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0051 SAINT JOSEPH STREET - Health
51 ST. JOSEPH STREET, H A-ISTIf1S. A= 291 214 TOWN OF BARNSTABLE LOCATION, SEWAGE# VILLAGE SESSOR'S MAP.&P.ARCE INSTALLER'S NAME&PHONE NO.Z Lug SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) C� NO.OF BEDROOMS OWNER 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 ori` 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 ad s _f �WN OF BARNSTABLE LocaTicrr si f To SeP� s s ACE VELLAGE ----(7-T�/ •�h S ASSESSOkS MAP.&].OT INSTALLER'S-NAMg&I On SEI'TZC TAN. CAPACITY LEACHING TACII.1T1' tom)., 3; NO.OFBEbRccMs BIDER O c � PERhUrDA'TE COhYIPI:tA�tCI< ITATE Sepaatton 17sstss►ce Between.the MaxuYtum Adjusted tsroph.w.ater Table to the Bottom'of Iltchtng lyacittty �eeY Pnvai Water supply W' -1I and Leacluttg Fscay. {If Any wells f tchiaese rw2eto EdgoWetand andLeacungn failit } t lCacality(Jiff ariy wetlands exist Within 3W'feet o :Ieachiti facility) Feet c G Hen rD, _P AAAA Furnished liy; O � v Q v 91) E:E rr\ V LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLE 'S N ADDI, ESS aUI QER 0 0" E DATE PERMIT ISSUED DATE COMPLIANCE ISSUED n �`7 rvr 'own of Barnstable P 4 A VIE>q, Department of Itegidatory Services : BAMU"L% Public Health Division Date >"AS& 1639. �m 200 Main Street,Hyannis MA 02601 AA . rfl>MAt Date Scheduled_ Time Fee Ptl —1120— ►Soil Suitability Assessmentfor ►Se e .lei po l Performed B Witnessed By: LO,CA'I'ION& GE NIilIIAL INI+ORMATION Location Address , SyS Owner's Name p�,r J � � Address Pal( VAA- Assessor's Map/Parcel -2-1 1 /Zi� Engineer's Name NEW CONSTRUCTIONfe REPAIR Telephone# �jb ✓ 33 ��. 1-and Use C f!. 06k /(� Slopes(35) S Surface Stones Distances from: Open Water Body> 2,00 ft Possible Wet Area>Zyo ft Drinking Water Well.> Oft Drainage Way >/4" ft Property Line L_ft Other ft SKETCH.'(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �.� S-2 Q �� �� Parent material(geologic) ��✓/ �ply r� Depth to Recb•nek____ 4.� Depth to Groundwater. Standing Water in Hole: AI Weeping from Pit Fnce 9 t r! _ � ti� Estimated Seasonal High Groundwater MimiI2AnNAuON FOR SEASONAI,MGEY WATER TAIIL IC4 Method Used: Depth Observed standing in obs.hole: -In, Depth to soil mottles: Depth to weeping from side of obs.hole: _ - In. aroundwuter Adjustment ft. Index Well# Reading Date: hrdex Well level Adj.f'aetor- Adj.Groundwater Level IT RCOLATION' EST Date Thne Observation Hole# Tinto at 9" Depth of Pere _ / Time at 6" f O Start Pre-soak Time @ ` • Time(9"-6") _ End Pre-soak. 1117 ! f--- G 7 Rate Min./Inch G y JI L Site Suitability Assessment: •Site Passed \ + Site Failed: Additional Testing Needed(Y/N) Original: Public Health DivNiim -Observation IIole Data To Be Completed on Back------------ ***If percolation test is to be conducted Within,100' of wetland,you must first notify the. harnstable Co'nse>rvation Division at least one (1) Week prior to beginning. Q\SNP11__ 11ERCFORM.DOC - :. DEEP.OBSER` ATION HOLE LOG Hale# ^ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency.%Gravep_. t Lo ` 3 * b"- 30 A _ l )3 ) S� DEEP OBSERVATION HOLE LOG Hole# Depth from .t p Soil Horizon Soil Texture Soil Color- ; '�`�SoiL� ' Other , Surface(in.) ;a ; ( (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % liv 1 1 fkn� DEEP OI1 TIT HOLE LOG Hole# Depth from Soil Horizon 5o xh�re Sail Color Soil Other Surface(in.) (USDA (Munsell) Mottling (Structure,Stones,Boulders. Con i to c Gravel) • 1 DEEP OBSERVAqkON DOLE LOG Mole It.. Depth from Soil Horizon Soil Text Soil Color Soil T Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. onsi ten raxo Flood Insurance Rate Map: / Above 500 year flood boundary No_ es Within 500 year No / Yes , Y Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s:material exist in all areas observed throughout the area proposed for the soil absorption system? 4pevi-olus If not,what is the depth of naturally occurring material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with . the required ffli/ in expertise andexperience described in�10 CMR 15.017., Signatur v `'v ( Date Q:WErfi'1CWERCFORM.D0C �y fi X 21 Y �+ M p Ir UI CO Postage $ ru p Certified Fee rN N IS ostmark� p RReturnO Receipt Fee Here p (Endorsement Required) 0 Restricted Delivery Fee �f2 N p (Endorsement Required) ❑ Total Postage&Fees r9ru s ra 0 i Kristen Parks 51 Saint Joseph Street Hyannis, MA 02601 Certified Mail Provides: r a A mailing receipt a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o. Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. c Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. 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 USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail' receipt is not needed,detach and affix label with postage and mail. f IMPORTANT:Save this receipt and present it when making an inquiry.. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Town of Barnstable Bares ���►�r�,,� ����� Services Department 1 f .Regulatory Sery ment p � �. y I B'M�`� ` Public Health Division 2007 019. 200 Main Street, Hyannis MA 02601 Thomas F.Geiler,Director Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL #7012 1010 00.00 2850. 9903 August 12, 2013 Kirsten L. Parks 51 Saint Joseph Street Hyannis, MA 02601 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic-system located at 51 Saint Joseph Street, Hyannis, MA 02601 was last inspected 6/21/2013 by Shawn Mcelroy, 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: Septic system is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. , Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER F THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\51 Saint Joseph St Hy Ju12013.doc 1 ' \ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. CitylTown 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. General Information -7 �� 2 1. Inspector: ��Q✓ Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage,disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection) was performed based on my training and experience in the proper function and& intenangppf on-site . '. sewage disposal systems. I am a DEP approved system inspector pursuant o Section 1.5.34 f Title 5 (310 CMR 15.000).The system: . t. - ❑ Passes ❑ Conditionally Passes ® Rai s ❑ Needs Further Evaluation bby the Local Approving Authority ' U10 6-21-13 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent.to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 A. t,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. �r 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. c *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•3/13 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 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or.high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ . broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 1 � ,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 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) I. 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 wate�'supply or''tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system,component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet`of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design�flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 'the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El El 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Titles Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 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? ® El Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information - .Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 P 9 P Y 9 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 51 Saint Josephs St _Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. CitylTown State Zip Code Date of Inspection D. System Information Description: ,i Number of current residents: 5 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? El Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2013 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town 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: Owner--pumped 2012 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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/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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form , 'm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1973 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ,: r ❑ 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. Septic Tank(locate on site plan): Depth below grade: 16 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: 1000 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" 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 14" 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. Grease Trap (locate on site plan): Depth below grade:p g 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts R f Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):, Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: - ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 177 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 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 N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 a Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 - page. Cityrrown State Zip Code Date of Inspection a D. System Information (cont.) Type. ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach pit was filled beyond capacity at inspection. 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 LDepth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No ti t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments condition of soil signs of hydraulic failure level of ondin condition of vegetation,omme is (note g y p g, g , etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a r .8 } - a T i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 51 Saint Josephs St Property Address Kirsten Parks Owner Owner's Name information is required for every Hyannis MA 02601 6-21-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, 8, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. " 351 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Disposal *pstrm Construttion Permit Application for a Permit to Construct( ) Repair vUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � S� (�� / Owner's Name,Address,and Tel.No. ®� Assessor's Map/Parcel l Installer's Ad and Tel N // i esi er's Naine,Ad s,and Tel.No. ✓' 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) R3 0 gpd Design flow provided � ��— gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �05 yD Description of Soil Nature of Repairs or Alterations(Answer when applicable) r- 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 H alth. Signed 2"� Date Application Approved by Date t9 Application Disapproved by Date for the following reasons Permit No. Date Issued S; - 5 - /C) No. o" '` �� Fee � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ F PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes i J 21ppYication for aisposai .6pstem Construction permit Application for a Permit to Construct( ) Repair�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.5` 57- Y0,5L—P// / Owner's Name,Address,and Tel.No. ` OGr/ Assessor's Map/Parcel Installer's le,A s,and Tel.No./��,�L,�s )Definer's me,As,and Tel.No. � � o ��SSA---fD'> Type of Building: / Dwelling No.of Bedrooms Lot Size / U sq.ft. Garbage Grinder( ) Other 0AType of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �?;3 gpd Design flow provided oC 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) 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, he system in operation until a Certificate of Compliance has been issued by this Board of Health. ° Signed Ap� Date 9— Application Approved by Date v Application Disapproved by Date for the following reasons Q I Permit No. e-y 3 5 Date Issued Th E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,th t the On-site S&wige Disp.Qsal system Constructed( ) Repaired( !/� Upgraded( ) V,, Abandoned( )by 4V/^ at a as been constructed in accordance �j with the provisions of T' e 5 and the forSystem Constrp ion Permit No. a0I 3 -3�b dated — '6 I y Installer / Designer #bedrooms Approved design flow The issuance of this pe"it s all llyno e construed as a guarantee that the system wi ctio /as designed. vu Date / Ins ector1 P 1 --------------------------- ----------------------------------------- --- � No. _ J �j Fee ( "y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) R pLir( , Upgrad Abandon( ) System located at v ZA , 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. X Provided:Construction must be completed within three years of the date of this perm /� 5- Date 6 Approved b ( i PP Y S1P/18/2013/4VEI1 09:21 Ali FAX No. P. 001 Town of Barnstable Regulatory Services Thomas F. Geller,Director MAM � A �$ Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,NLA 02601 0`fice: 508 3641-4644. Fax: 503-790-6�04 Installer& Designer Certification Forrn Date: 6l�j Sewage Permit-9 /3" Assessor's limpllparceld—Z,`'� r .� s . � Designer: k Installer: Address: P r� C �' T� `� � :address: I"���_Az On o �� /!/_� nil ,✓U�/� was issued a permit to install a I ate) (installer) septic systern at S�- ��'� �� � based on a design drawn b,r (address) dated Q 1 (designer) CezLL5- that the septic system referenced above was installed srlbstantialiy according to rive design, which may include minor approved chai,ges such as lateral relocation of?he distxibLaion box ancb'or septic tank. 1 cerYif-y that the septic system referenced above was irstalled with major changes (i.('. greater than 10' lateral relocation of the SAS or En'- vertical relocation OF Uy component of the septic syste-n) but in accordaace with State & ;vocal Regulations. Plan revision or certified as-built by designer to follow. OF UK D EN M. (lr_staller's Signature) l No 1140 G Si D (Designer's Signawre) ( MN Designer's Stamp Here) PLEASE I2E'T`URIN TO BARNS BLE PUBLIC HEALTH ]DIVISION. CERTIFICATE OF COytPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ,kRE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q:FtealftSepric.Designer Certi:fieation Form 3-2&Aoc - - '�.et�� st', q iS''.t; w '`� `. ;t i{ "exr .Nl �'$. ,.t a ,;4 ��'q t+r4u.. .. A .c-s'•v;, 4. t' TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 n -1/0 j t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO RAQN PARTA CERTIFICATION Address of Property;' S ( ST. `TG =`t��! �'{" Address of O.wnA: (if different) ,w Town: 33 ��e,gcv►�ct / tee N Yak �, Owner's Name: f_= LA E I- t,)\� Date of Inspection: tD Z i Zt a a Name•of Inspector: Y i�owac 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: ✓ Passes Conditionally Passes . 'Needs Further Evaluation By The Local Approving Authority Fails Inspector's Signature: Date: t0'2;7 The system inspector shall submit a copy of this inspection report to.the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D A]. STEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or,repaired.The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not). The septic tank is metal,cracked, structurally unsound, shows'substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. .' 1 �•vnrr- `�.,.w#{�r�4�'§;ie;<.tL�ws"F.�kx�F-�`�`y"�`�'''�4��r� Fxyv6'� K•S"h"�"�'"�i�'`�r1j�"V'm'� + 'f'�F'+rFruatui`+�tx':!,�.�. '�i,+w`��i::=t''�, i'F''..rFt k'ice" # ,:+s;,.y�w' i�►}t;, �► 4\ , TIGER ENVIRONMENTAL ENGINEERING ,. 969 WASHINGTON STREET ,• . BRAINTREE, MA 02184 617=849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,j PART A CERTIFICATION(continued) Property Address: S1 S-r :'oS t�W _S ? AY A d.l J. Owner: l�CE�ITK� Date of Inspection: l O 2.-'7 ). .:B] -SYSTEM-CON DIjTIONALLY PASSES'(coritiriued) " Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled,or uneven distribution box.The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed #y distribution box is levelled or replaced The.system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): r broken pipe(s) are placed obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT ; FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC'HEALTH AND.SAFETY.AND THE ENVIRONMENT: !+ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet of a surface water supply or tributary to a surface water supply.` The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. S,' eE T+.Y.ka`:�a.f.;,;tpti •rFi'�x�,j'�,fi'�}tf>.K-:e'��:Y. 2 w, 0 Y�.4ut.�K�'*t%41 ^M1� TIGER ENVIRONMENTAL ENGINEERING 4 969 WASHING STREET s BRAINTREE: MA 02184 617-84970088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: S1 G^f T '� �T F -Y/ � N�q Owner: kyea4 �L Y t " Date of Inspection: . s_: ICJ D] SYSTEM FAILS: s I have determined that the system,yiolates one or more of the followingjailure criteria as.defined in 310-CMR 15:303 } The basis;for this determination is identified below.The Board of Health should be contacted to determine what will ; be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS'or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS-or cesspool. :. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. 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 soil absorption system, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water r 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 1.00 feet but greater than 50 feet from a private-water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable .attacheopy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen: E] LARGE SYSTEM FAILS: ' The following criteria apply to large systems in addition to the critera,above: The design.flow'of system is 10,,000 gpd or greater(large system) and,the system is a significant threat to public: „health and safety and thee nviroriment-becausezone or more of;the following conditionS:exist ._The"system is within 400feet of a surf ace'drinking water supply. The system is within 200 feet of a tributary to a suface drinking water supply.. - The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area{IWPA}or a mapped Zone Il of a public water supply well). The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information:_ The intent of 310 CMR.15.302 is'to provide reasonable guidelines for the inspection.of existing systems in as non-intrusive a manner as is possible to avoid damage to the system and any unnecessary disturbance of the surrounding soil area which is related to the treatment process. The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner.The inspection criteria are intended to allow for timely inspection to avoid undue delay in the transfer of property. I understand that this report does not constitute a warranty or guarantee of future operation. Client or Representative �^h�t- �rZjE4?�.Yt` Date a1Ae'14 +�+iw'. 3 �, .. _ '�i'" w `!*'v Si° tia n c ;'may' 4W`sk ';�:k S•ti.' w ' ,4�G .l' .Y �^ TIGER ENVI.RONMEN'TAL 4 ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5 I S'T `k�� 17t� Sri— 4Ye�5. MA Owner: �A �ri,4Y Date of.I nspectio n: l0 /2'I Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow: The site was inspected for signs of breakout. All system components, excluding the soil absorption system, have been located on the site. - The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for K condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the soil absorption system on the site has been determined based on existing ..,. information or approximated by non intrusive methods., , j The facility owner(and occupants, if different from owner)were provided with information on the proper. maintenance of subsurface disposal system: r . 4 lot�"ve..Yrr,7Pr HaR�tnsrtFv*y-t'?T+Vie'f.,'�,p'w'�r�"hi1Fi'Y-b''A`,'�pF'�iSy'tsi�'!'i*��'�'f'�pk"�hX#1�'i � fr.s.r,a,.-:.�A'i'"A�►^+iNR:FjF ,w� ,.vrhp,.,. y TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET i BRAINTREE MA 02184 8 61.7-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: '57 1 ST 70---JE Gam" t*YA i_JsC 1 AP, Owner:: IYt�ttA �fcll�t �c 4' Date of Inspection: ICD Z'T FLOW CONDITIONS RESIDENTIAL: pesign�flow-- 33D gallons '� a Y •: . r Number of bedrooms. � 3 n Number of current residents: Garbage grinder: (yes o<R ,yo Laundry connected to system: (g=or no) Yes Seasonal use:(Kes r no) Y x Water meter readings, if available: (Vk4-,-7 ene. FmEce�ivTc- �C-rya G�'1�- r�cc L.,&+CNTty .' Last date of occupancy: 8 ri5 COMMERCIAL/INDUSTRIAL: Type-of establishment: Design flow: gallons/day '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: OTHER: (Describe) Last date of occupancy:' - b GF-NERAL FORMATION: PUMPING RECORDS and source of information. kJCt AvA=LAtL.C7 System pumped as part of inspection: (yes no If yes,volume pumped: gallons Reason for pumping: -- TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy �10 . Shared system (yes or -if yes, attach previous records, if any) Other(explain) StrT 'TF1K. >4Ct1=�1C. fT APPROXIMATE AGE of all components, date installed(if known) and source of information: Z2 YEa�s 5 :"'#��"�.r�1*sVNF?F9�7iP�t'`�"C"'''�P%3m+p# 'T"ar`•-"fi�""`tp ,'.,,,vv�}�;sX-43s�`'yC'Yr",t"' y+j�&s;.i''°�r"'.,,�`.,,yip.��m��"�•�,'�"1 ? iAF�r�c "xe'R'v'C"'�h�i3aH':to*�'r•� �,. ,4s•4. O :.� TIGER ENVIRONMENTAL t : ENGINEERING .. ;' 969 WASHINGTON STREET ' BRAINTREE, MA 02184 41 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . St S r "Monp�'Pg S—— Owner. i �Xaarc�Y Date of Inspection: Sewage odors detected when arriving at the site: (yes or no) • (locate on site plan). Depth below grade`. 1 Material of construction: ✓concrete metal FRP other(explain) Dimensions: •4 X q k 8 lom G�citr-NS Sludge depth: t Z" Distance from top of sludge to bottom of outlet tee or baffle: 1&' Scum thickness: 2 ' Distance from top of scum to top of outlet tee or baffle. C. Distance from bottom of scum to bottom of outlet tee or baffle: �e Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,. structural integrity, evidence of leakage, etc.) A ej-r 12c-rc-w f►��,`? E r, c°j ),-- -t-o 5t__y (,LC * si7 UM — `.ern f� Ae= _ TEE;S '"F'� S vL GSt�I��-"7'�. , �--� �t.�.C... • t..7rC,�"'1' =.:l�+Jl�t�`. Lts_ut_L j o !E 6.,jc, (�W_- Se 6zuCTURa�t- S DR E{J '�►.L^ CIF L KJ4f GREASE TRAP: — (locate on site plan) f Depth below grade: Material of construction: concrete metalL FRP other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outleXteebta 'Distance from bottom of scum to bottom baffle:Comments: (recommendation for pumping, conditiontlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property,) ddress:, 51 ST S-r 4YA,,JA��S l�+q Owner: 20i-w- -rfl b✓ Y Date of Inspection: to rl 727 /q 5- TIGHT OR HOLDING TANK: (locate. site plan) Depth below grade: s Material of construction: concrete metal FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of al/andf itches, etc.) r DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments:; (notenif level and distribution is equal eviden/�.s s`carry over,evidence"of leakage �nto`or'o`ut df box, etc) a": :. PUMP CHAMBER: (locate on site plan) Pumps in working order: (yes or no) e Comments: (note condition of pump chamber, condition)OU mps and.appurtenances, etc.) Mi 17 �;^�.�,,-.nr+r..�,t�..,. r,,F,,;+f3:-,er $y�,Ycyba.,t�;� ��+Y�►�".�r: AYE`��'r�*!'i�4�j �1^ two►i`'-..tika*r�F, 'of,'�:t;' �i+f�lr' 'i�,�*s's`s..:.'. . TIGER ENVIRONMENTAL ENGINEERING 969 WASH INGTON STREET BRAINTREE, MA 02184 . 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S ( sT �`o S'T (-�Y rtN.�J`S A Owner: Date of Inspection: (O f 2:7 /4 SOIL ABSORPTION SYSTEM(SAS): L EC�1T'JG s locate on site Ian, if possible;excavation not required, but may be approximated by non-intrusive methods) ( � P po q If not determined to be present, explain: Type: Leaching pits, number: 1 S x r DSO Gr�c�c�ys Leaching chambers, number: -- Leaching galleries, number: Leaching trenches, number, length: Leaching fields, number, dimensions: --- Overflow cesspool, number: --- Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) SAY So=f_ nJo Sat cis of I-t�'bcuk tx.=c rti4 w rLe- Q rz Ev-_crs CESSPOOLS: r (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 Irigication of groundwater. . Inflow(cesspool must be pu ped as part of inspection) F 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 /hydraulic failure, level of ponding, condition of vegetation, etc.) } TIGER ENVIRONMENTAL ENGINEERING y 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) t "may, Property Address: S'r Milk '(S II'' !owner: ► 1rt-rr4 t� t Y - „a, Date.of Inspection: ►© �2'? SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks } Locate all wells within 100':: . . . . . . . . . . . . . . . . . . . • .. 0 47 ., •,,,,�,, '� a . , . . . . . 5 r ° . • ,: . , . . . . . . . . . . . .. . . . . . . . tC - , DEPTH TO GROUNDWATER: Depth to groundwater: CZ {1 feet Method of determinafioq or approximation: Wo -rzc,,J 0�= G-vu}r7c�� eT -Te, 9 e43 f CUSTOMER CONSUMPTION HISTORY ACCOUNT NUMBER 291 214 cAls-TOMER_ NAME:---- RUT-H--A--------!NOEL--- - ----..- -._ ---- ------- - - Cv SERVICE LOCATION S1 ST JOSEPH STREET READING 0 DATES READINGS USAGE i f, -- -._. . _...---- ._._. _.._.. _ PERIOD-.._._._ (MMDDYY) ( CCF) ( CCF)- - '' a�.1-LOWANCE BALANCE FIRST 08 04 9S 10 P 10 SECOND 07 06 9S A -- -- AVE RAGE--WATER--USE - ----- -- --- - 10------ THIRD ---- -- - 00- 00- 00 --- -YEAR TO DATE WATER USE 10 FOURTH 00 00 00 FIFTH 00 00 00 NON.-. SEWER--USE_ _ . .. .._.- .._.._ _._...-- . ___--.---- SIXTH _._-..._---.._ . 00- 00- 00 -- ....... OTHER USE SEVENTH 00 00 00 - EIGHTH 00 00 00 --- --- — NT.NT-F-�---- -0-0- 00- -00 -- TENTH 00 00 00 NON SEWER FIRST READING ELEVENTH' 00 00 00 --- -- NON_.. SEWER---SECOND -TWELF-T-H--= -.0.0-- 00-- 00- NON SEWER METER NO. THIRTEENTH 00 00 00 FOURTEENTH 00 00 00 ENTER = FIRST SCREEN;. PFKEY 14. PRINT SCREEN. 1 LEGEND HYANNIS PROPOSED CONTOUR 98 PROPOSED SPOT GRADE SF, —— 98 —— EXISTING CONTOUR ROUE 2a 9�SFs + 96.52 EXISTING SPOT GRADE I c') LOT 35 W EXISTING WATER SERVICE r=„ �T LOT 23 t9 TEST PIT LOCUS 1V v 51 SAINT UPOLE JOSEPH ST. 44.4 S8413 40 E 00 43.2 118.54 / sT / LOCUS MAP SH GAR I ASPHALT /- LOCUS INFORMATION DRIVEWAY PLAN REF: 167/85 n I 2225' '� 12.5' 1-- / TITLE REF: 23347/315 I45.2 -------__ _ - PARCEL ID: MAP 291 PAR. 214 p I 21.76' - -------------- ZONING: "RB" I I-- FLOOD ZONE: "C" O 44.7 G �� G G O (� COMMUNITY PANEL: 250001-0005-C DATED:08/19/85 fw 14 N W Lj z ° W SEPTIC SYSTEM Lu LOT 24 !`` o (� REPAIR PLAN w ; z LP LOCATED AT: '0 0 #51 = 51 SAINT JOSEPH STREET f EXIST. 1,000G otr 44.9 SEPTIC TANK H YAN N I S, MA. 4 TBM =COR. CON C TOF - PREPARED FOR z I EL=45.0 EL=45.74 ) clq 0 KIRSTEN L. PARKS SEPTEMBER 9, 2013 i 12"0 12"P LOT 34 24"044.2 AREA=12,106t S.F. _z � OF ,yq sq 44.2 TH-2 I Q DA IYE 14-0 123.57 No. 1140 S0VITAR\a� ctli LOT 33 ` MEYER & SONS, INC. GRAPHIC SCALE P.O. BOX 981 20 0 10 20 iJ 80 '' EAST SANDWICH, MA. 02537 7I (508)362-2922 ( IN FEET ) 1 inch = 20 ft. SHEET 1 OF 2 J 1568 i T.O.F. NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (44.5) EL: 45.74 F.G.EL: 45.0 F.G.EL: 44.50 F.G. EL: 44.5 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a•` s :Q s 2" OF 3/8" DOUBLE WASHED _ TOP TANK=EL. 43.22 '' STONE OR FILTER FABRIC 3/4" 1-1/2" *' DOUBLE WASHED STONE A 6„ 4" SCH 40 PVC E 10"I s ®®®®• O ®®®® 14" C� S= 1 (MIN.) ®®®®®®®®®®® A' TEE'S ARE TO BE INV.41 .37 ®®®®®®®®®®® :a 4" SCH 40 PVC 2 EFF. DEPTH ®®®®®®®®®®® INV.41 .95 NV.41 .20 4' 2 X 8.5' 4' GAS - EXIST. INVERT BAFFLE PROPOSED DB 3 ,. •'N DISTRIBUTION BOX EFFECTIVE LENGTH = 25 INV. 42.20 INV. ELEV.= 41 .0 EXIST. 1,000 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON ��� �` ass BREAKOUT OUTLET TEE AS MANUFACTURED BY 1` D �, TOP CONC. ELEV.= 42.0 ELEV.= 42.0 TUF-TITE, ZABEL, OR EQUAL V _ NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING No. 1140 `� INV. ELEV.= 41 .0 ®la ea 10®®® PIPE INVERTS PRIOR TO CONSTRUCTION p ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ST ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX SRNITAR ®® ��`� BOTTOM EL.= 39.0 ®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 5 FT. 3.75' 310 CMR 15.221(2) EFFECTIVE WIDTH = 12.5' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.8 FT. WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGED OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION) 4) INSTALL INLET & OUTLET TEES W/ ADJUST. GRNDWATER EL: 33.2 GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 14102 DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPO/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DATE: AUGUST 1, 2013 LOCAL RULES AND REGULATIONS. DESIGN PERCOLATION RATE: <2 MIN/IN SOIL EVALUATOR: DARREN MEYER, CSE 1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.O. X 3 BR = DESIGN FLOW: 330 G.P.D. DDESIGNPENGINEER AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for gorboge grinder) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE NEW 1,500 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TP-1 Depth Elev. TP-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. 44.2 0" 44.2 0" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. A A LEACHING AREA REQUIRED: (330) = 445.94 S.F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND LOAMY SANDi .74 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 3/1 1OYR 3/1 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 43.37 10" 43.37 10" USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL. LOAMY SAND LOAMY SANG ' ' 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 10YR 5/8 10YR 5/8 STONE ON ENDS & 3.75 STONE ON SIDES: 25 L x 12.5 W x 2 D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 41.04 38" 7 41.04 38" BOTTOM AREA: 25' x 12.5'= 312.50 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE C C THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING MEDIUM f MEDIUM SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF CONSTRUCTION. SAND SAND . 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. (i TOTAL SQUARE FEET PROVIDED = 462.50 vs. 445.94 REQ'D 2.5Y 7/4 2.5Y 7/4 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PERC ® EL. 39.50 DESIGN FLOW PROVIDED: 0.74(462.50 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd � is 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 33.2 132" 33.2 . 132" 51 SAINT J O S E P H STREET, H YA N N I S, M A 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. �' ("Cj 15. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED) PERC RATE <2 MIN/IN. HORIZON) NO,GROUNDWATER OBSERVED Prepared for: Parks ` Engineering by: Surveying by: SCALE i DRAWN I, Darren M-M r, R.S., CSE, hereby certify that I am current) approved b MADEP MEYER&SONS,INC. HaoDu S'arve DMM eye y y pp y pursuant to 3t0 CMR 15.017 +�� .r N.T.S. to conduct soil evaluations and that the above onalysieihas been performed b :me consistent with the PO BOX98f (508) 419-1086 p y requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. F�4STSAIVDw/CH,MA02537 DATE CHECKED SHEET N0. 11 508-W2�2922 09/09/13 DMM 2 of 2