I - I : � I I I I I� I " � � 1 , I I � I I I I . I I I I � I � �, I�I I I I I I I I ,.I I I I I - I - I I I I : I I 1� I ---, I I I I . I ,,I 11 , � � 4 I I I I � I li�,i I I I I� I T�', . -�-1 I I I � 1.�I I I I I -- - : I I 11 I I I -� ,I I I I � � I !� I � �"� �� �� --.,-,.,-. I I 11 � 11 , I I I I 1� I I I I I � I i- I I I I I I I - I , il I 1 I I I I 'O RANT)MqW LY I I -, I I 1, 1�1 . I I I I ,�: � - I I 1, I I I I . I: I , i I � I , I I. ___ �, � I 11 I � � _, I � � I � � I I I I ,l I ,� I i I I I I I I I � . - : I" �i � 1 I . - I : I I 4 I I I � ,,� f 11 , �V , I � I I �e I � I J I; I� I - I - I I - "t �5.� 1 "I � f, I . . i I �� I I I I I -, : I I I I ., I I : I I TYPICAL 1500 GALLON ,H4- 11 0 SEPT[C TANK .1 , , I J J, t I � I I 10' min. from 1_1� . I I � 11 I I I � 1, �*'­,_,1,1:y,i- A"r,J ornw T"o_,­_� , I ' - I I I I I � I I 11 I I I I ! � I I ' ' ') 11 I I � . I -1 , -51i ,4,-.,,,,e��,� _,---�� fJ�___, ._ , I I I I � I I I I I 11 � I � -,� I e ;41­-_11­- I i 't-1 i I i: I I - . *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. I � I I , I a I-� I � :1 I I 1 I I I, I I I I I I. I I , 1_h_-� tank i, ,i I I �. NOT TO SCALE , I I I ,� - �' � I I � I , � � , ! �', I �, , I se to Septic I 11 I i � I I I � � � � I I . .1 1,1� - � - ,I , I � �,� , I I I Proposed House I I I I I I I I 11 I , I I I ­1 , T , I 1 .1JI - �;l�� � \,o r­.114��1;ll I - � I Flrst floor ele�. - 37.00 : , ��, , I I ,I- I 1� i I 1, 11 I . 'f I , I t . I I I ,�J'Svtic tank covers must be I I I I I I ­ 7 � , .1 41� I i I I � � � I I , I � 11 I �tln,L,,l I 11�, i,_______. 11� I I I , F I I i I I � i I I : -11 I v I � �4 j �': , " " I - , - I , I . , , , , � ­­ - , I � 1� I I I I , 3`� within,6 In, of finished grade h Grade Over T ank - 34.50 1 1 1 . - I . I I I I I I I I I : 3-24*1 DIAM� ACCESS MANHOLES 11 i I I 1 41 �,l ,., ', , '�. ; t � ,,, I I I Top of Foundation� - 36.0 Flnish Grad 92.. Finis Finish Grade D-Box . 3 Finish Grade Over Leoch Field - 34.00 1, I 1 1 1 ,,I , I I , , 4�. _-,f. �, 4.5 , , I I : ` I I I I F . I , 1 �� I , 1..� 4- I �. Elev. I I 11 , I �A ,,�,, 14 1 � I I I - , - a - , - - - i ,, I I I I I I I I'll � -il -i 11,�­ 11 � I I­ ': �, I I I I I I/ I I I I � - _ i , , ,; I SEPTIC TANK j,SH ALL B FAC70RYCONSTRUCTED OF,SOLIND �: I: 1 ,-�i * , % I '� I � I I I -, / - ,:i , I . I , I I I � I , I - 10, - *-- E I I ", ,^', la l' �, I I I " :/N I : , I I " �,,i� L I�* 14 - , -,,> � ,i�, " .1� ­ z�- I � I � � -, . - I I � I I - - , - I DURABLE WATERTIGHT MATERIAL AS PER TITLE V CODE 15.226. ., 2 I , ,-'r, ) !, I : I /111, / I I/ � I , 't,� I �t ,,� I , � I 1 I I I I __ J I , J' I' ,,� . � Ir I , ,�, I ,, � -� � I ;1 I I I __-­7 - - ­-, ­_- I I I - ---I I 11 .��-,. . , I 4 l -" ! ­1", I I � I - 1, ,�,, , �, I I � I I � I I%,I I..., �­?" I ,� � ..I I � I'l -I- I ,;,;, � �*, "; I I - I �"I I I I I I � . Ickla W­q -1, - I I I 11�� I I I I �- t,f�--­ I 1� 'I I I 4 I I � I � " � I . I / ! I - I ! �.i ­ � I i � � �, l 1, 11 , I It I I S - 0.07 � I 1 6 HOLE I � I �_ S=.005 : I I I . �3 i . 11 I I � C I t­­'_ 304 Fillissbon V11hil �� �, I � ... , I I � , I � � . - axkn Or I I 11 ! 11 .. -, CENTER AC ESSICOVER OF SEPTIC TANK TO BE f , I'll 1 3' M 1 1­, , I � %, 11 i i , I I CONCRETE FULL FOUNDA110N I ,,,, I DIST. BOX I , I I I I �.� i 11 , t 11 �, t , t - � 'A, I I ,-__� i � LO ­ -_--­�S-O 02 - - Washed Stone I I I I RAISED WITH ;THE APPROPRIATE RISER 70 WITHIN � I 1� 1�� -_k � _­ l - I I I I,��: , I - -1- I , I �- I r-4" Perforated P.V.C. i - I � , I . I ". I I " " � I I t� � , i I I I : .1 , - I V ", _ ., , , I r- � I . .. . �, I I I , �, I - -_ I��I 1� 11 �, I I I �,� 1500 GAL, � . ' I 1, I 11 - OF THE EXISTING GRADE AS PER TITLE V. ", 04 V , , I I � � PROPOSED PIPE cli S- 118* per foot I I 'In 6 1 .,:;1, -, � �� I I ION `) I ell SEPTIC TANK 0 2. 1 - I .Vi�Uert Fl,v.-31.5 , L - I � - , �­ �1 14 .I I I ,, , W t r - . if FROM FOUNDAT I I I I � �,,"I�'!""r l;', _�_ ' i* ,.�,:.-,, `lI � � I -, I I I M I " 44 �� 1, 9 9 I R @ q 1 - I INLE - ��­- 4 1 `k-, ltj `1_ 11 ­1 - -" : I I I 0 i'l � H- 1 15; '­ :"'. T-f!5:: " ,1�1 � I&I , " I 1 N 1 . I I ,, , �, -,-, *) '" Q. � I i, I I - 2 ); �. I 10 PI) I I - -- '6" %,,,I . li I _OLITI ET THE ACCESS 60vEIRS FOR THE SEP11C TANK, �, � , , ,4 � ,�4�; r I Basement Floor Elev. .0 0 0.11I.S. 1 i/4 02" Washed Stan ,�. . . . I 1� I `N,�. I . '�"r,, � it,,, i � I V I I I, . " . . I In I )ottorn of Lea h Facility Elev.-31.00 1. . DISTRIBUTIOWBOX AND LEACHING COMPONENT , '� � I I�k"`W%L . i 11 1, 1�1 � I I , I I 'a I - ,;,� : I I.'' , . , ,_­ )� ., �,. : I 1, I I , 15 llr,�,' � . I,, � #, � ); " N 5 1.*, ,, .- , , , . -7x- � � ,t 4. 1 -h �. __V I � � .I I �I . ��. . . I �1, � 144. i � I � - I I lt;�_,ll � �'I,1� I I I � I I n 2,� ,,, , - . I i,.'.�-�- 11 I .,,-�%..." ". 1 , ,.�,, I I - : I I I SET DEEPER THANi 1 FOOT BELOW FINISHED I 1­'t I � ,!, , �,,,,`�,�7 ,., I I. I I , , � � I v ­,-,! � ,,.,":,",�.�%-, : . I . I I I ,,,,- I -f _,`�L�1­1�.If i , ,, " !,,,- I-, I * " '' N�`-�','.­­ .11... I I " , - 0 _: ;L1.1. , f_ , I -1 M I , , . .,�,,:� , " , I ,, ': I I I jt����J . . . . . - �," I I GRADE S14ALU BE RAISED TO WITHIN 12" OF �, I . Ill 1l1'.!­_­­1 . i � - ; I I I'll I ! I I I � N' ,L 11 �, I i -f!"", ll� 'r­ �, 4,� , ­".' . _ ;'8A-Q'H-"`t,,�E ',,fl-j",�"­ , I .��TET."�-:75�,'r ,"T 771,�,-i-.'.E-0 FINISHED 2 GRADE.! I I I � q ,,:��,�`-, � I , �; . �' ," , ::",:,:",,­ . " I "i ,", . � �,�%, ,,, ,T , � ', , - I - .�ST " , � .. ., _� SYSTEM PROFILE it no""' , I , � , , , 8 ll 3/4'-1 1/2* i ;; ��'�I" . , 4:. ,, ,, . ..-, ,t V '.11..�1�, I _� I .� i 1� I Not to Scale , c I � I ., , , - I . .1 � L_�- I r,? 1 , �, . 4 ,, I I - . � I I I I I ,I, �', 1, - I - � - 5. PR d 11 - 160- " , '--�, q I `,, ;`1 % � I I: , , I �I compacted stone V > 0 � DEC) I I I _x. ,fli , � 1 I I I - � ''I . 0 1 INSTALL TU F_�Tl 7E GAS BAFFLES OR EQUALS I el � I -,.- & -� I I I � � , I I , , I� � 1, I I I ._ I I Is 1, IC! 5' STRIPOUT ALL-AROUND STEEL REINFORCED PRECAST CONCRETE I RED) fAa Rand Ce an.11 cm,e r&�i-ei:1-1:�'.." "A , I 11 ;1 1� I � � �� I I I - � I __ _T_ .�2tt.ct Qr9vndwater Elev.= 25.95 (5.2' Adjustment per Cope Cod Commission) ON ALL OUTLET TEE ENDS , WIN, �& "W - I I I I I I � I I J - - 11 I I i I I I I 11 1 �; K) I I �d I I I I I I I I I I ,,_.... -- - 11 � I I I ! I , I I I I I 1, � i , I � I I I I P LAN VIE � I I :, I � � � i� I 11 11 I I I I L I I ! I I I I I I I I I I 11,,�, I 'r LEACH F I � CROSS-SECTION S I Note: Remove soil down to,el. 28.50 & replace with I B � M _T&s . . I � I I I I I _Qf I � , i i r I � I I I I � - - 6 Il 3/4--1 1/2' 5 I J LQ _ _t.liole 1 Elev.=19.67 I I I � �, I I �'l : I I 11 I I I I 11 � I I , , I I I I I .2 � I I I I � I � � i I - , . , I compacted stone 0 clean coarse sand w/perc. rote less than or aq�t2rn of TS;J Hole 2 Elev.=19 50 � I I I i I . I I I � I I � '',, I r I I I I I I I � � I � � ' � I i : I 1 11 I : I I , � NOT TO SCALE � 11 >. I or equal, to 2 min./in. before & 'after placement , :I I I I : 3-24* REMOVABLE "1, � I I , i I I !I i- I I I I I I � 11 I ,�-I I � I I I a i . � � � I //,- I "-\ 1, I �, 11 � I I 1.�contractor is responsible for Digsafe notification �11 - I I � I I �, i � , I I I i I V 06 3ER VED Groundwater Elev.- 20.75 in TP2 I I I � I I - I � ,� I I I I I "I I I I I � I I i � -­11 � I -_ 11 � ------ � and protection of all underground utilities and pipes. ! I I I , � I I I I 11 I I I I I 1. ! i I 11 i� �. I 1 2'-6" on center .5'_0 on center 5'-O" on center 2'-6" on center - I I . I I - - . " I I . _', � - � I � I .! .4� � , ,.,..".., -- ,I.,I,�4 .. .. �. . I I � . -� 2. The septic.tank onq distribution box shall be set I I ­ I I I VT_�.',4'./, � 1, � r I � I - � - - I I I I I . �:, . . .: I .1 _�' I �...- ,, I .1 , � � I � I I I j "' , , ,:'' ­ 3, �il_r"I level on 6 , of 3/4 -1 1/2" stone. : I � I I I :1 ��] ,�,�­ I I I I 1 3- min. clearance t , , I ­ I , - � , I- I I I , I � I I utlot ., I � I I '.� �1L Backfill should be clean sand or gravel with no � � I , - ,- I � I I I - '�' I I I ,� I I I I �, -J -_ , " ,I .�. 1'r __ � 11 I , INLET--EE2�,-11V rnTMI 1jr-min. inlet t. 0 �, " . � I - I . I I .11 I : . I � I I I i . I ! . I I 11- I I I 11 %,I �', I � I - I I� I -= n��� OU TLE T I� .I �11 I � I I 1 2"-1/8"-1/2' __ -..", :..,%,%*�,.,,,..,: :1-11,11-1111.1.11.1�'ll'.1�.,"-."�l"...."""r"'.t""""".�.,�".."..�.�.,�,�,;."..�'.."....;,....�,.�'..""."."���.,....,.,�."..,.".,�..,.,,""""�..', I I .I I I % 11 ",�Jril I � qu d=- ,,, I 11 I � ,q T , stones over 3" in size. ! I I I I ---F .,��,,�".,..-.,:".�..".,:.-.�*.-.�,%,.-,-,��,,,-.,..�.%,.,.,� �.,,�,,.�..,.,,.,.��,�-.,.,.,,-,,.-.,�,.,�,,,.-,-�,,,.-,,.,.,�, - ... � I I : � I I I 11 1� � � I I I - - - �, " .., I � 11 I I I I " I washed Stone ' I I I I I I ­1 I 0 -/ ­. 4.� I I �1, I :�15' -7- 11 4.� This system is subject to inspection during installation I I - - I � 1.1-1 4-1, I �, � I I i I I., I � I - I � . I .il 'V � 11 I I,. � � by Carmen E. Shay - Environmental Services, Inc. f I I I !� I El r � .. 4'-O' min. ") I I 11 1 11 I � I �� ! 1� i . - ' - I'll I � . . I I , I, � 1-�'Liquid depth .I � ��,� � 1 3 4,'- I � i 0.el ,: . I I . 1 5. The contractor shall install this system in accordance 72 W ( , Min. I I 0 I - I I I I _t - shed Stone> 6* 1 1 1 J I � . I � 11 I I I I I I � "" . I " I T' Massachusetts state code, the approved plan " L I ��- , � ,��, I I I I I I I I I � I �I 1 ..., I with itle V of the I I I I I I .., I , I - I ,; I .1. I I r , : � _ � : . I I ,C I I I" I I I - I - : I I r� ,: ". I 11 I I I 11 I � . I �. � � I_ I ��"- -i:1� and Local Regulations. � : I I I - I I . I - -- �r ] . .", �,':- :.�­ I �­ I I , , I , I I I I I . I I � I I 1 15' 1 % I i �]­­:,,�,,,t.�:zi�,����-,�,-at�.,.�,,.,�.,,_,�",.7�;7,-,..�,,,.: � I I _ . .. 6, If, during installation the contractor I I I I i ­1 I I I I I I I � - "" I�� � I 11 I I I - I I I - I I I : I , I I I I 1 S, -ail- , I encounters any � f , I I 11 I I 11 I 1� I I , lo'-0, i I 11 I e- I I �11� I Soil C r I I I I I , I I I I I I " , I I "I I I I i � , I ''I I I . I I I , , , 1 1 1 r -,I 1, onditions or site conditions that (ire different I I I I � I I . I I I � � 1. I I �, � , I' I I I I 11 I I : I I � - I I i � I I I . I I I I i I I ,I i - ­ I - ! � I I I I �1, I I I - 11 I . I I � ,[ ' ' END SECTION , from those shown on the soil log or in our design I ,,4L I I I - � � I I I I `1 I 11 I I i I 1-1 � I il�� I I I 11 I � I � 1 � I � I I-, �, I ,� � I t I . i 11 �1 , I 11 I le , I I I . I � , I I I I 1�� � i 1, I I _ I L installation must halt & immediate notification be I 11 1, I . I � I � ! � 1 I I I " " :1 I I : L 1 4* perforated P,V�c 'Pipe � I i I: made to Carmen E. Shay - Environmental Services, Inc, i � �� I I : I i I � I .1, I I I I � I ! - -_ I 11 i I I 1 - I I I . I--- 11 I,;, , �, I '11- 11 I � I I I -, - � I � ____ -_ .I I � � ''I � I I I I - ; �� , - I I i I I I i I I I I " I �I I I I I i 1, � ! I I I �_ I , I ,1 7, No vehicle or heavy machinery shall drive over the I I 11 I I ; : I T­ I - . � I 11 � I . I - I ­ I 1 4 1 1 1 1 1 1 ; I i I - I I : I 1-1 I 11 � I 1 ''I, septic system unless noted as H-20 septic components' f i I I I - - I I I . : P E R C 0 LAI I \_/ 1 '4 ,TEST I t I i I I ,� � � -11 111� ,,,, I I I ,� I � I i I I i I I � I I I �, I I I I I I I I i , i � 1 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. i 2 � I , I � ,, - I I I � I I i I � I i I . I I I i I I I 1� I, I � I I " I I I l' � I 11 I I ,i, I i I .., I I f I I i i � - I ; , . � I I � I " _ I I � I , �: 9,1, All Distribution Lines shall be 4" diameter Sch, 40 NSF PVC pipes. � I , ,, � � i� - � � , I I I 11. I , I 11 I I I : , : Date of Percolation Test: AUGUST 18, 2004 ' , ,:�l I I - I [ I I I I � I I �,1,,,�i I . I I I I - �� � I I � Test Performed By LISA LYONS - DOWN CAPE, ENGINEERING 1110. All solid piping, tees & fittings shall be 4" diameter I 1� I � 11 I i I I I I I I i, I 11 I i I � . I I L - I I �, I I I . I I e I I I � � i, � � ",I I I I I I �r I � Results Witnessed By- DAVID STANTON - Borns'toblelebH I Schedule 40 NSF PVC pipes with water tight joints. , i I I I � I I I I �� , 1 I I il , r - I �� , �," I I I I I Excavator: UNKNOWN i I I I I � 1� I 1� I I : I- i I � � 1, il , � I i I 11. SITE and Surrounding Properties are Connected I ,;�; I i � I � - Percolation Rote: Less Than 2 min./inch 0 24' 'BELOW,GRADE. ; ; I 11 I I � I I I L I I I I �', I I Y � �, � I I I �, , - I to Mun�lcipol Water. I I r I 1 I I I I I I I � I � I I I I - - I I I i I I i I � I - I - J I I I ,, I . I I I �] I I I , l I ­ i� I , I � i 11 �� I I - I I I I I I I I I I I I �I,I "I I I � 11 I � I I �, � i I � I I I � �� I I I I I I � I � 7 Test Hole , � � te�t I Hole , I I I I I I � I � I � I . I � ; . - � t �­ .V I I i i I - I I I I 11,� l I I,,,I I I I I I I �, "I � I i � � 11No. 1 �lo� 2 1 1 1 1 �� 1, I I " I il I I 11 I I I I I I :1 I I I i I I ! I NOTE: I f i - I ,­ ­- - I ­- . . I I ­1 I ­ _ I I I I I I I � I I I ,, �, I DEPTH : LS �--E,L-E,V'. DEPTH, , ,�� OIL -_ ,Ii - , � I I I I �, I I I I . I ''.1 � 1 I I - t SO, S� 's - LEV.1 THE PROPERTY LINES ARE APPROXIMATE AND . I f � i I I , I � I I i II I I I ,�1, , � � I I ____ - I I 2 I I ' � I I ,�� . ,� I I I 0 ! 31. � i I COMPILED FROM THE PLAN BY BAXTER & NYE., OSTERVILLE, MA � I i, I I . I 11 I � I I 00 -_ 0 � I 31.50' - I I � � i ! � I �1, I I - 1 � I �� i i I I I I a i � e � ENTITLED "PLAN OF LAND IN BARNSTABLE, MA OF LILLIAN SENTEIO I I li I _�i �_ . I I I I I I I I ! I I ! , ; i I I I I . I I I I I I I .DATED APRIL 7, 1993 , 11 il I I 1, 1, i I I. - I i I I � � 1 , I I I I I I I I I � I I I ­ I I ­4 "I, 11 I I I I I I t I I .- '. I� � 'A. 31.331 . AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ' I i i', I � � : l O/A 2925 i 0 8 � i� � 1� I I T11 1�', I . 1 I I � I 0"�9" ,... I � I I I � I ' : i I I I I 'i � I I I� I ±!±� I � ,,IT SHOULD BE USED FOR NO PURPOSE OTHER THAN : kI -,1,�,�­� � C4 . I � I d � i !1, I I I I I I� I I I I I I � . I I � : : - I r 4 THE SEPTIC SYSTEM INSTALLATION. I I I : I I, . . I I I I I I r�z I I � ! I . I � I l � � I I �:11, I �_o I � (7� "I I I ''"I I , I I I I I I I 1 5 ; , "I, I I I I ,�I � -1 Pl M I I I I j I I � ' ', I i ­ I I 11 I I I , � I : '­- I " ,r ",i� , / I I � I 11 - i : 8' 4- 1 1 �.1 I -I I I I I ,- , ; \, I I :1 9";26" , 1 B. 28.901 , , B. ,29.50 i � I I � ,,, � I � I I I I I I I I I 1 -2 � I I BUIL9DING SET BACK REQUIREMENTS: i : I'� I I ��il �1 I I i � I i ! I , � -FINE I : I - I 11 11 \ � I j I I I i I I - - - I 11 , i 'I 1� � i, I - , I I I � I ( I I � I I I I [Med. , I � :�FINE I � I I I I - I� I 1, I I I I I ,� � I I I ; Sand � I I Sand � I I �1, , � I 59" W � i I i , 20 feet I I � I 1__� "I \ I � I I I I I � ,� � I � I I FRONT: I I - � I I . I � I I �� I I I � : I �, ,�] � I t � � I'll I I I � 11, I I--, I 1� 11 \, 11 'I I I I I I I I I ; � I I I 11 . � ':I ,, �, I I SIDES: 10 feet - I I I 11 __ I I I I I I � , I I � � 11 I � I : I � I i . I 11 I L i I I I I 1-1 17 11'�" , I I I ,� I I I , i i , I I I , �I �1_ \ \ 249. 19' 1 \ I � I � 26--136" ; C, 19.67i 24"-1144 �, icl, 11 9.50� � REAR: 10 feet � � � ll� \\ , 1'�� I,�, I I I I 11 I 1 _____7� 1, 1 " 1,77- , 11 I � � I I � " � i I I 1: I I :1111� �_ ','�" '' I L, \ ) I I , I I � I I - ": � I I I 1 � I I If I � I I I � i I I I I I I I I � : I I � I . I I : ,\ �, � I I I I i I . I : I I i � I /` I I I ­1 11� . , I I \ \ / I li I I I ; I I I 11, � i I ASSESSORS MAP - 290 PARCEL - 015-001 i i I I I I �1 � � � � � � I I � : 1�, I 11 I ` I \ I I i . I : � I, I i I I 11 � I �- , I I ; " 11 i � I I 1.111'' 1 , \ I ­1 I ��, 11 I : I I � , � : I I I I I I I I I � I � i � I : ZONING - RB � I I I I � I "I \ I � I I � I I I I 11 � I 1 I : I � 1. , I\,, - �i \ __ I " � I ! � I "I I I'' �11 : I � � I � e, 'I �1, \ I I I , I I I I I I ­ I -_ � 11 I I I i I - il I : I i � I , 31, I I I I ­ 1 : ,f'' I I �, I'll 1. I \ I \1 � N i I : I � I I I - I I C� 'I I .I . FLOOD ZONE C � t - I I � ; I : !I I � I\ I I I", \ i, I I -_ - �I I I I ___� I i I . 11 I : I � 1 I 1_� � � 1 Z , P I I I I I I i , � I I I I I I , -� " I � ; : ­ �, I I � ­ I I � , I I I I 11 I � \ , __ I J) I I I ,, I � , I \ I I ��, 11 I \ I "1 -_ �- I � I I , i , I - I THERE ARE NO WETLANDS LOCATED WITHIN A 200' RADIUS I ; �, � I I I I I I I I t Z T ! i I � i I I I . I I I � 1, I I �� l� - :\ I I \_ I 1-1 I - � � I ., I I ; I �� �' � I I , 11 I i I I � I � Z I I I I I .11 _� �� , I I f �', i 1, 11, ,� I� I I OF THE PROPERTY. I ,� I - � I- I I � 1� I I -I i I I I 1, � , I I 1, I I I I \ I I I � , , , \ I -_ I I I I I I I I I , , I I:- I ":��, , - � I� � 11 I , : : �� � I I , , �, \, - - __ I I I I I I - I I, i I I I I I I � �� , 11 11 I i,- I" I I I I J � I I 11 1: I . I , � , ­ � I i I I � r � "I � � I NOTE7 � I I .�. I ,, "< 1-1 � I I I v­ i I � I I 11 I I I I I � I I \ I : J��1, I I \ , " ' . I I � . , I I i , I f � I � 34 5 '­ , � I " z I I I I I ; ­ I I 11 1 -_ - , I �, I I I I I I 1 � I , I � I " I I���,, , 4, , I I I I I � I 1�1. I I I I I ,i I � I I I ­ . . ... I . I I IF UNSUITABLE SOILS ENCOUNTERED IN THE AREA OF � 1, � , \ Z 11. I I I : i� 1 � I I �.p � I � I I I- I I 1 *­�, I- 1, \ I I . 1� �, ,, I I I I i I I I 1, I I �- � I I : I ',I � I - ''I I- I I , , I - I i � I :1 � - � � I 1, I I I I � I I 1 _Z3 1 1­ I I I I I I I ,: -� �� I I I I THE FOUNDATION FOOTINGS, FOUNDATION DRAINS MAY BE REQUIRED. I � (Z I I 1, I 11 i, '' , I I I I 1. " I I 11 ,"'�,��L I'll I I I I I � I I " I I I I I , : I I 11 I I I � I I I'll, \ , \ I I I I : I " � I I - I 11 : I � - \ � I � �_ � I � ­ I Perc #1 1 1 1 1 1 1 1 1 i I I I 1-1 I I I � I I I I I �, CZ I � I �, I I � 1,, . I . ) - I I � I I I . I I 11 I I I I - I I I 1 �, , i, I I � I. I -I ; I I I I 11 ­ I I I I f 11 I I - � I 11 ­11 - I I I I I � I I I I I I � I , � I , I� I I I I I; � I ,� -11 I NOTE� � � I I I I I I I I I I I � I - � I I I � ,�, I I 1\ � \ 1-1 I I t:� - I I I I �� I I I I I I I I I " I I 11 I r�, , Z I I � � , � , 1, 11 �� � - I - 11 "; ��'_'�, � I I I I I I �k I � � ��'"i I I I I I � Depth 'to Perc: 42 to 60" ,�, 11 I _� 1: , �� I ! , I I I I I I � � I I , 11 I I I I I I I I -1- ,� y, I I 11 12i"', 1-1 I I I I 11 I 11 - - I I 1, I I 11 11 I I I � I � I - I I i I 1 I I , � - I I I ­, I I I I I I I �,� I LOT # 1 , : ", ' ,�� i,, , ­ " I I I , 11 11 11 11 I' - I 1, I , � , 1. I I I 11 , I I I � 1 �, � 11 I -1 = I I I �­�� I I ,:" I I � I � i 11 ­ I I I 11 I I 11 I , \ I � I I I __�, I 1, I , ,; I I � \, _� , �, \ I I I � " I - I I I"", ,, � I I I Perc Rate <2 min./inch :;, , I I I : ,� , I � I ­ I : I1. I I I I ,. � 11 � � � , I I I I� I 11 � " � �, I � I - �, I I � , ,,,,," ,� . I , I I ,� � I � I I 11 I I I :1 � I �, I I �: i I 1, i - - " PROPOSED CARA, , �.�%., I',, 1, I I I I , I I I I _; ,� : - "t, � '"' ": " I I, � � : �z I --I ��' A, � I ,,, � I '"�" I 1, I - I I 11 I I I 11 I ' ,.5' REMOVAL,,OF :UNSUITABLE SOIL AROUND, THE PERIMETER OF THE , 11 I I I I I I � �, I I � - � I ,�, I I - 11 I I 11 I I I 1. I I � � , 11 11 - I I I I � 1� I \ I I I I I I I I ��, I ,,- : �� ,� �', - � � i I '-' I � � ,- -,.\I 11 . 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SHAY ENVIRONMENTAL - TO ,CERTIFY THAT 5' of,SUI­l I ' 'I - " " I I �_ . I I ," I I � I I - I I ' I I Ir 11 , � � �� I I I I � 11 I I - 5.2' or ELEV 25.95 , - , I I I I I j,,,.,:"'� - ,�, � I I � I 1, I I I _�_,� , _ t �_ � �': 0 ': �I �, _,", I 1\ I I I I I -4-.I IV I I ,STET20 Elev. =;l � I I�'�, I'll , I � 1, I � I I I - - �, - , , 4, " , � , , _�� :1 � '3 i�,(:, I �', I I _l r I I CIO � I I I I I � I ADJUSTED H20 Elev. ,= 5.2' or ELEV 25.87 ," , �ADJU I I 1� ; I � I �� I �, I 1� 1, " i "I i. : I I 1, I - I� I I � - , I ,/ I I , � ,4i 11 I : - ,-, � . I 1, I ---' I I I I , I � I ' I '' I 1, - � I I -, I , I � I I I , 0 , LP I I I ­ 11 I � - , . I � I I:t � - I I I ­j I � 1 I", I I " �MATERIAL' BENEATH , I � � l , _ i I I I * I I � I I 1-1 � - � I � I F, - I : A� I - I 11 I I I - � �:, I * � � i , " " , , I � � I I I - I , I I I � � 1 I I I I � , I 11 , , ­­ ,I : I I �111'11 1�11 , I I � , -1 I i�', , I I I I I I I - - , " , I � 001,10 , , �, " ,�, 1,i� ". I - '' � I I I - -, I 11 I 11 I I 11 I I I , , , I ; I I � I , SYSTEM I. � I I L I I 11 � ­ � - 1-1 - , ,� 6 � . -': ; , � 1, 1, I '1� I - 1. I / �, 11 I I I ;, I ,- I 11 I 11 �, , I �e \_ ,_ I I1, vopose 1 1 � , 'I, � �", 11, "I I I ,;� I I \ -_ , I - - , I 'L I I 11 . I , I I -_ I� 11 I I e � I I I I I �11 I � / , ,I ", I I A - - - I �, I I I I I I ­ : I I I I � "" " �I 11 I �, I I 1� I I � I I I 11, 11­ r ,�' I I I � ' 'I � I? I I I i , � I �� I " . 1 � \ I - - - 1 I I I I I � I I I :, I � I I I I I I . I I � I I I I A 11 ",""I""i), L:'11 I, � . I 11 I I I 1,� I I � / � , I 11 I I � i : I - � I I I .� I I , �n I I ',I \ , � - � I V, � I I I I I I �1, I � 11 I I I I I I I : - ,'�� : , � 'i� I I I �, I I / ) - - I - I I I I I I I I I � I �I I 1 , , 'I., , � I I I i 11 ; 1;30�, , � : � I I � I � I �, I I I � I I�� 'Ill, , I I 1-1, - � � I I \ I I I / , I I I I I i I I I I _. ''I I I :" I I I I L 1 141, \ I - I I I �11, I I I I - I I I I . I I I / I - I I 1 #394 , � I I I . I � ­ I I I . 1 I � I � I I I 11 I I I I I I i ALL OUl*LET PIPES FROM THE I I I I I I% I I I I ­ I I I I � - �. 11 I , I , : � _111- "'I, I I ,� , , � 1 \ . 1 I - � . I I I I i-, - I I ­ i, _ LEGEND I I 1 , 11 I I � I - ____ '�,, I ; I I I � � - A,5J 1 1 1 ��_ I I LOT I / I - I DtSTRfl3U'nON BOX SHALL BE I .I � 1, I - I - I I 11 I � I I I 1, , I � I I , , I \ , I _/ , - � - I PROPOsk 1� ,#2 1 � I I I I � : 'FT, F 12' CON " ; 1, 11 I I I 11 I � I � . I I �, SET LEVEL FOR AT LEAST 2 1 CRETE COVER� I I I I I 11 S I : � , �0�� , I I i� I I �-//-\ 'I / I'll I I I I I- � ; I . .. � e il I I I 11 11 I 11 I� � I I . I I . � -11 I I � \ I ... � /- - -? I I r 11 re , � � 36,285 Square Feet '+/- I � I i I ii.:". , , ,: , 14 I", I - 11� -1 I I �� I I I 1� I . �_-1-41 PEDRO(W I � I I � 1� I I I I , '.1.I . 3 '5, Oulu 7,�1,",­.�:!­­­,ii I . I I . I I I I - - 5_C,I,i�J I � I I. I � , I I i -� --- ,.'. T -1-1 �. I ' i 11 , __ I I I , -� " 'r 2: L' 11 --- I ! - � � I I \ - , I I I I I I I ,, KNOCKOUT. I I r 11 11 I --------- � I I " � . / I I . ;I I I �i?, I I - , '.'kec- I COLOJIVIJ4 ." I �' � , I I 11 I I I -- � I I I \ I . - I "I, i I I F88XO] DENOTES PROPOSED : . I - 1,1� / ------- I- , , 11 , I - I � I Lj'/,, I � ", , , \�_ I " ___� __�__ - �� I I ,�, k I I I � L / I I , � 11 '. -11. I I I ­, , I L -_ I �I ­--� o,,e . I" I I , I I I I I I �; I I I ;, I i -1- - - OUTLET I I I 1 12*1 INLEIT, � I I I � ", I I I , 7 '. VG� � I�-, / I I ! \ � I R . I I I I � , I 11 . � I - I I ; 1i; --�. I I I I . 11 - I � ,�, I I i :,. � , , I --e�­ i I I I , I i "''ll, \,7 , I , /I ': -X 1;� � -,, I � I . I I ,� I "",I // - __­�,' . �,. �-_ I" ,� / \ / - I I i , I " � ,jl. I � I L 6' L I I 1�11, I I �I I - I I �,",, , I I LTI I I � I� I I ,I I _____� I I 11 / I I I � I I , . . � I , - ��, -11 I lilllll � tl , I � 11 I / 43 1 � I ��`,,'�-il ill`T_­"�:�.! I I ; ,.�- !2', I I I DENOTI ES EXISTING 1,�1:, " , L I I I - 4 ,� � 11 11 ­1 I I I � I., I -_ � � I I I I . I I � I i 11 11 I I I / I I � I ! I , 11 -- 11 I X 1 04.46 1 � 1, ' DECK 11 ; ; 1 7 1 1 -� 1, I I I I `slllel I I ll PL L - 28.0 / I I I I I I I : -15.5"-' 4" - SCH. 40 Tee- , 1� 5. 1 1 1 , 11 � . � I , 1, I I � I -'TEST HOLE # 1�, , : V'- 37. 1 _ 1" I ��;, I I I r I FNSH FLR L 0 �� I I / � I I, � --- I I 11 I WN I I / I I I I I � ; I " I N I I ,�:,�, I I � I I TOP OF FN �- 36.0 __------,� � "I � I i PLAN SECTION,, CROSS-SIE-C ION I � I I I : �, '11 11 I I I I ELEV.= 31.50 � , (-) ,10 -_ I I e � I I i . ; I �-A � -_ I I I I � I � I I I I PL � I I U� I �, I 11 -11 � I __�__ I � , � I � i I . PROPERTY LINE' I I , "I 11 il I I ! , �4 1 � I, �I � I � t __15 `11 \ \ -,A�l 0 , , I I � I I 11 -_ -_ �, I I I I : I I I I I �, I I I i i I I / I I i I ! � , 1.1, I I \ - '':''�, I I I I I i i ,� , I I- 7� 1 . ­ I I I - I �i I I I I � I r I 0 ," "t I I I I � I/ I � . ("' I I 1 !3 HOLE DISTRIBUTION BOX - , H-10:10ADING , i I 1 7 1 i� ,:� , ___----.2 � I I I I'' , " � I ­11 �, 11 I 11 �� i ,!P- \ \ a il� I ,� 4,6 '' 1 1 i I I � I i I I I , 11. . 11 I � I I I I I �i i 0 1 M 11 I I � n I NOT TO SCALE I I f. ,"' I I I I I 1 1 / I I � � ,k I I I I I I I , ` ,, , I I I : I I "A \ -al I I � I , � k"I I I I -11 I I M , � .�� I . I , I I ' 97- -97 EXISTING CONTOUR � 11 I 1� I I 1, I \ I I � , , I I I ­ I I I I I . I 11 I I I � I I I � I I I I I I I 1` I I I I Ln , Ill- �� I I / � f I I I I J ., I ; 0 � M _11\ r, I I L I . 0 1 1 1 \� 11 I I I I I ''I , i I I I I �1� , 14 %(,\ t- I I -_ I I I � I � I I I I 11 I . .� 1_� I I � I I � I - ­ 1­ 111111 �, " I I (2� �� �� :3 ' I ., ' 'I r IN. I I I I . � I I I I I 11 I Desian Cciculct�cn , I - k ' I 1��- - I M \ \ , 1!ill _� -1,' , I I I I _1� I - ! , I I �_�', I I I 1 I I I i, I I � .1 I � �, �V, / I I I i - DEEP TEST HOLE & I I Ix , 11'ri,I I I I I i I 01, � \ I ,, I I "I I I ji t 'p- , \ I 0 1 1, - I I I I - I I I ! I P, I I 0 1 �; - 11:0 � \_ f-- I I I ��,�, i" I / I I I � I I / ,� I I I ; Number of Bedrooms: 3 Equivalent to 330_Gal�/Doy I I I I PERCOLATION TEST LOCATION I 11, � I � t tlll� , -4 I , i I I I � � I � - I I I � i I - ,IV-- \ tZI , ill I � / 11 li I I ! Garbage Grinder: No I I � r "_ I \ I I / . I I I I I ! I :"I 4 ,,, , I W , � , ; I 11-;l -11 � I 1 34 'i 4 .5- 1 1 4 I I 1; I i I Leaching Capacity Required: 330 Gal./Day Miln4m ( Title V ) I � I I � i � , I 7 I --- I , , i I I I I I � ! - I I 11 I I � 1, I ,�­ I� I ' JE 11,500 GAL. Septic Tank. I 0 e . 0 1 1 1 -:� -�o 1 15 1 1 1 'I', ,� / . I/ � I ) 1 Septic Tank . - 2 x 330 Gal./Day = 660 ` I U FENCE � I L � 1_� TI I I- I , I I ; I i'l I C4 I I I I I I I "i I- / I � I ,l I I �� . r 3 , I I . � I I " I " I I I - � I 1� I I I i I . I � I I . I , 11-D I I , I I I I ; � I , I - I .�� I I I � 'L"� , I - I I 11 - I I SOIL ABSORPTION AREA: Using percolation :rotel of <2 min./inch , ",�, I . tl..) ­ ,� I � � � 1,�L I I I I � � I I i I � 4 t' I I I I I "I �i�� , " I I I I ! �,. � III- I I I , 1, �'r_ 38 1 1 1 1 1 1 : I � i r I I � _�� . r I � 11 -1, I I � � I Proposed Leaching Field Dimensions: 115' Wide by 30' Long. PRIVATE DRINKING WATER WE'LL � � I I I . - -1 I i I � :.-- 1 260 � I " I I . I � I __/ � '.1 , ,�,, 95 W ,� Z , I I I �I � � Bottom Area: 0.74 gal/sq. ft. x 1450 sq. ft�' = 333 gallons - _�� I -� , I �, I - I i � _-7, �', 1 9 1 1 1 ; I , � 1. 1 7� -:1101 I � I �_ -_ I , ,V I I 1 � 29 1 1 1 � Sidewall Area: Not Utilized i . I .1 I �, , � I I I � � I i I I e ! I I _,� I TEST HOLE #1 2 ,5 � _� 11 � S 8 D 55 1 1 � �)$ 1 ,� , I I I � I � REVISIONS : I "A I - - I I I I I Providi�g�� ,F, 333 gallons I � � i � I . I l I I I I � I I I I : I d I I I I l I � I J, I I ; I � I I I I I "I I -1 ELEV,= 31.00 1 1 1 � I �­ -1 I I I I � I I 1, I i I � I � I I 1 I 1. � I -1 I L � I I � I I : � I I . I I �� 1 `,,,� ­ �), , I � I I I I I I i 11 � 11 I - ! 1-�4�, 1 -i � 1� I I I I I , , I �, I I I ; � l I N O., DATE: , � �, I I I I I f r' I 1, I I I I I - I ! �, I 1: DEFINITION I I I I I 11 I ­1 � I I � I I I ; I I I I _1�1",I : I I I I I ! � ­ I I I I I I 11 I � I I I I I U I I I I I I � 11 � I � llili � I -I I � I I I I I I I � I se: 11 I I I 1. :I I I I �I �, I i I � I 1 I ,. " 'I,!I I I I I I i 30' x 15' LEACH FIELD NTH 3 LEACH ES I � . 'I', - � I . I 1� I I "I'll 1. I I I I I I 1 � I � ' � 11 I I I I I � 1. I I I I I ,,, / - I I I I I 1 I I I I I L � I TION OF LEACH LINES AND WASHED STONE �JREA AS SPECIFIED I 71 I : I i I �, 11, 1 ­144,,�,, 1 1 1 � , � I I I I SEPARA I , ­ I z � 11 I � - I - , I � I � �� I I I I I I I I I ! I � , ! � , I � I __------ I I I I - : I ­ ll� , _-, I :�i , I I I I � ; IN THE LEACH FIELD DETAILS. I I I I I I I I I i - , I I I I I I I I I I ,, I I ,��I I 11 I I I I I I I I I I I � 'I , , � - � I I I � / \ I I I I � I , . I I I � I I I :i, � I I : I �, "i" "I I I I - I __----- 11 I LOT #3 1 1, i I I I I I'- 1 � : I " I I I I I -1, � _ �il L I I I "I I 'I" I I � I I . I I : I I ; _',�, ; I I I I -_ ; � " I I I I - I I I I " I � L I I . I I I I I I I , I I I � � � I � � I � I I . I k : � I i I � I 11 � , i I I , I I I I � I i I I �kl 1 , � I I 11 " ' I I I I ' 'I , � . I I I I I 11 - ` � I ­� � -_ I � 11 11 I I I I i I I I ; I i I I I", I 1 3� - I I I I " I I I 1 , I : � I I � I 11 I I'll ­1 I I I � I : I , I I I I I I I I I - I -1 , I I I I � 11 I I � � I � I I I I I I I I I I ­ I ( I I 11 11 I I I I I I I I - I I I I 11 � I I � ; I I I I I I I � )_ �� I � I I I I I I I � 11 I - li - ' . I I I i I I I . I I t I , I I � I ! :1 I I I I If I I I I , I " I � � � I I I I I I I I 11 11 I I I I I I e i . I - I I I 1 I ! I I I _� I 11 i . i I � 11 I 1 1�� , I I � I : ! I I I I I I I I 7 I I I I � - 11 I � I i I I I 11 I I I I I I � ii,�1 , I I : ­ f �, - : I I I I I I I I I "I 1�1 1 : I � � I I I I I � ., P I'll � i ��' . , , 4 � � i I I� . I . 1� I I , '� . I I � I I - I I I I I � I : \ I I I Note: - ,Re ove soil down to el. 28.5 & replace with � I � I I , I ' ' I I , I I I r I I I I : I I �, I : - � I �, , I I I PROPOSED , l i'', I r I I �­[� I I I � I I � I I � i I . I! I I I i I 1. - � I �, I . I '! , I I 61"n coarse sand w/perc. rate less than or I 11 I I I I l. I I : * : I I I I � I I , I 11 - I I ! I 1 I I � ELEV. = 29-00 1 1 1 1 �, I 1 I ,� qu'al to 2 in./in. before & after placement . � I I I I I I I � I I � I I I I I I I I I - li I I or� nn I 1 I . I ; I I - Ili � I 1, " I I I I I i � I I i � �11 11 I � I � - I I I I i I I , 11 � I I I I � If I I * I I I I � � .1 I I I I i , I WN) I I I I I PR' EPARED F 0�`Fll� "- , 0 F PROPOSE-D SEPTIC SYSTEM � I I 1 4 1 �, I , § I � I � 1 (5 OOT STRIPOUT ALL AROUND AS SHO �i � I I I I I I � � � I I I I "; I I I I I I I I � 11 I I I I , � I I I i � I , I � . I - I � I 11, I � - I I I I i I , i I I !,I � _'_1 I I �,�, � I I I t I I I � - I :� � �, I " , I � � I I ,� I I I I I I I : I I i I :1 I i I � - I �' I I i I I 4 � I I I I : I I � I � � I " , I I I I � I I I I I , , ! & FOUNDATION LOC,ATION i I � I � I I I . I I , e­ I I � � I . �, : , I I .� f " 1 1'_�4 1 ' ' I I I I 11 I I r , - � I I ! I i I � ,., I I , I I I I I ­ 11 I I I � " I ,,, �� � , �� �'_ �I �, I � ]"-, � I ! i �' ! � 111111 f 11 � ,; � . . 11 � � I � I I . 11 I I I I I I I I I � I I, � I I� I I I � 11, I I I ,� �� I I I � I � ; � I I � I 0 OF � � I OF � I I � I I I I I � I I I i� �f 1 111111 I � . I I � I I I I I I I � I I I I � I I I I � I ' ' _� I I ,� I I I i ,Ii I - I , I " � � I I � I I I I I . � I I I � � . I I I I I I � � -I I I I I I I 1. � , � I I I I I , I! j ILMRT � I I I I �,i I I I I I 11 I I 1, I I I I I Mu"T I , e 1, I I � 11 I I - I I I I t I VVELLINGTON JR . SOARiES I ,'' � I I 1, 11 I , ­ ,� I I I � I I I 'I I I I - l� I I I I I . I 11 -, - - �, Z9 L�z T. "I - i . I 11 � I I I I I - I I � i : I I m #394 PITCHERS WAY 11 I I " I ; I � I I I ­ �, , I � I I I � I I I � I ; I I I � _�, I I I I l I I I I � I I I I I I I , I I I 11 " I I I � I I � LOT #4 1 1 � I , [ � I - . � I J I I � �I �.! - S , " I , I , I � � � I I I I I I I I ! I I I I � I I I ''I I . I I I I 11 ,� ��, I I I � I I t I I I I I 11 ,11 "v"i �� , MA I ­ , I I - I - .�i� I � _ ­ 1, ' ' 0 - I .- HYANNIS, �, . I ­1 I_I , , � I , ­I I . I I I I I 11, I I I , I I : 11 I � _� , � : I I I �1� , .1 I : 11 11 I I'll I I I I - � I � - I I � i I 11 : , I I , K : I ''� i� ' ' I I I -1 - - I I � I I I I ',�, � 1 I I I � I - � 1, I I ' 'I � i 93 �' WOLLEY ROAD '� �, 1� I I � I � - � I .. I I I I I - I I I I �,�; I- I I I . I I ;! � 11 . I . 1�i'� I 11 " , ­ I I I I I � , I I I I I I I I ir I I � ", I I I Il, I 11 � i I I I I 11 ­! i 11- I I I ; 111. I I _ I � I I I , I I I i - I I I I I I ­L ( 4 1 1 1 �l, I I I I I ; I I I e !-, , I I � � I I I I I I I I I 1, �r� � I I I ,, I I � I I I I I I I L 1, � - � . I ; , , � I I I -�r I I I " , I I I I I I � I It r% I I . I I I , ,, I I I i I I I : I I I I ,I I I , . I I I 11 I, I I I I I I I � I I - . I I I I I % I � I I I I I ,., I F, I i 11 I I I I I 1, � I : N", I I I I I I : � ­ I I 11 I I I . REPAIRED BY: ; I I . . I I I I I 1: - I I i I I " � . I I I , 1 , � � I z I I 11 I I � 11 I I ': I � I I I I I I � ; I 11 � . . I I I I I f � I I i I I \ � 11 I � I I .1 I I 11 I I I 11 I ­ � I I I 11 I I I I 1 � � I ' HYANNIS MA 02601, : ,, "I ._� - __� --y � I 1. I I ­­ ­ .1 � '' I I I I I � I � � I - I I I I � I I I � : ------ I, � I �",J,, , i r ! I I �� I I I I I � � ­ I I i , : "I i� I I .. I I I , I I I I I i I I I I 1 11 ' ' I 'll I " : I I . I I - I I I 11 I I � 1� I � ,,,, i I 11 - 11 I I � I I 1, I I I I I I I , ,�� I I I , , . " ' I I - I I I 1, I I I I I I --- (A I I 1 , ­ I - - ­ I i I i I � 11 ,� ,� PHEY E. SffA Y � I , _ � �� . ­ 1 ; I - ��, 11 I i ; I I � � I., � , I I I I I . I � � I , I I I I I I I I! . . 11 . - I I � I 1-- � I I I � I � � `� ' ' - "I I I ­ I I � r, I I I I I ,AR, I I I � I I I I �,� I - ­ I � . I I I I I I i � I 1 ''I I I I I I I I I I I I 11 ­ I I I ; 1, " I I ` ' � I I ; � I I I � I I I I l "I !, I i � I _!� I I'll �� , I 'I', I �, � , I � 11 1� 1. 11 I I , ' :'� E, I EyVV1)?0NAfE1VTAL SER VICES, INC. 1 , : " . I I I � I I , Ir . I � � I - I � I I ; I 111 I - 353 - 7149 � � I I I , 11: �­ I I . � I I � � I I .- 1 ,(k � I I � .I I " ,� I I I I I 1 774 - , I 01 I ,� �,�­ I I I I I I I ­ I— I ­ I I I I . T� 11 I I I I I � I I - I 11 I A I I I I � I I I - I � I I I I I I I I I . I i U 0 I I � �­ . I I I I I I 1 :1", I � - I - I I I I I , il I I : � �� I �� I , I , :� I - 11 I 1, I : _ - I I I . 11 -1 I I � I I - � I I I I - I I I I I I I I I - � i 1; Wl� I I I I , � 11 I I .� 1 , I I I I : � 11 �� , I I I I I I I I I I I I I I I , O., I P.O. BOX 627 I ,,�­ �, , I I 1.1 I il I I I I I I I !� � I I I � I , I . 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