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0731 PITCHER'S WAY - Health
731 Pitcher's.Way I. .." �,A=^271``1 r184 t., l +r.i a . . Hy annis P r I � o Y t 1 Y+jf o III n n a V h 1'U' AT�DF$ NSTABL� 7-7 1D9T I N PHONE NO. 011F.M.- TA CAP1�Cz`fY , $ACt3iQ BAGI�<1'RY' ttYP$) tom) a.oFIVSDRc',o . olm. oR �TAA'S'8: � CpN�14I+1CB 1RA'�: • Separacicn ll�s�;aa$etwee��o I , Ott a ouon bfl;o b� 11 kWOLAM"m l c`9k'auuudi+v 't'ebl �4 $. Y Bev db edt4 ae nuldtio .5e�t of t flity) d�' etlaa�and xe�cblt ilitY any.,ardg eiat vlt1��.3a4 Poecof k�lia$ ? '' ! '� ^f, � � � 1 � � t � � � W ', 4 �-. ..` i � W t � � � � � � , , ,��. � R� -- `. � d .� �l -• �w j j c I c a 5 � `•: Commonwealth of Massachusetts r7 Title 5 Official Inspection Form Y+�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll ; Owner Owner's Name two information is required for every y H annis MA 02601 8-18-20 - 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l 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 theproperty 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 8-18-20 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 -4 1 �• '•t- ' ! Commonwealth-of Massachusetts Title 5 Official Inspection Form t�) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way �l Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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: , C, ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. Y 9 9 g 2) System Conditionally Passes: ❑ One or more system components as described in the "ConditionalPass" 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): r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ILf' t�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board.of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ 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 s Commonwealth of Massachusetts ,w" Title 5 Official Inspection Form i.i Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments r 731 Pitchers Way J Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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 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: 4) System Failure Criteria Applicable to All Systems: ' You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ E 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 r� Title 5 Official Inspection Form I-li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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 El ® Liquid depth in cesspool is less than 6" below,invert or available volume is less 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts r� ,w Title 5 Official Inspection Form C�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r�Ci 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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 aH inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 0 of 18 Commonwealth of Massachusetts .� Title 5 Official Inspection Form C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2020 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 N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r U 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis . MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 z '° Commonwealth of Massachusetts 3, Title 5 Official Inspection Fora I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r ,< 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information �(cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form J� w., �rI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 'Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ . No Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 i nspecti on)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c Commonwealth of Massachusetts r� Title 5 Official Inspection Form ! Ini Subsurface Sewage Disposal System Form -Not for Voluntary Assessments fr'I 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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.): I "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.):, Good condition with water at working level and no sign of back-up from field. 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 %i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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.): * 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: 1-500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form i� w.� i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chamber in good condition with water level and stain line at 6" off bottom of chamber. 12. Cesspools (cesspool must be pumped,as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form irk Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of,ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i-�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , / 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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 6 .. d " P' A .I— c�3 a - . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form t w' • i�i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form C�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 731 Pitchers Way Property Address Jennifer Carroll Owner Owner's Name information is required for every Hyannis MA 02601 8-18-20 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. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LG AT ON � / // �c/��n-S 4f.4,4 SEWAGE 4-20cJ.7 VILLAGE 1-7k,4 ✓41/ S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NOA 4 r/4 f„i,S 7` .S`"b 8 7 J SEPTIC TANK CAPACITY C.Y )5 T LEACHING FACILITY: (type) _Td9d A S 2 (size) NO.OF BEDROOMS OWNER )DA&I G PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet FURNISHED BYE, 1 �C f\ J• � cJ r - No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 03 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Vs � Yicatiou for �Di ogal � gtem Cou0tructiou Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Ad4ress or L No. j<1,✓t/�J Owner's Name,Ad ress and Tel.N . Assessor's Map/Parcel Installer's ame,Address,and Tel.No. Designer's Name,Address and Tel.No. A) �� Dry oz Z a ,� so 7-7J7 /3 6 36 p S Type of Building: ^^�� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J[/ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi d of Health. Sigrnee Date /c1 / Z p Application Approved by Date i311,Y7 �+ Application Disapproved by: Date for the following reasons 9 Permit No. X!rZ� Date Issued " .'.. .--.. .'� .. ./...,,. ....-.-•-..-:...--•�_.,.....»,,... ., ., •mow,,... ,� - laoIl. z.. �./ V/ ii j k Fee :�. Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes r PUBLIC HEALTH DIVIS16�N - TOWN OF BARNSTABLE, MASSACHUSETTS i �0 Z(ppYication for �Digool 6potem Con tructiori Permit Application for a Permit to Construct( ) Repair(`f Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Ad ress or LJo No. � ���,,.d/ S Owner's Name,Address-and Tel N . R Assessor's Map/Pamel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'y �-34 -Z 36y 0S � ' Type of Building: t j' jDwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) i' Other Type of Building No.of Persons Showers( ) Cafeteria( ) j Other Fixtures ' l Design Flow(min.required) 2 gpd Design flow provided oK 5 7. 3 gpd l, Plan Date Number of sheets Revision Date 1 Title ` Size of Septic Tank Type of S.A.S. t i Description of Soil � 1 Nature of Repairs or Alterations(Ans�ve'r when apple aY 16 � JL� r Date last inspected: `4 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env ronmental Code and not to place the system in operation until a Certificate of i Compliance has been issued by this-B7d of Healt ,,. l Signe T . 'J Date j Application Approved by Date Application Disapproved by: Date ' for the following reasons / r: Permit No. Date Issued3/07 f THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS Certificate of Compliance ' THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by /r e at / /ems 1./�! �( tiy h� y has een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /O44-,dated Installer JZ Designer i-5A rrz-a i zs- i #bedrooms Approved design flow „/ gpd The issuance of this permit shall not be cojistrued ads a rantee that the system wf 1 fdnf�cctt ion)as desi/�'ned. ,./ �; / O Date Inspector //L' (' '�TjL pGO !�_ ll/,1�/ / I , - No. Fee HE COMMONWEALTH OF MASSACHUSETTS 9 i PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1i.po.5al 6p9tem Con$truction Permit Permission is hereby granted to Construct ( ) Repair �Upgrad .( Abandon ( ) System located at `� I 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 a corn lete44ithin three years of the date of this Date L,� Approved by ) /act 23 08 01 : 06P P. 1 _ Town of Balrnstable Regulatory Services - Thomas F.Ceiler, Direct or 9 Public Health Division Thomas lvicKean, Director 200 Main Street, Hyannis,INLk 02601 t 3i'IiCC: A8-362-464-4 Fax: 30Y-790 6304 Installer & Desil!iuer.Certification Form D;Ite: t Sewa-c Pcrini 07 5 ' � :.1ssessor'S ivIaplparcel d i-e ✓� �t� (..��.c Installer: i��C.�1 �(�cj,S f ' :add-%ass: �(1 i-7,u .Address: t O e>`X `I A(1.cw ro N�- 1 was is::uc;i a permit to install a (date) (installer) septic svgtt_m ar _ Uascd on a design drawn hv (addr: .5 j� /r 'e Me ���'..� dated _ 6 I cffli y that the S.IittC system referenced above was installed substantially aceordille, ttr the dc;si•_>n, which rnuv include ininor• approved changts iuch as 0i toe distribution box andiur septic tank. certify that the sef)Ue system referenced above wa:; installed with major changes (i.e. greater than I�' laic ral relocation of the SAS or ;in-.- vei tical relocation u:'any Cortzpcittieru of the septic system) but in accordance with State Lit Local ReOulations. flan revisi0r) Or certified as-btult by designer to follow. OFRE EY R �_ (Installer's Swriatur No. 1140 'ICI (Designer's Signature.) (Affix Designer's Stamp here) PUASF RF,TURN IV BARNSTABI.•E '(JUL.1(" HEALTH DIVISION. CERTIFICATE OF CO;�IIIIJANCE WILL NOT BF ISSUED UNTI.I. RorH THIS FORNI ANL � -BUIt,T (SARI) ARE. t:IyFD BY'CHE 13,\ltti5'1:189-F; i'1;13LIC FI1;.11,TF1 1)IVISIQV. Tfi ��IK )(01). -- W: I.1c;iklvScptic.'Ucrsigncr Certiticonon Form 3-26-0-Pdoc Doc= 1s099s878 10-17-20 8 2=55 BA,RNSTABLE LAND COURT REGISTRY NOTICE: The Town of Bamstabie recommendq,that tha— a_ n�+ . seek legal advice to prepare a property worded deed restriction document DEED RESTRICTION WHEREAS, �a� L • �• c7 h ��-rn of ( , (owners na e) 3q �, C� ,r 5� r,dw c_(` MA (address) is,the owner of ?3) P, C'h W'qG4 located (address) at r1`n MA (hereinafter referred to as '� 4 T y and being shown on a plan entitled."Subdivision of Land in • MA, Property off a4 D 1 5v / N . et al, duly recorded in Barnstable County Registry of Deeds in Plan Book Page ; Or on Land Court Plan Number Jwa WHEREAS, &0,4 b V; 6_6_A*46�4 as the owner of said lot has (owners name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot.as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;. WHEREAS, the Town.of Barnstable Board of Health, as a pre-condition to. 'gl�ting a disposal works construction permit for a septic system in compliance with 31Q,CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issudince of a building permit for the construction of a•single family home on this proRerty, is requiring that the agreement for the restriction on the number of bedrq(o,ms in any house constructed on the lot be put on record with the 2;4riistable County Registry of Deeds-by recording this document, u N NOW, T EREFORE,p vL ,b. VAI does hereby place the (owner's name) following restriction on his above-referenced,land in accordance with his with thAImmol , whieh-Festdefiens�alt . *+ run with he land and be binding upon all,successors in title: h > may have constructed (address) a on the lot a house containing no more than 4zad (0-4 bedrooms. o ham a agrees that this shall be-permanent deed (owner's name) restrictio ri affecting L�- located on: /,P r�/?� �?/,& and o being sh wn.on the plan recorded in Plan Book , Paged Or on Lend Court Plan For titl f see the following deed: Book , Page , . Or Land Court Certificate of Title Number / qd o� Execu%d as a sealed instrument /.?-�day of 6wner'k signature C AIZ It q r 6 Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss , 200 � Then pf irsonally appeared the above-named / known o TqA be the person who executed the foregoing Instrument and nowledged , st the same to be ` free act and eed fore me ' �. '94 . ,, c...Al �A , .A tA ,.,- a s# a tip Notary Public -� - r1 ► ={ s E3ARNS ABLE COUNTY My commission expi es: ,;� REGISTRYOF DEEDS L A TRUE COPY,ATTEST (date) JOHN F.MEADE REGISTER Oi� � t / 4a, ,��`� .F: pRnleTaal E REGISTRY OF DEEDS R J TOWN OF BARNSTABLE LOCATION % /i �c /t t�2 S °� y SEWAGE# lae7�P 5",!!� '-/ VILLAGE �y� '�'' S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.OP 4 e'l� 4 f SEPTIC TANK CAPACITY CX .5 T LEACHING FACILITY: (type) 5`4d e—,4 Y-5 2 (size) AK,J-�1-3 NO. OF BEDROOMS OWNER ��Li G ,�,E�� S C3 PERMIT DATE: ! � COMPLIANCE DATE: 4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet . FURNISHED BY�%~ .� n.�.Q C�nr 1 . I (J J i i COMMONWEALTH OF MASSACHUSETTS ®� � EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r 7 DEPARTMENT OF ENVIRONMENTAL PROTECTION e" O,M SY0` TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ( ,'�G A e zr l,/;}I --I Owner's Name: G Br ra ll Owner's Address G2 Date of Inspection: Name of Inspector: (please print) < Company Name• 65 !//® ^ 7_�G � Mailing Address O o_)Z Id 98r Sf4 A —1 11,74 0.16�� Telephone Number CERTIFICATION STATEMENT 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 finiction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes eds Further Evaluation by the Local Approving Authority -11, airs Inspector's Signature: !—� Date: X8 D5 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the-time of inspection and lender the conditions of use at that time.This inspection does not address how the system will perform in the future under the sme or different conditions of use. Title 5 , d Inspection Form 6/15/2000 page l Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTII+ICATION(continued) Property Address: ��' t;✓ek Owner: hOr Date of Inspection: / Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A.�j System Passes: I I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B_ System Conditionally Passes: AS 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`riot determimd"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 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERT/INCATION(continued) � Property Address: �V/ / 17��L G W vl q vrvlr'e 001 C 0/ c��--- Owner: G o Date of Inspection: (� 0 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 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the entiironment- 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. 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**.M hod used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOP—M PART A CERTIFICATION(continued) Property Address:_ d ! TC tt yr Gv;a 1,7 �j ad 6m� Owner:/ /Gf Date of Inspection: /8 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ail inspections: Yes o 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'/z day flow � Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Hof times pumped y 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. V any portion of a cesspool or privy is within a Zone 1 of a public well. _ A/A41y portion of a cesspool of 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 cert M- ed laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppu36 provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria ex2.st 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. barge Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,600 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Xn the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinldng water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—1®vPA}or a mapped Zone H 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 wid1310 CM R 15.304.The system owner should contact the appropriate regional office of the Department_ Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMS INSPECTION FORM PART CHECKLIST Property Address Owner: G �fm Date of Inspection: 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 v Were any of the system components pumped out in the previous two weeks? v Has the system received normal flows in the previous two week period? — _v 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? v Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? m/ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the b es or tees,.material of construction,dimensions,depth of liquid,depot 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: Y no 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(3)(b)] S I Page 6 of 11 OFFICIAL, INSPECTION FORM-NOT FOR YOLUN T ARY A.SSESSM[EN'TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT C 0 SYSTEM INFORMATION Property Address: /�I `4ck"1 L--� / l g 4� a mf�z /� cbt60 Owner: G Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .3 Number of bedrooms(actual):DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): It" Is laundry on a separate sewage system(®yes or no):,� [if yes separate inspection required] Laundry system inspected(ye�or no):/?,Vw Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): /10 Last date of occupancy: CONIVILERCIAIANDU'ST IAT, Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgketc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL,INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYP SYSTEli2 _ eptic 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) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no)/j ` Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �f SYSTEM INFORMATION(continued) Property Address: J (/ / ���'S L✓� cz ems' Oot G — Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: -` Materials of construction: ast iron _- 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) el Depth below bade: Material of construction: oncrete metal_fiberglass polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: _ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: ��1 pt,✓S ✓1S Distance from bottom of scum to botto fputiet tee o�jbaffle: How were dimensions determined: �/O/P a° s e!ir cr r Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structaral integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): _ l✓ l /� < . �✓ ems !° ® �Z 5�� / ,--1✓ f- /1.1.G GREASE TRAP:k1li-locate on site plan) Depth below grade:— 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert;evidence of leakage,etc.): f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �1 v� iS Oo-60/ Owner: G p r ,o Date of Inspection: / 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBITTION BOX: (if present must be opened)(locate on site plan) 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 to or out of )�f � �/�j/i LPG�-1 PUMP CHAMBER: /" locate on site plan) ( P ) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSM[E TT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: l'TVkt-5 L./eh Owner: 1"t C of*--P' T Date of Inspection: / ®� SO.EL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length- leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,dam soil,condition of vegetation, y etc.): 0 It / J ,[[ / J/ (/!i'CiH� ��oe� y+eG �p ll�l��- b/GjCra�ic ��+t�l�� 47 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 or 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.): Page 10 of 11 OFFICIAI,INSPECTION FORM-NOT FOR VOLUNTARY ASSESS_�ENTS SUBSURFACE SEW AGE DISPOSAL SYSTEM INSPECTION FORM PAnT c SYSTEM INFORMATION(continued) Property Address• �� i T C�vf G✓a� Owner: G l0 Date of Inspection: y /8' B 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_ j-4 _ Y o Page 11 of 11 T OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PARS'C SYSTEM InNI+ORMATION(continued) Property Address: [,, ,1' Owner: G _1 Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells _ /h4 '��. �✓ . Estimated depth to ground water Id- . feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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 hi h gro d watt elevation: /ti s '- �� O/B� F j17. —&fZlotAZ t UG�'E Ann t L`-1 - `-3 T�t�ZOC>,AA .s ►moo Gacz-�.oc.� Urzl�>� . . ; ' �,`T�ia �t�CL� -. . - t�t L� Ft-o�,c•i = 11b +� 3 s ��O G.F�t7 �I�PoSAL �iT - usE tocao �� . . AWIOV , TOTAL_ °DIE.S1GtJ -roT�t... Tj�11,.�(.F�yt./.T 33p�d?P. . � �• � gip. :,���: � j. t i ' t�r-DL TXOQ 04ri" !°'I� Iml&J,otz lam.. 1 � ry, a r Pei , �t fl .C��t�vS f�j�e_ ,t.,• I.Y� i� t � .1 I ( 1} i _ ... � �'••f�•1 6.r i �. �. C �a []�(�(�pp{� C�� `.a '•a } � ty 7 h •f � I 'S, � 1 f i �l i l/�li1PD A. BAXTE t • P.t ��'Ir 7.�4.�4 i,. 3k-6 • r�� I , i l ; , �: f i }. 1�OL ° 0 .•• r 4.Of t .. Ao. -- f�4tD 10o qS aw `� f _ TO LeAcN PIT s�bt� V41T'4! sroWF gRf� ► . ' 1 FtZpl="t L_Ea lz I C-CRTdPY Ts--IA-r T14G— (70L)aoArit34 5t1��3 1-i6:�L:t5e.3 Gt 6�t_;�(S W t"t'6-1 TP �dDE.t`te-�Es t ! ti ; ! `to w►� o� LOT -1 , ! {� t>ATE � fL�GIS'i�dZ�Z�� bets St��V�Yot Tt-A 1 S r7 LA" le, W OT BASF® 014, AG4 } : ; o s Ev-v%Ll- Ica .�t7.G1 C�ah6 alt= 1..,��C" ivi i-1L� j� Town of Barnstable OF 1HE 1p� Regulatory Services ,,���� ; Thomas F. Geiler, Director BAR 059. •e� Public Health ,Division ArEp��s 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 nor 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. 017 LOC.A >a0N SEWAGE PERMIT N0. ICL-j V�, VILLAGE v INST LLER'S NAME i ADDRESS B UILDE R OR OWNER DATE PERMIT SSUED DATE COMPLIANCE ISSUED r , 1 %J t 1 • I Town of B i rnsta:ble. P# Department of Regulatory Services Bt& : Public,Heal Division Date 039. ,b$ 200 Main Street,!0 nnis MA 0260110 ' VO Date Scheduled A 110J. Time Fee Pd. / ,Foil Suitability Assessment for Sewage Disposal - Performed By� f G(L.>2�iY) Witnessed By::D �'` W WD i LOCATION & GENERAL INFORMATION Location Address 3 i r(� S WA Owner's Name ©`' L'f4;�p v /�( P ei •Address Assessor's Map/P4rcel: 2-1 V Engineer's Name PrA f eA M e—,� NEW CONSTRUMON REPAIR X Telephone# \5 0 zz Land Use Slopes(%) Surface Stones Distances from: Open Water Body 'ft Possible Wet Area Z� ft Drinking Water Well Z�ft . Drainage Way ft. Property Line 7 ft Other ft SKETCH:(street name,dimensioos'of lot,exact locations of rot holes&pere tests,locate wetlands in proximity to holes) Ses Pto fob 51 �i S6W A-6C— PLA7J n 14 SDI a7 I 7/J + C �? I `5) i F Parent material(ge010gic) jy C� —( { Depth to Bedrock Depth to Groundwater. Sanding Water in Hole:' '9 ; Weeping Prom Pit Face Estimated Seasonal iHigh Groundwater -- DtTERM[N TION FOR SEASO�iAL IIIGI1 WATER TALE Method Used: ` 3 Depth dbperved standing in obs.hole: _In, Depth to Soil mottles in, Depth toiweeping from side of obs.hole: in. ©roundwater Adjustment fk Index Well#— Reading Date Index Well Ievel Adj.factor _° Adj.droundwaterl evel,,,,,,, PERCOLATION.TEST D�tt: �rltu� Observation I Time at 9" 4' Hole# z i Depth of Perc 49 Time at l0 Start Pre-soak Time.@ 10 /0 Time(V-6") / 2a End Pre-soak Rate MinJlnch 4YWL Site Suitability Assessment: Site Passed_d__ Site Failed: Additional Testing Needed(Y/N) Original:.Public He$Ith Division Observation Hole Data To Be Completed on Back----------- ***If percola#6n test is to be conducted within 100' of wetland,you must first notify the Barnstable 6xiservation Division at Ieast one(I wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 0 1,a IOC �3 kld4k j t 2,S (O/ Coose ,gut/r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Ccasistency.%Gravel) 11 / .11 10kel OVA sh- Aiyl DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisteno %'Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil 1 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra 1 t • Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No/= Yes ` Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist.in all areas observed throughout the area proposed for the soil absorption system? ' J If not,what is the depth of naturally occurring pe ious material? V, .�� Certification I certify that on 10 (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required-tr ini g,expertise and experience described in 310 CUR 15.017. Signature Date d Q:\.SEPTICU'ERCFORM.DOC No..........-.f!. .... F�$... _' ..........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration for BhiposFal Workii Tonstrnrtiun rantit Applicatigg is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � ® Locatio •Address T w�®e �(J C� ! LVor t ............. --•---.........�.-•-•--•--------•--.......................... ..............................-•--....... .0. ..........................................-•• Owner Address ........................................................ •-•-...........--------...--- •.....................................••--• Installer Address / UType of Buildin�g// ? Size Lot../2/110.........Sq. feet ►., Dwelling�No. of Bedrooms�... v��.................................Expansion Attic ( ) Garbage Grinder ((rq pa,., Other—Type of Building 2�1fJ'C[.E''....__..... No. of persons...............,---------- Showers ( ) — Cafeteria ( ) Oth r fixtures ..................:........ WDesign Flow...... .........................gallon per person per day. Total daily flow...... ....................._:...gallons. WSeptic Tank—Liquid capacity/f)+/)0.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------1-----____.. iameter.........I...... Depth below inlet........?........ Total leaching area ...sq. ft. z Other Distribution box (t/� Dosing tank ~' Percolation Test Regults Performed by.......... ......................... Date___: _ _.� _...___..... Test Pit No. 1____ ........minutes per inch Depth of Test Pit.M._.......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � - .j.__...,. -1 ��... O Description of Soil...------.12 -------------------- •--....� .'SOI ` x ... ----- --••-----.........................••d........... . .-----------------------------------=---•---•-----...•----------•---•------------•--------•----------•---------------•-....•••-------•-•--•••------•--•--•---------------......sue x ........................................................................................................................................................................................................ V Nature of Repairs or Alterations—Answer when applicable................................_____...._..._...__..............__....___..._......._..._..._.. ------------------••--•----••--•----------•---•--•--•--•--•-•-•---------••-••-------------•-------.........-----------------•-••••-•----•-------•.......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued=th and of health. n r. Date Application Approved By..../ `� - --- `t1.1C-7. ........... Date Application Disapproved for the following reasons-------------------------------------------------••--•-----------------------------------._...------......-•----. -•---•---------------•--...-------•----....--------------------...--------•-----•-----------••-----•-•--------------•••--••--••----------------•-••-•-•--------•--------•---•--...-•-•••----•-------... Permit No.............................. 2L - s - -- Issued ------ . ----•-............... %te FnB.,2..S__.f......... No.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ......................... .................OF........................................................................................ Apphration for Dispogal Works Tonstrartion "amit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System a 1r , r*7— O&�................................... ........ d.4.......... .............4ja Locati ddri Vs loe .8 ....... ............... ............................................... .................................... ....... ........*------------------- Owner Address ................................................... .................................................................................................. Installer Address Type of Buildin Size Lot__/Q,_//.q---------Sq. feet U Dwelling��No. of Bedrooms 2.................................Expansion Attic Garbage Grinder ............ No. of persons___..____.____.1---------- Showers Cafeteria a Other�.Typeof Building J.AW --- �''Oth fixtures ....................-:............................................................................... ................................................. Design Flow__.... ........7...............gallons allons per person per day. Total daily flow-----0.1.90______________________gallons. 04 Septic Tank—Liquid capacit�W_#--gallons Length________________ Width___...___.___... Diameter._.__.-..______. Depth..-____.____.... Disposal Trench-No_.................... Width_____._.__._.____.__ Total Length..____._____._..__._ Total leaching area....................sq. ft. '...sq. ft. Seepage Pit No....... Diameter........jF...... Depth below inlet.......6......... Total leaching area_ .... Other Distribution box Dosing to y Percolation Test Re�ults.` ,/,Performed by..____.___ ......................... Date..2// . ..:2e............ �-4 1,. I .......... to ground water_._.._.__.__.__.__.___..; �--4 Test Pit No. 1--'o..........minutesperinch Depth of Test Pid ... Depth .................. 0-4 44 Test Pit No. 2................minutesper inch Depth of Test Pit______.._.__________ Depth to ground water........................ 04 ........ ......... ..... ...............U........ ...... 0 D scr*iption of Soil--_[ .41 -S0g-S6-1C ............................I.............................................................e .............................Zo.......................... ................................................................................................................................................................................S�*/y ....... U . W ...............................................................................................................................................................0........................................ Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------- ......................................... .........................................*-----------------------------------------*......**.......................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issue y th . bard of health. gnedzx.e.4A............................................................ ................................ Date Application Approved By-----". .............................. ----------- .......... Date Application Disapproved for the following reasons: ........................................................................... ............................... ........................................................................................................................................................................................................ Date PermitNo.......................................................... Issued..............................I-------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF, .: :..... .............................. (5rdifirate of Toutpliatta n THI s TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired� by.......... • ............................I...stal...................................................................................................... ----------- ler it.......... .... ---------------------------------------------------------------------------------- ------------ h n accordance with the provision 1 5 of The State Sanitary CQAp-as described in the as inst..' Isiol,7f application for-Disposal Works Construction Permit No.- dated_... ---------------- -/------------------- THE.'.IS$UANCE OF,THIS CERTIFICATE SHALL E CONSTRUED AS A GUARANTEE THAT THE SYSTEM,*),NILL;-,FUNCTION ,SATISFACTORY. DATE---... ............................................. In........................ Spector...................................................;................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ :OF.......... N -------------- ................ Tisposat Work mitrurtion '"amit Perinission is hereby ...... t granted... . ------------------------------777,�,T-------------------------------------- ............... -A or Repair ( `)4`ii 4i wage Disposal System atNo.----- ................................ t 4S........................................................................................................................ A• ti Zr.pet shown . as shown ated.......................................... oAl ;�&41 onstr, ......................... ........41 _70 ............... / oa ---------------- fYH DATE--- ............................................. ................. FORM 1255 HOBBS & WARREN:'INC PUBLISHERS "C,Ll-::- V-7&m l`ter - S T:SMDZooAe� ►...to GAizbcAGe Urcl r�IL.�4 FAW L _. %tO 4 3 u Ste: t and C A g-. lit �l POSAL PIT usE loci G�. a i i �UGWAL.L Ae1CA + Ii5oo S.F. ! ; 375 G.P.D. 3� 80 S TTom AOMA= ; D S'F. I tit TorAL �.E.SIGN s 425 G.RDD, � s � N �$oK � ! = 4 s S y 7..:Dr✓f1Gt>LATIO I..t -.QQTE • •• U. I t ' _ t .4 c2 too I a I i Cs� RICHARD A.' r 2 ;, 1 i:l 1; JA u BAXTER .� :. i .6� k rs Na N 4 21048 LA::, d tr . !� w '�� tj � i. L 4 �• { I�-.V I 'v ' � ' i ;.) 1 zr M , !, �. t•,I V ! _., 1 , S x •, I�Jt 1 ,, ' 1 •, � p i j �� ��TIF11(►'�IQO'.�i r � �i r 3114 f"18 Lol t '_ r J'rPioB IOao ILJV. ��SOr !j PPB viST: IW I 1 S, oao MG ; GAL.: LGAaA I t '' t f i s,�...,{. t t• -•., 7. i "" +_. •-�-j'-' �- L� �r t '� 1 ) PIT Wlr►a r i ' w 1 ? L ,! CEIZTtF1ED PLo PL.l1ti`.i : LOCATi3OW, 1+4yA1.11,iiS 7 l 1 ' Z CS � cc�cz-r1�Y THAT TNT t�ou#.1�v� IDi.� •Slaawl.l. ; j '�� _ � P't.-'Aw i 'R�F'�REtt:leE � °� t-iF:��t�►J GtPL �IS :.W LTN Tt-� SID�.LI►-►E :' , t AI.Ita SE7I"'•ALK �-CgU1�EMGl.l1'S. OF TNT � � i' , ' ' ' t ! t-�JT:f �;.' � .. .. � G •F 'Tow► !, of ` ,QR�,'rA►3 A PATE 1 J BQXTCiZ. �`,. �.JYE IWC. I ;. t2EGtS`rctZir�; ( t_.Lwip ? `5uev&Yci1 �. TH1 a: t7LAI-d 1 L-1oT 13ASC'C7 caL�i:'A�.1 I ; I .05TE2V1 .1C� , 'o /MASS. IIJS: L:JM C:IJT �iUF.�II �{ Y'L�C: UF, S�i:ei USEC?...:i"cU l? ►►Jl:.� 1,�o'C' ( i W r APr�trl Gb.1�l T ;} • 1 LEGEND PROPOSED CONTOUR 98 PROPOSED SPOT GRADE p y' ur, —— 98 —— EXISTING CONTOUR O E R c7 0 $ o ' . • + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE gp0 �L TEST PIT a cs Sq A = 55.08 ft /� AS o \ 39 gn G T'\ ATE 60-y_ LOCUS MAP N.T.S. Gl,- ` y GENERAL NOTES: /c'P /�`�� \�� �F �I 1• BOARD OF HEALTH AND CHANGES TO THIS P�\ F LAN MUST BE APPROVED BY THE LOCAL ND THE DESIGN ENGINEER. \` STONE \� T q 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS, \ 60 �� OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DRIVEWAY // / ��� LOCAL RULES AND REGULATIONS. i 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 8 + TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN \\ 20 ft /�C i •� �� ENGINEER BEFORE CONSTRUCTION CONTINUES. 61 \ Oo / ;� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. �, �\ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF \ �`L O� `�/� ,O 0 / + �. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF LOT � HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1 X AREA = 12110 sf 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED °_\ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Existing Leachplt\ \� j CONSTRUCTION. (Note 10) 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND FILLED 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 61 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 7 1 4 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING \ Y/ O -%, 14. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW y / 1 FOR THE USE OF A GARBAGE GRINDER 62' \ 0- =12 tt 15. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING_ � OF algss 16. 2—BR DEED RESTRICTION REQUIRED. BENCH MARK �. o. 1140 y \—' 62 PAINT SPOT ON BULKHEAD CORNER t ci51 PROPOSED SEPTIC SYSTEM UPGRADE PLAN ELEVATION = 62. 75 QNITAR\a� 731 PITCHERS WAY HYANNIS MA BARNSTABLE CIS DATUM •Z� •� ' ' MAP: 271 Prepared for: McPhereson SURVEY REFERENCE: G LOT.,184 Engineering by: Surveying by: SCALE DRAWN JOB. NO. LCP# f08503 DARRENM.MEYER,R.S. Zoo—Teak Abrironmentel 1"=20� DMM PLAN OF LAND BY BAXTER & NYE, INC. SURVEYORS Po Box 981 (508) 364-0894 E4STS4NDW/CH,MA02537 DATE CHECKED SHEET NO. DATED: NOVEMBER 16, 1977 506-3622922 //27/07 DMM 1 Of 2 JI, I , ELEV. TOP FOUNDATION "NOTE: ALL COVERS TO BE MARKED WITH MAGNETIC TAPE g (Existing) 62.79 F.G.EL: 61.50 F.G.EL: 61.50 F.G. EL: 61.50 FINISH GRADE=62.0 ' MAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVER OVER LEACHING = 3.0 FT. Q. COVERS TO WITHIN 6 OF GRADS 2" OF 3/8" DOUBLE 4 1 L = .30 SHE STONE - - DOUBLE WASHED ST 3 1/2" " 6° 4" SCH 40 PVC WASHED STONE • L 10' 4" SCH 40 PVC ®S=2% 10"I :INV.59.06 S= 1 MIN. s ®�®� O ®®®® A (MIN.) ' 14 ( ) ® S= 1% MIN. ®la®a®®®®®E3® TEES ARE TO BE ° E3aa®®UU®a®� „4 •p 4" scH 4o Pvc � 2 EFF. DEPTH ®®®�®®®®®®� INV.58.75 INV.58.55 4' 1 X 8.5' 4' EXISTING OUTLET GAS PROPOSED DB-3 BAFFLE H-10 DISTRIBUTION BOX EFFECTIVE LENGTH = 16.5' ,. INV. 59.31 EXISTING 1 ,000 GALLON SEPTIC TANK INV. ELEV.= 58.45 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT GAS BAFFLE TO BE INSTALLED ON PIPE INVERTS PRIOR TO CONSTRUCTION OUTLET TEE AS MANUFACTURED BY ELEV.= 59.00 TUF-TITE, ZABEL, OR EQUAL 2) D-BOX SHALL BE SET LEVEL AND TRUE TO TOP CONC. ELEV.= 59.00 GRADE ON A MECHANICALL COMPACTED SIX " INCH CRUSHED STONE BASE, AS SPECIFIED IN INV. ELEV.= 58.45 ®®E3 la Ea�Ea® 310 CMR 15.221(2) ®E3®®®® 3) REPLACE EXISTING 1,000 GALLON SEPTIC ®®E3 a TANK WITH 1500 GALLON SEPTIC TANK BOTTOM EL.= 56.45 ®®®®E3®® IF FAILED, DAMAGED, OR UNDERSIZED. 4 5 FT. 4' 4) INSTALL INLET & OUTLET TEES AS REQUIRED SEPARATION -5.98 FT. EFFECTIVE WIDTH = 13' SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 50.47 SOIL ABSORPTION SYSTEM (SECTION) N.T.S. (500 GALLON LEACH CHAMBER (H-10) LOADING) SOIL LOGS P#: 12003 DESIGN CRITERIA DATE: NOVEMBER 16, 2007 NUMBER OF BEDROOMS: 2 BEDROOM (26R Deed Restriction Req'd) SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI DAILY FLOW: 110 G.P.D. HEALTH AGENT DESIGN FLOW: 220 G.P.D. �1 Elev. TH-1 Depth Elev. TH-2 Depth SEPTIC TANK (VOL. REQUIRED): 220 gpd x 2 = 440 gpd (USE EXIST. 1,000G SEPTIC TANK) 61.49 0" 61.47 A p" GARBAGE GRINDER: NO (not designed for garbage grinder) A LOAMY 3/ND SANDY LOAM r LEACHING AREA REQUIRED: 220 gpd/0.74 = 297.30 SF. 60.99 B 6" 60.97 B 10YR 3 1 6" USE TWO (1) 500 GALLON PRECAST LEACH CHAMBERS (H-10 LOADING) LOAMY SAND SANDY LOAM WITH 4 Ff. ON ALL SIDES: 16.5'L x 13'W x 2'D 10YR 5/8 10YR 5/8 BOTTOM AREA: 16.5 X 13 = 214.5 SF 58.99 Cl 30" 58.47 C1 36" SIDE AREA: (16.5 + 13) X 2 X 2 = 118 SF TOTAL SQUARE FEET PROVIDED = 332.5 vs. 297.3 REQ'D MED. SAND PERC 057.5 MED. SAND F DESIGN FLOW PROVIDED: 0.74(332.5 S.F.) = 246.05 G.P.D. vs. req'd 220 GPD p Mgss 2.5Y 6/4 2.5Y 6/4 o� D PROPOSED SEPTIC SYSTEM UPGRADE PLAN MEYER �`�+ 0 731 PITCHERS WAY, HYANNIS, MA No. 1140 Prepared for: McPhereson 50.99 126" 50.47 132" { �£C�STE Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARRENM.MEYER,R.S. Zoo-Tech Environmental N.T.S. DMM SANITA?0 POBOX961 PERC RATE <2 MIN ("C" HORIZON) PERC RATE <2 MIN HORIZON) EAST SANDWICH,MA02537 (sos) 364-0894 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED •2?,07 508-362-2922 60</27/07 DMM 2 of 2 j - � Y a Tim Scales -� Residence t �~ J 268 Pomponesset Road t Cotuit,MA NOTES: EaL +reran cr/en j .en.G... Tna.a GNG DESIGN,Inc.e'a I .r en r,e r r,a • .. GNG aDESIGN.lxc�a cIN 15R®8.25" 14TO9.5° nore:Mln.Neep DIY ROOM 6'-O .i PNROM TIP P L EAp T. UN 91pE OP CLG, O 93 D � KITCHENF-T II OBI IIUUII . •IN a GNG DESIGN Inc. `~ 247 ONSET AVENUE n I _ P.O.8ux 1200 UNHEATED ONSET VILLAGE,M A 558 DN TEL.508-743-0904 FAX 508-743-0903 2 0 4 16R08.25' gngdesign@comcast.net EAIFA�T 15TCd9.5' v GNG ' checbee GNG 4,-eii �=l AS NOTED — —— 25-5° O eD UNHEATED BED RM. �' •IN � BATH SCOND FLOOR` 24-0' 485 SQFT HEATED SPACE !I 24'-O" Sheet Title FIRST& SECOND FLOOR AS BUILDS I _ Number # F �. DO. �. JUNE 6,2005 Sheol Number AMMI FIRST FLOOR PLAN SCALE: 1/*' = 1'-O° � r� SECOND FLOOR PLAN SCALE: 1/4" = T-Oe 2