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HomeMy WebLinkAbout0029 REDWOOD LANE - Health 29 Redwood.Lane �• Hyannis A = 288 l 11 TOWN OF /BARNSTABLE LOCATION oj�':; VOOC� Yl SEWAGE# _Z 0I A- H Z VlJLAGE//vgyJf7, S /l11t ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. (!SQA=r e-Ji0 IJriR e /�ttPS —,P7- 8Sc7 SEPTIC TANK CAPACITY y41 LEACHING FACILITY:(type) /,a 4 KC 39 HG "0(size)Av; NO.OF BEDROOMS -3 OWNER 6r PERMIT DATE: COMPLIANCE DATE: IF J Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A6 6ramcl(v L�y Feet Private Water Supply Well and Leaching Facility(If any wells exist on 010S C� 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 Cr 09 d lip. r TOWN OF BARNSTABLE LOCATION aq ;�*PAOOO P7 SEWAGE# VILEAGE A(Cp Q rJ 11 r s ASSESSOR'S MAP&PARCEL or0f , /I / �PbF 'aS NAME&PHONE NO. *t r 49�i vi o-7J;C f-I SEPTIC TANK CAPACITY LEACHING FACILITY:(type) .� M'Sc' (size) NO.OF BEDROOMS OWNER '�o b et i cict U PERMIT DATE: COMPLIANCE DATE: Separation Distance Betw(ef`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, nand-sketch in the area below t ❑drawing attached separately I e, Q 1 r Commonwealth of Massachusetts W Title 5 Official Inspection Fora a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Redwood Lane Property Address Nw7 Joe Young Owner Owner's Name " information is M required for every Hyannis MA 02601 7-13-17 1-1 page. City/Town State Zip Code Date of Inspection .ts �j 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. filling When A. General Information la �c f fillip out forms S/.� �' ��������t��t���f►��Nii� on the computer, use only the tab 0 AN sp 1. Inspector: r •• 9y key to move your O: • G cursor-do not JAMES m•'• ' use the return James D.Sears =�; Name of Inspector key. i c�:• ;v, Capewide Enterprises �'• c+ o:'� Company Name 7�• ryT1r,..• ._ 153 Commercial Street �i��F 5 INS?*Gp��`�� miunnln►�� Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-17-17 Spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ZLI114 V/ff Commonwealth of Massachusetts W Title 5 Official Insp ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 . 7-13-17 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: Note: Plastic tank. The system is a 1500 Gal. Tank D Box and two rows of six chamber's. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):. ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in swoMm is less than 6" below invert or available volume is less than '/2 day flow I €/3 C/11 AI& t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. - ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts. H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 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? ® El information the.facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been.determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 29 Redwood Lane M Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 - page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. plastic tank D Box and 12 chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-55,000Gals g ( y g (gp )) 2016-52-000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f - Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 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: NA 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): l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2012 Permit # 2012- 142. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: feet Material of construction: El 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.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 10" 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. Prastic Tank Sludge depth: 1" t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•'y 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 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 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt- Plan -Tape Sludge Judge 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 at working level. Tank and covers at 10" below grade. In and outlet tee's. No sign of leakage or overloading. Tank should be pumped. Note: Plastic tank. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 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.levek Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is H annis MA 02601 7-13-17 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D Box is 16"x 16"-18" below grade. Box is clean and solid. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. ._ Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two Row's of( six each)ACR 36 HC H-20 biodiffuses. Ck D Box and camera out. No sign,of over loading or holding water. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. Citylrown 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.): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is Hyannis MA 02601 7-13-17 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately s P o" A - -3 13 -a-= / --� O O V s d t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Redwood Lane M Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ND Estimated depth to(—high ground water: 14+ feet Please indicate all methods used to determine the high ground water elevation: 4 ® Obtained from system design plans on record If checked, date of design plan reviewed: 4-5-12 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: T.H.on Design plan 4-5-12 no G.W. at 14'+. Bottom of leaching around T-6" below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Redwood Lane Property Address Joe Young Owner Owner's Name information is required for every Hyannis MA 02601 7-13-17 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 I t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable. r# .I/ Department of Regulatory Services Pablie$ealh Division Date arm 200 Maio Street:H;"MA OZb01 Dade Scheduled i Time _ Fee Pd ,foil SuWil'try Assessment for, S age Disposal LOCATION''aa&� GL INFORMATION , u=doa Address•,2 9 �iorvW Jaye ; owmes Name te 4ee4•' V Address 6o eGR�P Asaesmes M Fe r'a Nam NBR/CONSIR ROAR TekphD°e •,a ( 1. LaadUse 5/Gt'PG1" � ' �Slopea(96) l /b swamStaoe`s. -- � It_; Pssible Wate Arae ft Drinking water well 1 t: i Dsmims 6oaK vpan water Bode a` .` V. ; � . k - . Way ft lice � ft Otitcr ft Drainage P4!aprny � .. _ AIG SSETCS:tshac aurae,dbtaosia�bf lot,exact b>cations oi'te�t nale�s�.,,pol�test,la�te3w�ads in proodtairy to Uaiea) 7 L5 -8 l TV Is ji, �x /-1V r ( . /D Dod Deplb to lledmak Za P'a / nd material(gegleglc) p Depth to aroandw4er: Smalling water In Rota' dl eWe Weeping ilom Pit Pbca Bgdmemd Semneal high Gmaedwater 3 • D i TION FOR SEASONAL ffiGS WATER TALE Method Used: 6 l/! la. Dept m toll tltoalee In. Dot smainng abW bale _ �I Depth tat_.vgeepingxca�a8 fmm 1y �,M).lbetothok A Otvnndw6ter IndexWellf nae. y x>c� Qy Ted • ,� PERCOLATION�x obsc.adan � 19itwac9" �...._.. .�...— Hole# 48 rr 'lime at tr Depth of Pere smrcptesoaeThne.� D minibtd e�e.aoak ' `L. eAp Site Stiiaw"Ash Site PaasLd Site i�iledi Additional Taft Headed(YAM- , orienik.Pabtic HOO Divisiaa Observado Hole Data To Be CompleW on Back- *,t„ Pe rcola Qn test is to be conducted within 1o0'of wetland,you mast first notify the Bamstable tion Division at least one(1)wedk prior to be&ning. - - _ 'o Q DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Harimu Soil Te=4rre Soil Color Sal ' Other Surf a(in.) (USDA) (Muss A M° g ( BM" S h� AA DEEP OBSERVATION HOLE LOG Hole# �- Depth from Sal Harimm Soll Texture Soil Colo Sal Other surface(in.) (USDA) (Muoa w Mottling (St ucwre.Stoma.Bouldem omvcn eat 11 /D DEEP OBSERVATION HOLE LOG Hole# Depth from- Sal Harimm Sal Texture Sal Color Soil ' Other Surfm 00 (USDA) (Munsdl) Mottling. (Sauc u ae Stamm Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Sal Hoemm Soil Texture soil Color iw Other Surface(in_) (USDA) ._ (Mansell) Morning . (Structum Stomm Boulders. Flood I ce Rate Ma ` Above 500 year flood boundary No— Ya-LZ' Within 500 year boundary No c/ Ya Within l00 year flood boundary No-Z Yes Denth of Naturally Occurring Pervious Material Does at least four feet of Untumlly occurring pervious matelot exist.in all areas obsorved throughout the area proposed for the soil absorption system? S If not,what is the depth of naturally=wring pervious material? Cerdfwation I certify that on 011 l ?4 (date)I have,passed the soil evaluator examination approved by the Departmerli of Baviromnental Protection and that the above analysis was performed by me consistent with the required tra Uawand expaletwe deacn'bed in 3,10 C MR 15.017. signatare Datc `t 7� No. d � � �. Fee /'QU THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer� t�L/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppliLation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( `) Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. A REDtacoD 4.4 OYAVA)15 Owner's Name,Address,and Tel.No. p-oAssessor's Map/Parcel a�g f L) 6W -4 � � Zt-L Installer's Name,Address,and Tel.No. 08-477 -3f,17 Designer's Name,Address,and Tel.No. S'�jg„Q33�00q I i . 3 ST 3�kv comui+ s4wO cs+ Type of Building: Dwelling No.of Bedrooms 3 Lot Size ESL)5 sq.ft. Garbage Grinder( ) Other Type of Building $E�t( �l �_No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 345, 81 gpd Plan Date 4-2-ok o(a. Number of sheets ;P1 Revision Date Title P ci R f)ts2A)eZ L&)G HYA�N is Size of Septic Tank 1500 (34,.(,0 L) Type of S.A.S. ml 20AAA C�P7 h 1)tO 0tF7ZL&A;)C Description of Soil d o*(O-S y C 444� 2 y°` / 5,cz� fCAI / Nature of Repairs or Alterations(Answer when applicable) NaQ 14-10 D -fie. rb ;I R.ow& os (,z 14r-CD cAbU-c-L W -are tgloblyFrV.StK 0 Am bgeced e!°4;aAr�-ieweAlzad SFrs,' Aoxut Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. oZ D —I Y Z Date Issued - u c No. O 1 (�l 2 r,. ►;. Fee i7 THE COMMONWEAL F.,TA'OMASSACHUSETTS Entered in com uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS R#pj ication for -Misposal 6pstem Construction Permit .Y! I Application for a Permit to Construct( ) Repair( Upgrade O1han�on( ) Complete System ❑Individual Components Location Address or Lot No. ;9 REDwa� f yo0jis Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 4241 RO© CUAII ID,No4 u-l�vF�y I Installer's Name,Address,and Tel.No. y q�..14-?? ..$,S7 7 Designer's Name,Address,and Tel.No. 5,02„93?-004 d Type of Building:' f Dwelling No.of Bedrooms 3 Lot Size 150!_sq.ft. Garbage Grinder( ) T Other Type of Building No.of Persons Showers( ) Cafeteria( ) F` Other Fixtures Design Flow(min.required) ,3 3(7 gpd Design flow provided =3 4 7S, 21 gpd Plan Date Number of sheets �� Revision Date 4" Title Q� wA?zZ =ft Y ?j1< ,. Size of Septic Tank / 5aQ�UC�j_,oL) Type of S.A.S. :-9c;k 4 asp 62 D IO NEF-i4*4 Description of Soil I Nature of Repairs or Alterations(Answer when applicable) WN Q5,-.2ep i)L,4.Srf<:- TABJc In N 1M) 14-10D �-, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signiad /, Date S A6 I G Application Approved by /f r Date —(�r 2 Application Disapproved by Date for the following reasons Permit No. ),2 Date Issued Z ---------------------------------------------------------------------------------------------------------------------------------------- a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( X) Upgraded( ) s Abandoned( )by 6AP&oXt)g L_,&tL'{Sg_PA(j,_(&g JJX at 1G r e�ni�T .y �l (C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. U►) /`�� dated Installer e A j M— A h g; [?!UT2X pa jjCf, Designer V 14 s n #bedrooms Approved,design flow �1�� ,�7 gpd The issuance of this permit shall not b construed as a guarantee that the syste I will fun t n esig e' . Date f/p Inspector f No. 2 d Fee UU — { THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at �n and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. JNIdlln Date �— /0 — I � Approved byD r, n Town,of Aarnstable Regulatory Services s • Thomas P.Geiler,Director '. AwiTt • Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,.MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 5 /Z Sewage Permit# Z0 i 2— 1`l71— Assessor's Map\Parcel 2 99 Designer: l/ SS7 zf;"w7_5 Installer: — Address: ��� � j �� Address: ���� lot Z was issued a permit to install a. (date) (installer) septic system at _44 based on a design drawn by (address) (designer) w dated !� 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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. AW, q�yG �(l lees�Signat�) o VON�h'E M o ,p #1068 q(Designer's Signature) (Amx Designer's Stamp Here) RETURN TURN 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 3-26-04.doc p �� ru 47f Egli �- I C I A LLn m Postage $ '�I S E3 Certified Fee :� O� p Return Receipt Fee R Postmark O p (Endorsement Required) JHr2 p Restricted Del'very Fee. r-9 (Endorsement Required) I O Total Postage&Fees ,�, , S C r Mr. Robert Halliday 60 Chandler Street Unit 2 Boston, MA 02116 Certified Mail Provides: (asanaa)zoozecnr`0086�0�Sd a A mailing receipt tt A unique identifier for your mailobb -I--L. d A record of delivery kept by the.postal Service for two years important Reminders: ` 2 Certified Mail may ONLY be combined with First-Class Maile or Priority Mail& m Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. A For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is regwred. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery" a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 0 'tMPORTANTA ve this receipt and present'it when making an inquiry. Internet access to delivery information is not available on mail addressed to AM and FPOs: SENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,.2,and 3.Also complete A. item 4 if Restricted Delivery is desired. ❑Agent ■ Print your nam X e and address on the reverse ❑Addressee yso that.we can return thb-card to you. y(Printed Na ) C. Date of Delivery ■ Attach this card to the back of the mailpiece, �r A N BOSr or on the front if space permits. D. Is delivery address dill nt m 17 1. Article Addressed to: 11C21122 If YES,enter delivery addr elow:iR 2Mr. Robert Halliday Jd� j �.160 Chandler Street Unit 2 1 i Boston,-'MA 02116 3. Service Type ❑Certified Mail ❑Express Mail i ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ; ;j ;F; !! i„i . i ; ;;i ? 7006:. 0°810i 0000 fi3524 5720 (Transfer from-service iabeo !!1 1! ! ! 1!' ' x i. PS Form 3811,February 2004 Domestic Return Re 102595-02-nn-1540 I I UNITED STATES POSTAL SERVICE : F i rst-.C-I ai"Mail,. eIg se s voc„•. .. • Sender: Please print your name, address, and ZIP+ o m 2 v Town of Barnstable Public Health D.ivisl*011�- LISPS q� 200'Main'Street i Hyannis, MA 02601 I r Town of Barnstable Barnstable t �-America City Regulatory Services Department I I m nA ASS.LE.M Public Health Division ASS �Q op 039 ♦� rfOMAtA 200� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7006 0810 0000 3524 5720 March 30, 2012 Mr. Robert Halliday 60 Chandler Street, Unit 2 Boston, MA 02116 i ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. ( The septic system located 29 Redwood Lane, Hyannis, MA,was last inspected on 1/24/2012 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is structurally unsound You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health l Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\29 Redwood Ln.Hy.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21861 21); -t 'Gl JZ C 1t u � Logged In As: Parcel Detail Tuesday, March 27 2012 Parcel Lookup Parcel Info Parcel ID 288-111 I Developer LOT 10 Location 29 REDWOOD LANE I Pri Frontage 79 Sec Road I Sec Frontage Village HYANNIS I Fire District HYANNIS Town sewer exists at this address No I Road Index 1356 InteracMvea p Owner Info Owner HALLIDAY, ROBERT J & CORLISS, J TRS I Co-Owner HALLIDAY REALTY TRUST Streets 60 CHANDLER ST, UNIT 2 I Street2 City BOSTON I State MA zip 02116 Country Land Info Acres 0.17 I use Single Fam MDL-01 I Zoning RB Nghbd 0106 Topography Level I Road Paved utilities Public Water,Gas,Septic I Location Construction Info Building I of 1 Year Roof Ext FAT�560� .! Built 1954 (Struct Gable/Hip wall Clapboard UAl'12401 Living 884 ( Roof Asph/F GIs/Cmp I AC None I 1 Area Cover Type 2 GAR 2 Style Cape Cod Int Wall Drywall Be Rooms 3 Bedrooms 12 4 Int Bath E Model Residential I Floor Carpet ( Rooms 1 Full I 2 2 Total BAS> Grade Average Minus I Type Hot Water ( Rooms 5 Rooms I BMi 3 Stories 1 Story F A Fuel Heat Gas Found-I ation Conc. Block Gross 2848 Area � Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21861 3/27/2012 � . ,_ k - � �' + A ) , . . 4 - , - �, z � � � r E P f . 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Syste Form:Not Not for Vol ntary Assessments e �wC� � Property Address / Owner Owner's Name information is required for every ✓1 /f �� //�� �o� bT D� �� /� page. City/Town State Zip Code Date of III r pection 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;fomis A. General Information on the computer, use only the tab 1. Inspector: IMD key to move your cursor-do notuse /'0 /S-zo, ke the return Name of Inspector - y Company Name -Sly Company Address Crty/Town State Zip Code S ��= 77- Telephone umber License Number B. Certification I certify that I have personally.inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: r-a --i ❑ Passes ❑ Conditionally Passes Faiis ❑ Need Further valuation by the Local Approving Authority ; a • C� 1 I, k Inspector' Signature Date o`/ t.a,J The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform Y r in the future under the same or different conditions of use. i5irs ,mb rep 5 orraar Inspection Form:subsurface a sysr—-Page i of 17 Commonwealth of Massachusetts Title 5 official Inspection Form " Subsurface Sewage Disposal Syyy t dem Form-Not for Voluntary Assessments set✓Oo� / / L /Y4 Property Address � CA 11 Wei Owner Owner's Name information 5 ry q N�(j �✓ �!! o?Y14 required for eve page. Cityfrown State Zip Code Date of I ftpecti6n B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 rtle 5 O(0dal In spection Forth:Subsurface Sevsge Disposal System-Pepe 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form kviSubsurface Sewage Disposal System Form --/Not for Voluntary Assessments Q T i(i/G✓''90 Ci Property Address Owner Owner's Name informatjoh is required for every R✓1►?1S O/ page. City/fo" State Zip Code Date of I pection B. Certification (cont.) 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 [IY ❑ 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 pipes)'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 t5irrs 11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface SewagepDiisposal System Form-Not for Voluntary Assessments 1 1`QBc)G✓ood /r/ Property Address 1 /A dal Owner Owners Name information is '1r1rI �✓T j-� UcL6 02 02`f 1oL required for every page, C4[Town State Zip Code Date of f nspecdon 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 ❑ Er Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/16 Title 5 Oftiat 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 / 00 Property Address Gl / 1 Gl Owner Owner's Name information is required!for every "I Ct✓iV11f dw page. CitylTown State Zip Code Date of In pedion B. Certification (cont.) Yes No I � (�OS 01,,h C�ess�p'�, �lGt i 1 ❑ � Required pumping more than 4 Umes m the last year NOT due to clogged or —/ obstructed pipe(s). Number of times pumped: . ❑ L�' 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. ❑ ny 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. ElLi',/Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the . questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11%10 Title 5 Oftic'ral,lnepedion Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form,of for Voluntary Assessments 9 Property Address a /�C a Owner Owners /) �[ 0d`/t �1 information is 7 p` required for every page. Cityfrown State Zip Code Date of I pection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ [P mping information was provided by the owner, occupant, or Board of Health ❑ 2 re any of the system components pumped out in the previous two weeks? ❑ s 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? r/ ❑ Were as built plans of the system obtained and examined?(If they were not vailable note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? [�❑ as the site inspected for signs of break out? ❑ IE 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, ensions, 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 een 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): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): �3c I • t5ins-ti/10 Title 5 Official Inspection Form:Subsurface e Sewag Disposal System•Page 6 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System F rm-Not for Voluntary Assessments ,,/oo Property Address Owner Owner's Name / information is `/A U �19 �f^ 0���/� [� /required:for every /!/�` page. City/Town State Zip Code Date of I pectin D. System lnformatlon Description: 2 e S 6 1 J Number of current residents: 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 years usage(gpd)): Detail: Sump pump? ❑ Yes o Last date of occupancy: 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: Isns•ltno Tdie 5 Oflidal Inspection Form:Subsurface sewage Disposal System-Page 7 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis osal System Fo�-Not/for Voluntary Assessments C l�/O o oL Property Address W/7,�c:7i //-/I�d a Owner Owner's Name 11 n information is 61 0�f 01 (,o�6 / a �y I�required for every page. City/Town State Zip Code Date of Ir spection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: /v 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 ❑ Ingle cesspool , Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•11l10 Title 5 Offiaal Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name L information is r uiredfor eve page. City/Town 19, Zip Code Date of I ection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 9J y— 0.'91 S/✓!co E. ta Were sewage odors detected when arriving at.the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: /Z feet Material nstruction: cast iron ❑ 40 PVC other(explain): -� r Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) F If tank'is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: (Sins 1 v10 Tale 5 Offices Inspection Forth:Subsurface Sewage Oispxsal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo - Not for Voluntary Assessments 9 Property Address ga //1 � Owner Owners Name information is O O� �y required for every 4l✓� �f page. City/Town State Zip Code Date of nspedion D. System Information (cont.) Septic Tank(cont.) 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 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•1 i110 Tille 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not fo Voluntary Assess ents Property Address /J Owner Owner's Name informatign is required for every A/ �L 6 page. Cityrrown State Zip Code Date of Inspe on D. System Information (cunt.) 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 15ins•1 f/10 TWe 5 offiaal Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not for Voluntary Assessments g oa Property Address e 7 Owner Owners Name iformation is required;for every / q Nl h/I 91/ o� page. Citylfown State Zip Code Date of Ins p lion D. System Information (cunt.) Distribution 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 into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order. El Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address / Owner Owner's Name �,L/ information is requiredfor every Ct��/f Al 0a6 q2 c, d- /U__ page. Citylrown �" State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate onWiteplan) , Number and configuration Depth—top of liquid to inlet invert Depth of solids layer 0044 SiveP Depth of scum layer / Dimensions of cesspool n Materials of construction ��i L c, J)V C 4yf Indication of groundwater inflow C� Sf�o��c —S4106IV [IYes No �ins•1p10 U✓1�D H� Title 5 OrridW Inspection Form:Subsudace Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Forth - Not for Voluntary Assessments Property Address // J4 Owner Owner's Name information is required for every Ct✓1✓1 rS / ��/ /'//¢ Q,l 6�/ OL If hk page, City/Town State Zip Code Date of Ins lion D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): / 0 '5r vIS o� 1��Gw �� �► Gt/t°. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I �e c/r,✓o 0 Z--,(/ Property Address // r 11 G Owner Owners Name information is required for every Gt✓i /l A4 ��� 010,111, page. - CitylTown State Zip Code Date of Ins ction 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 ;hand-sketch re ic water supply enters the building. Check one of the boxes below: in the area below ❑ drawing attached separately 0"t"I Q l 7 23 t5ins•1 V10 Title 5 Official Inspection Forth:SubsuAace Sewage Disposal System.page 15 01 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments orwocqd Property Address Owner Owner's Name information is G 44 fl //p/f A%� Da 6�/ � �IA required for every page. CitylTown State Zip Code Date of Ins lion D. System Information (cont.) Site Exam: ❑ Check Slope �---�❑ Surface water �� O ❑ o Check cellar ❑ Shallow wells Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ erved site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: /�/J �S o 4/0 V/,—G✓ ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: "�o Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11/10 Title 5 Official Ins pedion Form:Subsurlxe Sewage p(sposel System.page 16 of 17 r �n, Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal Syste Form- Not for Voluntary Assessments Property Address / Gi ! l Owner 50 wn er's Name information is required for every hG01hy 4�� C�olb7 oZ /OJ[f/ page. Citylfown O` State Zip Code Date If nso 'pection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed �/Sy. tem Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t8ins•11/10 ridle s otridai Insp ection Forth:subsurface sewage Disposal System•Page 17 of 17 GENERAL NOTES: West ASSESSOR'S MAP: 288 � } CD End PARCEL: 111 - N Rota 1. VERTICAL DATUM: Assumed 5 S ue REFERENCE: .PL. BK. 110 PG. 29 - 2. MUNICIPAL WATER is AVAILABLE. �h��hsre u ec Pier rn FLOOD ZONE: C Town of Barnstable CN 3: SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM #2500010006 C (7/02/92) a UNLESS OTHERWISE NOTED. c� c 4. ALL PRECAST& PLASTIC UNITS TO CONFORM TO AASHTO: H-10 & 20 o m 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. y LOCUS 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA 9 9.0 7 FO a ENVIR. CODE (TITLE 5)AND LOCAL REGULATIONS. a 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO LOCUS MAP N.T.S. agel-00-® 100.00 OO CONSTRUCTION. r- - - &AG/SET O LEGEND: / p il at PROPOSED CONTOUR r101.35 FND x 1��. 44 SPIKE NOTE: Pump and backfill failed cesspools. x 101.51 x 98.67 SS 10..2.09 ) 99 PROPOSED SPOT GRADE 1Q2 1 Sgja �00, 101,17 1010 9 NOTE: Regrade, as needed,to maintain a - 40 - EXISTING CONTOUR i/ 03.84 0�., .�r0/SH OFF er) e�� F � 1 maximum 3'of cover over leach facility. - 30.23 EXISTING SPOT GRADE Meets Breakout EL. 100.4 i 13 _2 30 s 19- TEST PIT NOTE: Regrade, as needed,to 1F/1T 103. �j04, //SNOT❑F`F o 101.51 maintain minimum I'cover over o NQ) 6, ° ® EXISTING WATER SERVICE I � sewer line from tank to d-box(top of / 10�,7 103UP/ 7/28 o X o WORK LIMIT LINE O sewer line EL. 101.28-100.6t). 98.03 c� 10 1 113' 40 5 ° '._;.� j 104,27 8 N ❑�K 03 �/4�ner 1 L )'k 11 1�03.93 C B/DH/FND y c, oMo o ao � S14.6 Q� 49 �. 1d3,85 Benchmark set: / rn�,` 2 i 10 .86 N aF BF Mgffq�ti / ! m` L 1Q �t �� AMY L. tiG i TERRY o Right corner conc. step = 9. 8 _/ i VON HONE F`, i ARI / ..y #28 1.1 5+S.F. a EL.= 103.28 (Assumed) / i6 TOF=105.52 2:: . �/ x�104.45 o y v WARNER ., / � No. 1060102. 8 No. 38721 x 91 .69 (Full) Parce'�111 ��I91ER� REG! E i A <c�9�,18 � / / Q. 4 l 1 `201N-❑A110, / no Porch cnfa o0 00 NOTE: Removal of fill (5')to clean C1 a�' / 110 1 I 1 (Slab layer along southwesterly end of x 97.4 0�� 2 0� , . 022 2 38 ;i j Nry trench may be required due to grade / 103 0 T- T � changes. Replace with clean sand 9g� ,5 3,19 / Patlo { NOTE: This plan is to be used for septic P 101 per Title 5 specs. , I� x ( 1 system purposes only and is not to be ! Gar. St considered a property line survey. o TIC/ ND I , ckad ' 00. 1 104.58 (Slab) I p p Y Y e j 02. 3 F T-❑IA K x 8 4 Ns�29°0' �� .104.69 is x 104,80 29 REDWOOD LANE, HYAN N IS, MA �0� 1 jx 10 3.01 03.80000"!1, 104.89 V H i PREPARED FOR: Maximum Feasible Compliance: 105:94 . Title 5, Section 15.405: 104,04 �, associates Robert J. Halliday S T K/T C K/F N D SEPTIC SYSTEM DESIGNS - 7'variance request, proposed 13' Abut. Structure 32ococuicRoad Halliday Realty Trust separation between leach trench and (Slab) 1 Sandwich,MA02563 60 Chandler Street, Unit 2 10 5.93 508.833.0041 foundationBoston, MA 02116 -No Reserve Area required, upgrade of Surveying by: Terry A. Warner. P.L.S. existing system t, 22 Long Rood Harwich, MA 02645 DATE REVISED SCALE SHEET NO. (508) 432-8309 04/08/12 i ill = 20' 1of2 Provide Riser over D-box NOTE:All components to be marked with of EL. NOTE:To prevent breakout,final grade T.O.F.(Full) to within 6"of final grade magnetic tape or similar prior to final cover. minimumm 151to beyond edge of leach (Cover be carried out a EL. 105.52 I minimum to be watertight) F.G. EL: 102.0-104.0± F.G. EL:103.0± F.G. EL: 102.0± Maintain Min.2%slope over leach facilityto prevent pondin facility. Existing grades meet breakout Existing �- g F.G. EL: 103.0-103.4± across property line. Install risers w/covers over inlet and outlet to within"6"of final grade Clean Fill per Title 5 Specifications Inspection Ports within 3"to grade Existing Main Line T BB�Acoess Covers min.20"diam.peT Code o EL. 102.19 L=16' penm pen L=55 :' Naturally Occurring Suitable Sand 0"Per Lin t R eat Length 00 4"SCH 40 PV 24"I.D.DIA 24"I.D.DIA. L=10' Top of Unit/Breakout EL 100.4 W c o 0' 4"SCH 40 PVC i 4"SCH 40 PVC " J =6%(2%MIN) HORIZONTALSTRUCTURALREINFORCINGRI4S UWEHENUE) ° ° J N J (I-ULL um; @S=1.2/o(1/oMIN) s" @S=1.4%(0.5%MIN) 0.89 Eff. Depth w o �' m. 10 lu 14 EL. 100.95 EL. 10t0.1Uuuu m o 0 Install Gas Baffle EL 100.2 PROPOSED DB-3 EL.99.96 Use 12(2 Rows of 6 units)Biodiffuser Arc'36HC ~m on Outlet Tee a EL. 101.2 H-10 DISTRIBUTION BOX } H-20 with End Caps without Stone in a Trench 10.77' 8.37' Floor EL.98.0± 1 Configuration set 6'apart (Install PROPOSED11500 GALLON Tees)et&Outlet Wmoe than one oatertest for lutlet ness if E PT IC SYSTEM PROFILE (30.5'x 2.87'x 0.89'Each Trench) H-10 Fralo Septech TANK EL. 8.3 EL. 0.7 (Plastic)or Equal on Level, ADDITIONAL NOTES N.T.S. Bottom of TH-1 Calculated Adj.Groundwater Compacted Base DESIGN CRITERIA SOIL LOG 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design Sanitarian in the event of varying soils from original soil test. Number of Bedrooms: Existing 3 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E.#2517 i1 INSPECTOR: DON DESMARAIS,R.S. , BOH 2. Failed cesspools to be pumped and backfiIled or removed for placement of proposed Soil Type: Class I DATE: APRIL 5,2012 10:00 AM septic tank. Design Percolation Rate: <2 min/Inch in C1 Horizon PERCOLATION RATE: <2 MIN/INCH IN C1 3. Water line to be sleeved at any sewerline crossings and within 10'of any septic Daily Flow: 110 G.P.D./ Bedroom x 3 =330 G.P.D. PERMIT#: 13593 components, as needed, per Water Department requirements. Design Flow: 330 G.P.D. (Min. Required) TH - 1 TH - 2 ��� EL. 102.8 EL. 103.9 4. Septic Tank and Distribution box to be placed on 6" crushed stone or compacted, level Garbage Grinder: Not Allowed A base. Sandy Loam sanay Loam Leaching Area Required: (330)/0.74 = 445.95 S.F. 10YR3/3 91, 102.05 91, 10YR3/3 103.15 FLOOR PLAN AN Septic Tank Required: 330 G.P.D.x 200% = 660 G.P.D B Loamy Sand Loamy Sand N.T.S. Minimum 1500 Gallon (Proposed) 10YR4/6 10YR4/6 Use 12 Biodiffuser Arc 36HC Units (H-20) in a Trench Configuration: 24 100.8 24" 101.9 i 2 Rows of 6 Units Each with End Caps, Stoneless: 30.5'x 2.87'x 0.89' C1 C1 Bedroom 1 Living Coarse Sand Coarse Sand Room 1 Effective Leaching Area: 2.5Y5/6 2.5Y5/6 i Attic Bedroom 3 Storage 7.79 SF/LF x 5.0'/Unit= 38.95 SF/Unit (Per DEP General Approval Letter) Perc 445.94 SF/38.95 SF/Unit = 11.4 Units. Use 12 x 38.95 SF/Unit=467.4 SF @ Bedroom 2 Bath Kitchen i 48"B m Breeze Way I Design Flow Provided: 467.4 SF(0.74) =345.87 GPD 2ndFloor 29 REDWOOD LANE, HYANNIS, MA PERC RATE:<2 MIN/IN.(C Horizon) 1st Floor <9"@ 10:30 minute �° ' " V H Garage Pr� L5 _ Ae PREPARED FOR: ® �� associates . Robert J. Halliday 174" 88.3 120"1 193.9 SEPTIC SYSTEM DESIGNS No Groundwater Observed No Groundwater Observed 320 Cotuit Road Halliday Realty Trust No Groundwater Observed in TH-1 or 2:Adjust from Bottom of Dry Test Hole 1 Sandwich,MA 02563 60 Chandler Street Unit 2 MIW-29, March 2012,Zone B(8.16%Adjustment=2.4' Utility 508.833.0041 Bottom TH-1 EL.88.3+2.4'Adjustment= EL.90.7 Calculated Adjusted Groundwater Den Boston, MA 02116 I,Am L.von Hone, R.S.,hereby certify that I am current) approved b the DEP pursuant to Surveying er y y fy y pp y p Bath Terry A. Warner.P.L.S. 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been ;� Lnd 22 Long Road performed by me consistent with the requirements of 310 CMR 15.017. I further certify that Harwich. MA 02645 DATE REVISED SCALE SHEET N0. 1 have successfully passed the Soil Evaluator's Exam on November, 1994. Basement (soe> 432-esos 04/08/12 1" = 20� 2 of 2