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0527 SCUDDER AVENUE - Health
527 Scudder Avenue Hyannis P A = 287 018 4 V tl y 1 Yi( 1 0 O I� ~ TOWN OF BARNSTABLE LOCATION �� � � SEWAGE# 07` : /VILLAGE A ASSESSOR'S MAP&PARCEL ` INSTALLERS NAME&PHONE NO. �� � r�r-G✓\V_ SEPTIC TANK CAPACITY LEACHING FACILITY: (type)„I i (size) NO.OF BEDROOMS A -OWNER - � L s PERMIT DATE: 61,A C-710 77 COMPLIANCE DATE: �. Separation Distance Between the: / Maximum Adjusted.Q o ndwater Table to the Bottom of Leaching Facility Feet 7` Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) I Feet Edge of Wetland and Leaching Facility(If any_wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY —�) d � ?t'°' /la •;`. .No. © Fee A�61L_,�Z THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye Application for Mioposar 6petem Congtructiott Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System-CJ Individual Components Location Address or Lot No. Se[ 7 S L v d U tf 6r%j C_ Ownef's Name,Address,and Tel.No. lA-/ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Scv �\ M 19"_-A_ SZ)£f acN 00611 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r ` Signe s1. Date ! l Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued \/ o. d , Fee O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION -SOWN OF BARNSTABLE, MASSACHUSETTS Ye I Z[pplication for �Oi5posaY *pgtem Con0tructiou 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete SystevieE?Individual Components Location Address or Lot No. So[ S ff Own s Name,Address;and Tel.No. Assessor's Map/Parcel ti Installer's Name,Address,and Tel.No. Designer's Name,Address 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date a Title i Size of Septic Tank Type of S.A.S. Description of Soil i 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 ofrfTitle 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed',N Date Application Approved by � Nja Date Application Disapproved by: Date i for the following reasons 44 Permit No. '' Date Issued V THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS / 0 L' Certificate of Comphattce D� THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by �� at U has been constructe in acc rdance with the provisions of Title 5 and the for Disposal System Constr ction Permit No. dated Installer CCU Designer 9 #bedrooms Approved design flow gpd The issuance of this permit shall not be 'onstrue as a uarantee that the system w' n as deli ned.(/ Q Date InspectorV J ———— - ------_ -------------.-- v _ — ----��v�l ...r No. � Fee 7T TeMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwtgo$al *pgtem Con5tructton Permit Permission is hereby granted to Construct ( ) Repair ( V/ Upgrade ( ) Abandon ( ) System located at S7 a and as described in the above Application for Disposal Sysiein Construction Permit.The applicant recognizes.his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction ust be c mpleted within three years of the date of this Date (,O Approved by iN OF A qs,., + irr lr �C �G xr Tr M MICHELE „r CUDILO - 0 N0.34774 to rr ry v t STRUCTURAL- f —.__--__—•��_._ -T- --- — �— I A F� ? ---- -- -- = j✓ I SGISICE � 'I_� __—.-:=;�•� .-----1'-�"r ._i. •�1' 1. I IONA 1 Ili I t Typ•.NEWBIGFOOTFrG& I W117a..PIER W1 M r� n (NEW DECK ABOVE) 4 q I etu7r.ed xr �ureWL irr . ice •1. I __—_—� Lid 9=.GRADE HT.; l FDN.WALL-FM t 1 +" -- tll ASSUMED ® I EIST% .GRACE HT tl, Il i l o z a FM WALI4-FTG.t I H EMT.BASEMENT i Q Am :I t•., 5 ' m I i CII -G ti SON '6 a' (NEW THREE j I ROOM ABO I I 5 � will i - pi i ili , i I II q O 1 q i i o" 1 II I; :ZYP 14E�X3W X13Wi f I . - lIl S�It CONE.FrGs.a 3{ O-F.S ,yam• ,I j'.� � • � � `�I $�1j} 0.LALLYCOL'S. �. t ---- o =- •mac ---- ti il, ��Dsrnv* 1 j — — _ ,Wf.FULL HT. �; �+4 [i1 (NEW DE K ABOVE}• 'I IC g I ' i I FFrrG.wa4�SUMEo 111I' sll4 t I - 1 (tliEw MUD i — ` RQOM ABO --- - --—---~ EXIST.FIRST FLOOR ABOVE)r W P j 1• I - I N Ft uLb _NE.VB1Gk0TFrft*Q i t „ Ntv P wlt W,I_• VERr.CF q zv piiilr xP wuM1 !, , 4 (NEWENTRX, I I I ABOVE) ~ ar sr I w I TV si aw. !r yr FOUNDATION PLAN FT- 1p �toE.b�sTftrLt>v 1 � tom- / or�5. ._ - _ - MICHELE CUDILO, �•�. - m -`'�` 1 `- Consulting Structural Engineer I - 123 Cottonwood Lone. Centerville, Massachusetts 026J2 i tl _Drawn By: MC Date: o l� D r aWin g tale: AS NOTED Rev. p Fie Nome: S SK- Project No.: i N OF MA " �� M1�HELE cyG`rm �l u At.CUt)IL fRAa ' o p N0.34774 U RUCTUA TR - - - - .T• 5.,:�j,3'"ids�0} R \ 1H I• �1 i r �t4 t T. P. 2X Oa 19' A C. P I I M - _ - , • I F T. X1 :I• ! r v. Te L TA - 1HH' r ice ' '4. e'�� -�r.. �" -I •ter .r° ra.c4ixto I II P.T. 2X10 ,! 11 IRt?'temLJOMT�t a GN6 OyETO fltnEUtaN ,ag ES � RED lu"',Fi$A9n REPLACE OMED 152 � M NC.S I I I ... y: , 1ez. wtaH crvrts IG� >: .e I I I. - pwplqt WsrtKtv� ,: •, onWrc ;•• r _r 17 . . �. e I aw• ar ry FIRST FLOO -R ERAMIGNG PLAN N � grtM IN(� �� L4 SCALE•1/4H=''1t-0a � 4M6E1t- oV2- SM�.I� ©��fov��R f°tak� G I f`liid t �V# - \tjl Z�vyw4D67 n r"H to ':. IVIIC$ELE CUDILOi C , P. 'eer . onsultin str Centerville, 1Aessochuselts 02532 173 Cottonwood Lane. Centery Drown By: MC Dare: o f i to D r awin g $C i:1 pD6_. ' Scale: AS NOTED Rev. 0 s 11:�r 'LEI - Ile Nome: Project No.: Y DECK SHOWER ON - -- } ro." ra LV' - gU�4Roor'l7• WALL- 6 1 KITCHEN W.W LAl1NDFiY 1 LAV. Tlr ll l O TNREE SEASON Ii00M G b r A I woummum 1 I � �tsr,��fl D(�• � „ � G� tab STl,Ir A I v�l nJ� ilk -• �O!r #W' . �`` 4- b x ��'- -fl _ �` rwllrr ^� wart rayH 4a+rr �,►7 • wort I Iwd Fbttldi.� NEW DECK WI BALCONY ABOVE t 1 . h i..,.... ..a,::., AWING 1 ---- — i• ------------ PLAY AREA C 1 I 1 � 2 y i 1 DEN 1 A'1-- AREAy' I 1 M ry 1 0 FOYER -- -- 1 MOM OF A/gs iou Q r•1 w 'ri r•lew_ -- plgV ra x r• • �� MICHELE tiN . „v rz CUDILO zn No.34774 c STRUCTURAL FIRST FLOOR P( AN S1aNAL , l c o�S. rtv=- MICHELE CUDILO, P 1 Consulting Structural Engineer Engineer 123 Cottonwood Lana, Cantarvlllc, Mossachusatts 02632 Drawn By: MC Date: , tl Drawing _l27 ,.SCVDD Rev. o jT l5 FOK-.T.� ' I� - Scale: AS NOTED SK ,� Y Fle Noma: Project No.: r f ,N OF Adq MICHELE Lum CUDILO 0 rl�R c� Stk4rt{4rk� o No.34774 U I TRUCTURAL o j MABT`.FI BED ROOM (VAU�,7ED CaLNG) Ee� BATH i ---- - ODS10NAL i °O Y 3�� �� M§�• � _- :DECK.__`.." BATH BED ROOM UPPE6,1 W. wx....:.:. BEDROOM -- .. - •.- BED ROOM r - lL T - i.. _ -L.�. '- ---.'._: ROOFS_._.•. .�..... _T-i'_.—:. .. ..r-. �- .. _T - I r.. �" jam• 8.,. SECOND FLOOR PI AN 2 m'R- -sue To stOOPFU& 5�r Z-l(o d�� �s FIST' 1�bN •• ' ' �•� SST. s 4 � 15. - h I`� 1Px D JsT COW _ G)2j> t; oop_ W1hL,L5 �>✓fl�-�f ro f moo Nanl Sfiy b Cor��•1,. to Is`c Ili CtaG �,Vet. TO' Z—zx a 1p7=c7Zo5.:__: v- +�zL MICHELE CUDILO, P.E. Consulting Structural Ehaineer i 123 Cottonwood Lane, Centerville. Massachusetts 02632 _ Drawn By: MC Date: O %8 % t{ Drawing Scale: AS NOTED Rev. 0 File Name: Project No.: I �N OF!AAs m �1�1u 02� MICHELE 9G�m CUDILO 1 No,34774 gDr,66-FiT, STRUCTURAL R� �,aU,vFRurnE k AL-- 6 . WNI/iLLfG-F1f P£IYW ALL- s• Fcl�Il? F1fYRD i susnNO ROOF Ct SQL-2,2 y:I4 �, scReaaPORCH 1 i OHM. 1 � .REMovEo �' I PATCH ROOF I TO MATCH EXIST:.. I � „�uwsrwmaew i oasnee ROOF I Tq�OR°0°WlITO AIICM '. I pffif.peG!- �, nAf°gAT/16Af 1 I s AmFR�. I i 1M1fE ate! 1 1 C.6 Opel •• Q 1 I I � 'IYPCAL• • I � I - W101Y1l6RT WB.V EXISTING ROOF' I d. anaw�deswresr I , - TIP". - , 1 � Q� lgl�l°LRM9W/E16SIMtl i DOSTINe RadF {! ,a I NEW ROOF ' 1 NEW R , d �- I '-----_-------- ------ -- . ' E XSfV48 ROOF I I - I O I f � 1 .NEWT ------------ re \(Y,iLI°EfALWlO�i1N° ' WTOIALL!°Nif0116�W16t . .. a�1 OEfY/WE1cRl.17 ROOF FRAMING:PLAN <) 1M3,ziz�o�/� o/�-�f�b ©��� Au- P�D�. r �r� f C k ZNg r-L, MICHELE CUDILO, P-E. Consultinq Structural Engineer LZ3 Cottonwood Lane, Centerville, Massachusetts 02632 Drawn B : MC Date: e% y o ��� �� Drawing Scale: AS NOTED Rev. p File Noma: Project No.: i i I irp _ ¢o . �- � N Ia I N • FILE �/ �" o-�¢ ' GRvSb1ED stark ((s�MP�LT�.� �:: kLI:.S M��•( � -f�c.R-�!cy�� 2�- : �tPP�R-z"�_. Pt as r�1c� j —.f�l. ►�ATI�t��-'f j. LES 1C4{ T jz)eQJk� 6geo'Ftl ?T 1 UT 5 TD S (Tl bow cou.ps'e-- Cs) VzfL H-e r- Uvt I SAiO - ASH OF SASS, O MICHELIE tia 0 CUDILO No-34774 v, STRUCTURAL • �c:srE�°� RETAINING WALL(S) @ -WALKOUT BASEMENT l GENERAL NOTES AND MATERIAL SPECIFICATIONSu 1. For site location and grading information, see the "Site Plan", design by others. 2. Provide sufficient temporary bracing and shoring to permit the safe installation and completion of all work without damage to property, house on abutting lots, and without jeopardizing the safety of any person(s). 3. SEGMENTAL PARAMETERS SHOWN. FOR TECHQ—BLOC. 4% to 7% Backslope required by manufacturer. 4. Place backFitl soft beh hof watt WITH POSITIVE PITCH USING A SWALE AS REQUIRED using. medlur! sand. MoDrc ?7orC5. -..- MICHELE CUDILO, 1P.E. I Consulting Structural _Engineer 123 COttonwood Lane, Centerville, Massachusetts 02632 i _ Z'j SCL/DD L r Drawn By: MC Date: / / it Drawing �-j Y l 5 �D 6LT 1" care: AS NOTED Rev. 0 _ S K Ile Name:DCLeSH Project No.: i a Uul I b:I ASNtL;I RAI IU USED WI I-H CONTINUOUS WOOD STRUCTURAL PANEL SHEATHING_ i >UTSIDE ELEVATION SIDE ELEVATION 1 - --- —= Extent of header (two braced wall segments) -Extent of header(one braced wall segment) •� =a ' T Min. 1,000 lb Pony E- Braced wall segment '" s-01" '�i s=` _y,s .a ••, tension sirs I wall 1. - >'' � Table R6.02.10.4 'l'•" "F"`: '� M per IRC " :.-. Strap shall be gh ei t t3. centered at JIZ bottom of F.u � header. '. ,.r=:w .\. Lw,�.4�::5"•/.'. •., '�%.'�N4:gf1�C��%', "c�l`�'y��.`•::J1. r :'.:' �• 2'to 18 (finished opening width �� a `' `' ?1 16d sinker uK;.E'•� Y;�I..•11 r.J. nails (0.148" sheathing to header with 8.d common i � ';;t;. I l Fasten she ' �•���-r4' i 1. ''i'=' x 3-1/4 ) in I `nails 0.131 x 2-1/2) in 3 grid Pattern as shownir_4aj;,' l rows l I, kEiaiky,."`sj$ �::.: .d;;c•—�;c::.9.4: " •1:;.s;; 1, and Y o:c:in ail framing (studs and sills)typ. ,gin ;,.,,,,,,�;1yy "� I,;.,:;.;. 1•'1; @ 3 o,c. Header shall be.fastened to the king stud 1 1, Wood StrUC- it a^.�: with b-16d sinker nails(0.148 x 3-1/4) tural panel. '•::. -1 - Minimum 1,0.00 lb strap shall be 'y :�. 1,. '• :::;:,� must be 10:' 41,.. ,,, 1 centered at botfiom of header and installedFI= f.e,5 continuous -�� - Max. on backside as shown on side elevation' from top of height 4ia�:•ax. a� �, '�'r wall to bottom I For a panel splice (if needed), Y �k `: of wall' or 4-it? pane edges shall be blocked and ~w` 1 �$ tly �; ., r _r,;� from top of • ���'<�• ��- occur within middle 24" of wall height •,:�, ;I•.;3,>x• ,,;, � , wall to �`"'"-•"'( permitted Wood structural panel strength axis F. ` 1!'•r:=$: =''i I J:•:�' :1.: •1 '�'Ir:14.ti1i•'�i•:F l•e . •I•,°. ,• „�•j� �;,� ,, + splice area ,.�J;_,��f� Min._number of studs shown�-_—___ __ ,,�.. .��� ___^rid _ __.^._ ., ------'- .'}�YE�;'.jr;Kai....;:, '�t'1'�:. I'I ��: -F.Y•'+:....: °i�aYb:.::i 'I•F 'h�i 7/1 6" min. Min. length based on 6:1 aspect ratio. `.� p� l:•'> ` '� thickness For example:16" min. for 8' height. wood ...... =,: 't �' structural ;' ". rL7 ".. panel sheathing �-Anchor bolt per IRC Table R403.1.6 typ. — No. of jack studs per -• Min. 2"x2"x3/16" plate washer IRC Table R502.5(1&2) ee Table 1 Not to scale OVER CONCRETE OR MASONRY BLOCK FOUNDATION • 1 -P�M: Form No. J740■ C 2008 APA-The Engineered Wood Association ■www.a MICHELE CUDILO, P.E. ,ODi�I- 1�1 :5 T6LpL�rIC� Consulting Structural Engineer 123 Cottonwood Lane, Centerville. Massachusetts 02632 52.-7 _5e4t>j>evz, Ar�, Drawn By: MC Date: / % Drawing cale: AS NOTED Rev. 0 S K'- i File- Name: p Project N0., I Full Height Studs. Full height studs shall meet the same requirements as exterior wall studs Double Top Plate selected in Table 5 (See age 12).The C S 2- minimum number o It height studs at P�lat�e uplt�Strap ¢I o jc each e of the header shall not be less Refer olable 7 or than half the number of studs replaced � 14 or 15} by the opening,in accordance with Tabl 9. Full height studs shall be permitted to Double Header I replace an equivalent number of jack ice(P�Sg r� G S'L2 studs,when adequate gravity connections' Full Jack Stud Header Uplift Strop are provided. ' HeightStud Refer to Table 9 Window Sill Plate Window Sill Plates.Maximum spans Jl window sill plates used in exterior walls slial] not exceed the spans tra given in Table 9. oundato� 103-A u• Connections around Wall Openings. Header and/or Girder to Stud � Connections. Headers and/or girder to o stud connections shall be in accordance i �� with the requirements-'given in Table 9, 1 Bottom Plate Window sill plate to-stud connections shall be in accordance with the l requirements given in Table 9.. 1 _ Top and Bottom Plate to Full Height CRkgy�reS ds and Headers Around Wall Openings_ 'Studs. Each full height stud shall (�S O� be connected in accordance with the ' /� �'L S�(�A P f es��� Pr���-V (��,� , sv�►uE,-JT requirements given in Table'9. } �'� Table 9. Wall Openings-Headers in wddbjaring Wails RIF Header Span (ft.) Ju heir.of Uplift (lb.) Lateral (lb.) ;;•w ^,; 4 r<=.� ull-lie ht Studs 2 2-2x4 _•J' 1. I 277-- -- 132 3 2-2x,4 416 198 i —_ 2..,2x4 - -- . __�',2_ 554 264 5 2-2x4 3•• ; 693 330 6 2-2x6 -- --: 3:=— 831 --- --- ------_396 62 7 2-.2x8: — -3 i 970--—-- ---4 ---- 8 2-2x12 3 —; 1,108 528 9 3-2x10 3 1,247 594 ; 10 3-2x12 _ 4 _ 1,385 660 11 4-2x10 4 ^- 1,524 - 726 i Y CO . AL�kI—OF—M7o►SSACHUSETTS Title 5 Official Inspection Form '0 Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Property Information: MAP 287- PARC 018 I 527 SCUDDER AVENUE — HYANNIS PORT, MA 02647 Property Address QUINN, JAMES P. Owner's Name 527 SCUDDER AVENUE Owner's Address -; HYANNIS PORT MA 02647 City/Town State Zip Code JUNE 21, 2007 _. DateMIX ,... 2. Inspector: i JAMES D. SEARS Name of Inspector r a A & B CANCO Company Name 350 MAIN STREET Company Address WEST YARMOUTH MA 02673 Cityrrown State Zip Code 508-775-2800 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Fails ds Further Evaluation by the ocal Approving Authority - & ector'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 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 COMMONWEALTH OF MASSACHUSETTS v Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. Certification (cont.) 527 SCUDDER AVENUE Owner's Address HYANNIS PORT MA 02647 CitylTown State Zip Code QUINN, JAMES P. Owners Name JUNE 21, 2007 Date of inspection Inspection Summary: Check A, B, C, D or E/always complete all of Section D A) System Passes: N/A ® 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. Answer yes, no or not determined(Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ® The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of compliance indicating that the tank is less than 20 years old is available. ND Explain: REMOVAL OF GARBAGE DISPOSAL. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 l I COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 527 SCUDDER AVENUE Owner's Address HYANNIS PORT MA 02647 Cityrrown State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection 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 ❑ obstruction is removed �✓ distribution box replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: N/A 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 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 527 SCUDDER AVENUE Owner's Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection C) Further evaluation is required by the Board of Health (cont.): N/A 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.Other: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 527 SCUDDER AVENUE Owner's Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection D) System Failure Criteria Applicable to All Systems: N/A You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓� Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow ✓� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ✓� Any portion of the SAS, cesspool or privy is below high ground surface water elevation. N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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.] YES No ®✓ The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. Yes No 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 527 SCUDDER AVENUE Property Address z HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection E) N/A- Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 ❑ M the system is within 400 feet of a surface drinking water supply 0 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 I I 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 an large system Y 9 Y p Y 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 i COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityrrown State. Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No Pumping information was provided by the owner,occupant, or Board of Health 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, including 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: 0 Existing information. For example, a plan at the Board of Health. 0 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)]. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 ' COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments a s Subsurface Sewage Disposal System Form D. System Information 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityrrown State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 3 Does residence have a garbage grinder? Yes ® No Is laundry on a separate sewage system?[if yes separate inspection is required] FiYes No Laundry system inspected? Yes ❑ No Seasonal use? Yes No Water meter readings, if available(last 2 years usage(gpd)): 2005—2007/110,250 GAL Sump pump? Yes 0 No Last date of occupancy: PRESENT Commercial/Industrial Flow Conditions: NIA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.) Grease trap present? Yes No Industrial waste holding tank present? Yes ❑ No Non-sanitary waste discharged to the Title 5 system? Yes No Water meter readings if available: Last date of occupancy/use: Date Other(describe): Title 5 Official Inspection Form:Subsurface Sewage Disposal Syst em Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form Not for Voluntary Assessments " Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection General Information Pumping Records: Source of Information: N/A 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) Tight tank.Attach a copy of the DEP approval. Other(describe): Approximate age of all components,date installed (if known)and source of information: AROUND 1994 Were sewage odors detected when arriving at the site? ❑ Yes Q✓ No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 COMMONWEALTH OF MASSACHUSETTS N Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityfrown State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Building Sewer(locate on site plan): ✓ Depth below grade: 18" feet Material of construction: ❑ cast iron 0 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 Septic Tank(locate on site plan): ✓ Depth below grade: 21" 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-GALLON PRE CAST Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum Thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? ASBUILT—TAPE—SLUDGE JUDGE Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 II COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection 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 & COVERS AT 21", TANK AT WORKING LEVEL INLET TEE, OUTLET BAFFLE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene other(explain) Dimensions: Scum Thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 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) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 COMMONWEALTH OF MASSACHUSETTS m r Title 5 Official Inspection Form d Not for Voluntary Assessments " Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityrrown State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Tight or Holding Tank(cont.) N/A 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 a copy of current pumping contract(required). Is copy attached?. ❑ Yes No Distribution Box(if present must be opened) (locate on site plan): ✓ Depth of liquid level above outlet invert 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"— 32" BELOW GRADE, WALLS GONE ON BOX. ONE LINE IN —TWO LINES OUT. D-BOX NEEDS TO BE REPLACED. Pump Chamber(locate on site plan): N/A Pumps in working order: Yes ❑ No Alarms in working order: Yes ❑ No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityrrown State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): ✓ If SAS not located, explain why: Type: ❑ leaching pits number: © leaching chambers number: 6 ❑ 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 SIX (6) INFILTRATORS 2"WATER. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 COMMONWEALTH OF MASSACHUSETTS 4 W Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Privy(locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 City/Town State Zip Code QUINN, JAMES P. Owner's Name JUNE 21, 2007 Date of inspection Sketch of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 fi et. Locate where public water supply enters the building. �. 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 527 SCUDDER AVENUE Property Address HYANNIS PORT MA 02647 Cityfrown State Zip Code QUINN, JAMES P. Owners Name JUNE 21, 2007 Date of inspection Site Exam: Slope Surface water . Check cellar Shallow wells Estimated depth to ground water: 13.5 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: TEST HOLE 13.5 WATER TEST HOLE 8' — 5" BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT 5' BELOW GRADE. D-k 1 r 7 — (�a/Tv-m Al Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 4,v �f THE Town of Barnstable OF tp� • , '' "o Regulatory Services * BARNVSeABM Thomas F. Geiler, Director 9� 16A � A,ED3,Ip Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER A septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving the report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a.. particular property . would be listed on the Disposal Works Construction Permit. QASEPTIC\Disclaimer Private Septic Inspections.DOC y RECEIVED MAY 3 12005 COMMONWEALTH OF MASSACHUS TT&N OF BARNSTABLE EXECUTIVE OFFICE OF ENVIRONN1 HE LTH DEFT. a DEPARTMENT OF ENVIRONMENTAL PROTECTION tiK �,M cNee 350 MAIN STREET WEST YARMOUTH,MA �CD 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 287—PARC 018 Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner's Name: SALYARDS,BRIAN Owner's Address: 4 COUNTRY LANE WINCHESTER,MA 01890 Date of Inspection MAY 17,2005 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 , CERTIFICATION STATEMENT I certify that I have personally i�ispected the sewage disposal system at this address and that the information reported below is true,accurate and corn)lete as of the time of the inspection. The inspection was performed based on my training and experience in the prcoer function and maintenance of on site sewage&,sposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CNIR 15.000). The system: Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system^w*mer shall submit the report to the appropriate regional office of the DEP. The original should be sent to the sl,,stem owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Continents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not addrf ss how the system will perform in the future►ender the same or different conditions of use. Title 5 Inspection Fonn 6/15/2000 1 9 � Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 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: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N. ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Fonm 6/15/2000 2 f Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 C. Further Evaluation is Required by the Board of Health:N/A 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 D. System Failure Criteria applicable to all systems: N/A 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 leaching is less than 6"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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(hiterim 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 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 if Were any of the system components pumped out in the previous two weeks? if 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,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 FLOW CONDITIONS RESIDENTIAL✓ Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yea or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2004—29,250 GAL/2003—6T500 GAL Sump pump(yes or no) NO Last date of occupancy: UNKNOWN C OMMERCIAL/INDUSTkUAL Type of establishment: Design flow(based on 310 CNIR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, soil_absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: ' 1994 Were sewage odors detected when arriving at the site(yes or no): NO i Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 16" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 31" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 27" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: TAPE&PROB Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET TEE—OUTLET BAFFLE NO SIGN OF OVER LOADING OR LEAKAGE GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): 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"—32"BELOW GRADE,ONE LINE IN—TWO LINES OUT.BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: ✓ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17,2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: �— leaching chambers,number: 6 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 SIX INFILTRATORS,DRY.LEACHING IS Y BELOW GRADE. NO SIGN OF OVER LOADING. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: _ Indication of groundwater inflow(yes or no):- Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 026=46 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17.2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. pV NT 4 `I• - - Title Inspection Form 6/1 /2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 SCUDDER AVENUE HYANNISPORT,MA 02646 Owner: SALYARDS,BRIAN Date of Inspection: MAY 17, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 13:5 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet SAS) Checked with local Board of Health-explain: 7 Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE 13'—5" WATER. TEST HOLE 8'—5" BELOW LEACHING. BOTTOM OF LEACHING AT 5'. U_ Titles Inspection Form 6/1 5 12 000 I 1 I . TOWN OF BARNSTABLE 49 LOCATION + -- C' > � SEWAGE# VILLAGE / ✓'� ASSESSOR'S MAP&LOTS+�� jNSP T,.rS ER'S NAME&PHONE NO.../7f- SEPTIC TANK CAPACITY LEACHING FACILITY:(type)'.. (size) NO.OF BEDROOMS , BUILDER OR OWNER T PERMIT-DATE: G9MPkiANCEDATE: .�`' / L'J Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 /5' 10Jr V i g 1 { V i�fl� TOWN OF BARNSTABLE r_OCAno"N r�S' �LJe V vQ-SEWAGE # VILLAGE ti ASSESSOR'S MAP LOT297- 04 `INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /68 6 y 6t LEACHING FACILITY:(type) �H �y (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I A�� r 1 sJ `r� N O O ' 4 L TOWN OF BARNSTABLE L ATICN�� � SEWAGE # VILLAGE ( n/S //)�81� ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 6z PHONE NO.&I SEPTIC TANK CAPACITY �60� LEACHING FACILITY:(type) (sue) N k NO. OF BEDROOMS,��PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER�GU- DATE PERMIT ISSUED: �5r7q— - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � o r cr o � - �g 6V r- No....-1-L-p-^iL3 FEB......3-0......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinit for Diriputiul Wur1w Tomitrnrtiun Prrafit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: .. `7 ----•,..... Location-Address (orr Lot No. .............. ..... Owner Addres �►v ;cz- 0 .� `.... ... -.------------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms----........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------_--------- ----- No. of persons___-___-_______-.._--__.-_- Showers ( ) — Cafeteria ( ) A4 Other fixtujUs .............................. W Design Flow..........' .__.__._..K-_-_.-._----_-_gallons per person per day. Total daily flow....:j171`P_<�........................gallons. 04 Septic Tank-L Liqui?- f! y1 _:gallons L Length---1�7-__-____ Width--------- Diameter..:............. Depth................ Disposal Trench--No ..... Total Length---.��, 0......... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date..--------------.....---................ Test Pit No. I................minutes per inch Depth of Test Pit...-................ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ••--••----••--------....•-•----•...............................•---•-••---•--•-...........------...........------................•---•------------.._...----- ODescription of Soil..............................................................................------------------------------------....-•-•--•------------------•--•••......--------•-•- x V ---------------------------•-----------------------••--------------------------------..........-------------------------•-------••------•------------....--•-•-•-•-••--•-----•........------------------ W ......-•---•------------------------------------------------------------------------------------------------------------•-------....... .....................---•--.I--..... x or Alteratiow Answer when applicable.— �Q!� �-._.�._ 1 U Nature of Repairs '�? .�...... p .....0 t--s�2T...Lti+z_x_-...� . ..fhj_�. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—T�l e undersigned further agrees not to place the system in operation until a Certificate of Com 1' nee-has-b-er_m_ * d oar o Si \ C� �n�e --�- �. .. ....... ........................... . ... .......... .............. . .:.�J .. �!/.'.-.... Dare Application Approved BY (� ...� ...... `7..:Da� .?.. . f Application Disapproved for the following reasons: ....................................... . ..............................................-- ............................... ................ ................................................ .. ..... ........................... . .................................. ..... . -- ...................... ........................................ -�... Dare PermitNo. - .... ................ - Issued ..-- -........................................................... Dare -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t TOWN OF BARNSTABLE Cfer#tftrate of Cnomplianre G THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by �.-V--Z(�/�r .. +->-..../. { k..` Im�r..-------............................................................................................................... l at ..................................... . ........... )Q .. .. .............. .. .......... ........... ..... has been installed in accordance with the provisions of TITLE 5 ofj e State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ./-.._i'yL� �----- dated _....._.................................._. .THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. c �' DATE ...._._.. M.... n.7--G1` .., .:'._ ram'. . Inspecto 4 , _... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. I....1------I 1_?, FEE..�`2 Permission is hereby granted = ' _- - ------ ....... -------- � -.......`7.............................. to Construct ( ) or Repair ( an Individual Sewe Disposal System at No. 5� -���> = .....'.GI !<<C `� �lc. ..."-------------------------------- �... L_� Street \ as shown on the application for Disposal Works Construction Permit No.. -th-1 Dated..----- 7 c�........___ Board of Health DATE---------- = �1, -� 9- - ----------------------------•----•-• FORM 36508 HOBBS&WARREN.INC..PUBLISHERS ..r-,__,:-w,w...`.r._ ,-�iy...,w..w....�._,,,,. _... .a...,�:...a.•...G�.H„r�1,�+........-'....�y��. ,.mj... ......,,b.,t^r.i. «..;ros+M.w � ,., y yt�;.:�.._. ...R....,•�F ,.._. ._ VS F:cs.... it?......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripw3al Hfurbi Tontitrur#iun 11antit Application is hereby made for a Permit to Construct ( ) or Repair ` ,.� an Individual Sewage Disposal System at: ...�� `7 �.... ................................. ---------------------•...--------------...--- Location-Address or Lot No. ............. .... �r�au��jy�c��cSC �' '`r-` _...... -----•-•-••-------... ..! --- •-••--------•.................................... r---- Owner Add Installer Address UType of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms._. ____________________________._._E�pansion Attic ( ) Garbage Grinder a Other-Type of Building _------------------------- No. of persons-------- .------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow...........5—-?�_________________gallons per person per day. Total daily flow._. ? ........................gallons. R; Septic Tank-,-Liquin�pdci4v j_Q'Ye..gallons Length---li� ....... Width --------- Diameter................ Depth................ . .. W Dis osal Trench--No Tw�t�-\ Width..... . x per. _ .t.________._ Total Length... ......... Total leaching area....................sq. ft. 3 Seepage Pit No..................... iiameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit------------------... Depth to ground water........................ ODescription of Soil........................................................................................................................................................................ x w ..- UNature of Repairs or Alterations AnsNver when applic`able._.'f/1 `..... Agreement. ✓-J' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—T�e undersigned furtl�Ier agrees not to place the system in operation until a Certificate of Complia ce—la�as-been-iss,u d[%L'` ar ea th. r/ Si ned ......_--���.................................. _........ ............... .---777 .. Date p, Application Approved BY .. .... .... _ ....I...... ........ ..:� ............. . . ....... .......�..= f y. ,. . . . Application Disapproved for the following reasons: . .................... ........ .. . ...t................_........................... ....................... Date Permit No. i...........1-711-----3.. ...... Issued ----..................................................... ...,....... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f . TOWN OF BARNSTABLE (9jertifirate of Compliance THIS IS T0 CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by ....... .......... .....c, -------................-----------------------------------------------------------------.............................................. ............................................................ I Inswil', at ......s5�al...........xa—&WWC/r .................. e7. ------- -------------------------------------- ............. has been installed in accordance with the provisions of TITLE 54 Tbfe Sta onmental Code as described in - - ------- ---------------- the application for Disposal Works Construction Permit No. ---- ------- dated .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CgNST21EIS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACj-9RY. --e DATE-----.............. -------............ lnspecto��- ...................... `'tti pc,-�r o r NO.... .... R V Fizz ........... rns eConservatl Depart a HE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH igned pate OWN OF BARNSTABLE Appliratinn for Diripwial Works Tnnitrnrtiun amit Application is hereby made for a Permit to Construct ( ) or Repair ( 6-roan Individual Sewage Disposal System at ....Sd'�......-•..._. .alcl e......_- 1 =- l --------------------- ---- ------------. ..---•--------•-------- . p ♦ Lca�tion-,:,/,/dress � y/�� y� � p�+i I,ot IQ�p�[��/ J/'��•�ry .... .!_./� ...._..... .ftS- ....................................... .!• ..... i.------..®.P..------/...fib---»!_.L2.......:.' .... Oa ncr Address Installer Address vType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms...................-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------• No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P.t Other fixtures -------------- -------------------------------------------------------•--•---•. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter_............. Depth................ x Disposal Trench--No. .................... Width-------------------- -Total Length.................... Total leaching area....................Sq. ft. Seepage Pit No..................... Diameter..........---------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( . ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -----------------------------------•----------------....................................................................................................... 0 Description of Soil........................................................................................................................................................................ W V ...............•----------------------•--•---•----....•----------------.....•--•---------------•••--------•----•-••-----------•--------••-------•--•---•-•-•--------------.............--............... W x - ---------------------------------------------• U Nature of Repairs or Alterations—Answer when applicable._ .-:.+5` A.Ll.._--2.......XN.P1��_7�(q�)Cs...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issue by the b t•d of health. q C Signed .......... ........ ----.-...-- -- .....- ....... �.. ...L..' -�. Dace ApplicationApproved By ...... . ... .... ... .. . .. .......... �...... _- -- -- ---------------- - ----------.-.-...-................ ...-...........-.................-.-.... Dare Application Disapproved for the following reaso . ...................__..... ...............................................Q-4 ... ............�. ..... --'-----.....................----------..................--._...................................----. ...............-Darer-............... ..Permit No. .... .....I................ ..... ........... ..... ...... Issued -......................... ....................................... Dare THE COMMONWEALTH OF MASSACHUSETTS ~� BOARD OF HEALTH , TOWN OF BARN STABLE � CITertifirate of Complianre THIS IS_TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L--- S.� y . .. at ------- .?... ....1.............'ra-a'-446 1-----At/`e,...... ,,�•9. 7n.�I`...... - �.r.. .................. has been installed in accordance with the provisions of TITLE 5/of lie State En onmental Code as described in the application for Disposal Works Construction Permit No. .._. ..-.:. ....... dated ................................ HALL NOT BE CONSTRUED A THE ISSUANCE OF THIS CERTIFICATE S S A GUARANTEE THAT THE, SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... -...�"r' `� ._ ............. - Inspector ------------ -- ..... ........ ............ -------------------------------------------------------------— -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " � V1 TOWN OF BARNSTABLE FEE........................ r Permissionis hereby granted-------------- ---------------------------------------------------------------------------......................... to Construct or Repair (-,.-ran Individual Sewage Disposal System f � ) P� � P at No. = 7 �cu !' "l ei; �. �/ . . r I ---•-----•-•-•---- (. as shown on the application for Disposal Works Construction Per�mrt�No,-j.�--....Dated---_�.?......-...... ... e Board of H,ealt� DATE............... f ;_.................•------------_----• FORM 36508 HOBBS&WARREN,INC..PUBLISHERS t,. yµ 6:3 .e'I.f ��---•.a'-.- -�F-.e.+..+.L�...+�.w-•w.,._....."�e; S,�w' ....v.. ,..,�... n.--4�-..... 2 s,...,_..r.^.,.;.s.:+.-g."'-' ..-..-rw........ i No.. - ------ Fss. �._............... THE COMMONWEALTH OF MASSACHUSETTS -7 , �XBOARD OF HEALTH / ' TOWN OF BARNSTABLE Apphration fnr Mi5p ml Works Tontitrurtion Ifermit Application is hereby made for a Permit to Construct ( ) or Repair ( �n Individual Sewage Disposal System at, ° ------ omlion-Address Lot No. n R f a vl S1R low 1`dS 0.--- - 7Gi _..... �A���� o,�-ncr Address a ............... of.:..... ..- ---------------- ------------------------------------- ------------------------------•--- ---•-----------•-••-----..........--------- Instalter Address d Type Building f Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.............................. .. Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of ersons..............--.....--.--.. Showers — a —Type g p ( ) Cafeteria ( ) d Other fixtures .... ----------------------- W Design Flow............................................gallons per person per day. Total daily flow................................._..........gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width....------------ Diameter......--........ Depth................ x Disposal Trench-- No. .................... Width.......------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-----............... Depth below inlet..--................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..................................................................... ---- Date........................................ 0-a Test Pit No. I................minutes per inch Depth of Test Pit-------------------. Depth to ground water........---............. fs Test Pit No. 2................minutes per inch Depth of Test Pit--............--.... Depth to ground water........................ .94 --------------------------------- -•----....•------•--------------•••--------•------.......-•-------..................................................... 0 Description of Soil.......................................................................................................................................................................... V W x •--•------•------------------------------•-•------------ ---------------------------------•------------------- •---•--- ----.......................................... U p •-at ions ----Answer ..�i_�.-.... l�� - � v�� � ��vfi,.�.�1i� �.�:..........! ................i ...----"�'-'-�� ns—Anse�r when applicable--------�---'Q .............................................................. Nature of Repairs or Alterations i" Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b and of health. 0 Signed .............. .......:...:.....�• :.--...... 1. . v tDate Application Approved BY ,.,....:�1�1/�i :..- .. � / 4 1 Y.. ._....r........................................................... Date Application Disapproved for the following reasonsf ........ ................................................................................... ........................ �1......1. - n ...................................... ... ................ ......... . ...--.. . ............._......................... v7Permit No. ....r ... e��../..................... Issued ...................................................... �fe...... Dare r TOWN OF BARNSTABLE LOCATION -��°� S_C!J a /� AL-1£ SEWAGE# ;%4LLAGE l y /�o/P T ASSESSOR'S MAP&PARCEL 01 � /tiSP£c �/ NAME&PHONE NO. d ' �✓ C O SEPTIC TANK.CAPACITY /y j c. LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER Q, v l A✓IV PERMIT DATE: DATE: _d 0 Separation Distance Between the: fi 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 FliRNISHED BY O�- �° 1 rr �\ � ,, ++ W i l TOWN OF BARNSTABLE tt LOCATION �� C ��rte /4 SEWAGE# l!VILL� AGE /e /,r7- ASSESSOR'S MAP&LOT /NSf'g 2i&I_.a,E 'S NAME&PHONE NO. ���, SEPTIC TANK CAPACITY �'E� / 1 C— LEACHING FACILITY.(type)!. (size) NO.OF BEDROOMS BUILDER OR OWNER �� ��� Jr PERMIT DATE: GOAdCE DATE: J`�' /9 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 w V V -5 o E 0S� o� . . . THE COMMONWEALTH OF MASSACHUSETTS ;KM I �BOARD OF HEALTH —� "�` TQWN OF BARNSTABLE Appliration for Diopwial lUndr, Towitrurtiort Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (-'5—an Individual Sewage Disposal SK�tesnt at*�d&&2_ 11 AL e �Z. • '�__..-•--------------•. ........•--- ••-•-••--....V...--._......------•---- ------•------------------•-----•-•----•----- ----------••-------------------•-•--•--.... ion-Address or Lot No. / - -- �-) ----------------------------------- Address lJ CI Y�� !/ •-•------ Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms......... --------------------- -----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-------------------.-.-.---. Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------------------------------------- -•---•---•---•-••-------•-•-•-•-••••......•-•---....--------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gal Ions. WSeptic Tank—Liquid capacitvi gallons Length...`-------- Width.....L.t...... Diameter..-------------- Depth................ x Disposal Trench—No. .................... Vidth.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No.---.---_---_-.--. Diameter.................... Depth below inlet.---.....--......... Total leaching area..................sq. ft. Z Other Distribution box (/T Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit..........----.-..__ Depth to ground water.---.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ---•---------••------------------------------------------•••••••--------......•-•-••---......_•-•-•-......................................................... ODescription of Soil........................................................................................................... ............................................................ x U ---••--•••-•••---------•----------------•--••-•-•-•----•---•---••-••-••••••---••••..........•••---------•-••-......•----------...--------•--------------•----•-•••-•-••-•••......-•-•------••......••... W ----------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Rep i or t rations—Ans e� w e a plicable./�7.r ----/000 �� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm ntal Code—The undersigned further agrees not to place the system in operation until a Certificate of Cc lia has b sued th rd o Signed ......a ._.. '' t. ��� ..... ................................. .......................................... ................Date.................. ApplicationApproved By ........... ........... .................................. ............................................................. ---------------------------------------- Dam Application Disapproved for the following reasons- ---------------------------------------------------------------=----------------------------------------------------------------------- ....... ................................................ ..............-------- ------------------ ------------------------------- Permit No. ....... .....V..-.....J 1� Issued ..... .. ................................... . to Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirak of Compliance THIS IS TO CERTIFY, That�h l l ivi al Sewa - Disposa4 System co stru ( ) or Repaired C CJL ?crr l4 A-� / � `• 1 �.. ------ ---------- - -.... . - - - - bh � Si �!� � L �Gc���� at -----------------------------------------------------.....- .... - --------------------------------------------------- --------------------- ----------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .----- .. ......../.-1-5 -------- dated .._......----------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL'FUNCTI.ON SATISFACTORY:-A DATE... .. �..^. �-------- --` Inspector -----.�---------------- ------ ---------------------- -------------------------- --------------------------- ------ -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... �.�1 FEE. ... .. Disposal ��� rks %onstrudion Vrrmif Permission is hereby granted..................../lOt�Pft /`7%u �l���/, - -------- -` ------------- ----• to Construct ( ) or Repair an Individual Sewage Disposal Sy tem atNo......................................................... 7 �.. �C=C .... {-t"--------- � Street as shown on the application for Disposal Works Construction Permit No.-_!-����-�__ 3_ Board of Health c DATE........ ------------..... ... 1...... �. FORM 36508 HOBBS&WARREN;INC..PUBLISHERS No.. .../(5` Fiz$.....-. ..�2....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w TOWN OF BARNSTABLE AVVIiratiun for M#i-Vi1iitt1 Works Tunutrnr#inn rrrmit Application is hereby made for a Permit to Constructs ( ) or Repair (--San Individual Sewage Disposal Stem ��at: /„IC�-� .�CC .. •................... .------•---...-----------•• -•---•----•----••-----.......••••.....---- ,e�i�./,/� Q� oc ion-Address or Lot No. ...................... »....................................................... ...._._........................ Owner Addres Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._._..__.____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________• No. of persons...----__--__-__-------.---- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow--------------------------------------------gallons per person�Vr day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacitv� gallons Length_._.E.___.____ Width----q....... Diameter-..------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No.................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (') Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test PitfNo. -1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a - .....---•-----•--------------••-------------•---------•-----••-••-•--•--------------••-...•------------•--------------------------------•••----..........---- 0 Description of Soil........................................................................................................................................................................ x ---- ..................... ---•-------r-�- U Nature of Re ai s or rations—Answer wh a plicable.1C �tGU __..� b©_..... �f7�� � `�.._.. .__... . .............. Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued b�theabYard of..ea�°th"�� Signed(—`C....d -.... ..........................."-.... - - - _ . Dare ApplicationApproved By ------------------------------------------------------------------------- -------------------------------------------------------------------- ---------------------------------------- Application Disapproved for the following reasons- -------------------------------------------- ------------------------------------------------------------- ------------------------ .. ............... ... ....................................... .... . ........... .................................. ........................................ Date Permit No. ....... ....y... .....1 �.JL�^^ Issued -:.:..................... ....................................... Dace ------------------------------------------------------------------