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Home My WebLink About0697 SCUDDER AVENUE - Health 697 .Scudder Ave --� -- Hyannis A= 287-062 i i I i I TOWN OF BARNSTABLE =i3OCATION�i kk-��/ SEWAGE# VILLAGE� ( «S ASSESSOR'S MAP,&PARCEL v. .. r•• INSTALLER'S NAME&PH �PHONE NO. e� � `SEPTIC TANK CAPACITY ` �2 ot-= 'y i LEACHING FACILITY:(typed) t -yZ'-� `s size)' NO.OF BEDROOMS OWNER TCi PERMIT DATE: 4 L 20 COMPLIANCE DATE: 71 (0 ,Separation Distance Between the: Maximum Adjusted;Groundwater Table to the Bottom of Leaching Facility R ":«u ''_ 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 facili ) Feet FURNISHED BY �oC3 Cl loll Th y� Z U V A. f No. D D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for MI8tl08af *pstem Construction Permit Application for a Permit to Construct('� Repair( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. C 4 � 4nn 3 l Owner's Name,Address ind Tel.No. 14 Assessor'sMap/Parcel Z97/0 2 j Installer's Name,Ad ss,and Tel.No. Desi is ame,Address,and Tpl.No. n v L� � �5 0 ;�2 ~33Y r4s L114,,J, Z„C Type of Building/ H5 E a,t 1)/ +�Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other Type of Building 9e4*F;Q( s'� /e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Y Design Flow(min.re uire ) q0 gpd Design flow provided ( ®. gpd Plan Date 2L 2�2ly Number of sheets f Revision Date Title S.`-te P4qn &VUd r&"Ai F h+S Size of Septic Tank or Type�o°f S.A.S. ?-✓� C-19.1 �/lr f'l S^t6Y� Description of Soil See. °T � ��-0(�� yr=f S44 6'!, !0—6/8 q0 g-1a2' ec G` Nature of Repairs orAlterations(Answer when applicable) l Date last inspected: Agreement: ! The und/rsigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with he provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance ha been issued by this Boargy f e lth. gn Date V U Application proved by ® Date Application Disapproved by Date for the following reasons Permit No. Date Issued --------------------- ---------------------------------------------- ..�.••y..._ .l �. � S �, r .�. .v�, ^". ,,..,:?, �iti..• a .rr ... No. Fee THE COMMONWEALTH�OF MASSACHUSETTS Entered in computer: Yes .' PUBLIC HEALTH DIVISION TOWN OF BARNS:TABLE, MASSACHUSETTS. �! _ ._. , WolirationJor Disposal-6ps r—tonic- uction .3prrmit.--=•-. =- Application fora Permit to Construct�+'^) Repair(�) Upgrade(��) Abandon( ) ®Co plete System ❑Indivi dual'Components j, Location Address or Lot No. f c x 'fir _ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel v� O Install'er.'s i,4"Address;-and cTel'?No Desi ner's Name,Address and Tel.No.-. :a 7./��+�+?h C.M r/yr,,k'f�^j t �Gl�ivf {,rif,'�F�i7� ti Type of Building:` Dwelling No.of Bedrooms:., � 6' � Lot Size �� sq.ft. Garbage Grinder( )� Other Type of Building (�C� �F r'� '�s jr No.of Persons Showors( ) Cafeteria( ) `` Other Fixtures r Design Flow(min.required) q� gpd,• Design flow provided (0 , � gpd 1 Plan Date 5/ �!'��0 �' Number of sheets ( Revision Date -6, ; Title 5. � eon Pe-vig rd° zip/)(ar{'�t- l n+ Size of Septic Tank 2 c<) (r,c,t Type of S.A.S. 7-71V 6-7 cuss .ti fr Description of Soil Sec, . "T t t -3:o-ta'A 4&/ !/U ��j-102" C ��e/¢J Sf` F li+R�y. ��"' /�l�/ r! ! rFJ 1�I.�Ss1-A✓, r Nature of Repairs or Alterations(Answer when applicable) `` � ;��• ;� _ it -Date last inspected: -- ;..- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ri w h�ccorda'nce 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 Boar fof Health. g d �.y 1> _ v / r s `.Date 60 Application Approved by / / O�,1, , / / „i ;/� ` Date t'/.� ` Application Disapproved by w W / Date for the following reasons Permit No. / v ,/ " Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired.(1" ) Upgraded( ) Abandoned( )by , at C`77" SC cdd,_I" A Le 1' �gno�; !N'� �`R/-rha)been constructed,.in accordance with the provi- ions of Title 5"and the for Disposal System Construction Permit No. �/ ', d Installer Designer ,�C,/j vc s7��^^s`.4 s't/>hf �`t'c,KCl/KAf �yC ,bedrooms Approved design flow �9U f�' ;ti 'f t �+h�e/ gpd Theissuance of this pe itit shall of be construed as a guarantee that the system will functi6n�asdeaigned. Date /'> 6/ Inspector _ - - - - =-- - ------------------- -------------------------------- No. Fee `12V�lbr� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE;MASSACHUSETTS Misposar 6psteiu Construction 3permit .Permission is hereby granted to Construct( ) Re air( ) Upgrade( ) Abandon( ) System located at [ 7 S G(�( +t,r{ /lc. ;.y rt i j f AA r` f J and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction muusAbee,c."o�mppleetted within three years of the date of this permit. "9 / �jDate //��(��/' Y//7`�_ Approved by -, ' f ' I Town- � f Barnstable P# ' De prtmtent of RegWatory Services i l�ublie Health DivisionMAM Date � // 200 Main Street,Hyanais;MA 02601 Date Scheduled- 11h IT ,-Titne, l+ee Pd. t/6 Soil Suitability As'sesgmentfor e " e l isp®sal N ;� 4 Performed-By: , Witnessed BY. - p LOCATION& GENE�INFORMATION Location Address Owner's Name Address�9J Assessor's Map/Parcel: a� F 7— v " v"� Engineer's Name- ,o/ NEW CONSTRUCTION REPAIR Telephone It - (� ✓ / / \ Land Use� Slopes(%) �S - `Surface Stoacs Distances from: Open Water Body ft Possible Wet Area �j ft Drinking Water Well ft Drainage Way ft Property,Une ft Other ft SIME'TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) \ r " Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fnce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIOH'�'ATER TABLE, Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: In, Dcptti to weeping f",,side of cb—h0lc: _ In, Groundwater Adjustment tC. Index Well# Reading Date: index Well lavoi Adj,&&tor— Adj.G--- ou,tlwater t�vn1 , Observation PERCOLATION T +'ST Date�.,.�.�.., Thne Hole# �✓) Time / ' at --^----- 9" Depth of Pere Time at G" �._ Start Pre-soak Tim _— Time(V-0) End Pre-soak ' Y Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Consei vation Division at least one(1)week prior to beginning. Q:IS EPTIC\PFRCPOR M.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell • ) Mottling (Structure,Stones;Boulders. • i ten�y,96'Gravel) 1 `= � G ELT Low /6 104 C DEEP OBSERVATION HOLE LOG hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. — - o sistency.`Yo Gravel) 10 uJ G - h 12 CT DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Congiatency,%(IMYCII - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders, Cositn f y ' Flood Insurance Rate Map: Above 500,year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No.____ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv'ous -terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of ha rally occurring pery ous materlal? 144 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 periormed by me consistent with . the required training,ex e e p ience described in 10 CMR.15.017 �J Signatur Data Q:\S.F-?T1WERCP0RM.'D0C i Town of Barnstable WE"°�.� Inspectional Services Public Health DivisionBAPIMABM CO t�Aas Thomas McKean, Director ,a 200 Main Street,Hyannis,MA 02601 �``', i C Office: 508-8624644 Fax: 508-790-6304 > Installer& Designer Certification Form Date: Sewage Permit# -- JCg&Assessor's Map\Parcel 2 Designer: Installer: e/t� Address: Address: 6! ;&AL ( laG� On �ciL Un kS W(rAwas issued a permit to install a (date (installer) septic system at 7 f c,C dV,v Ap— based on a design drawn by (address) _Fvl%ilw4 'b-eieC`h dated (designer) l I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that th system referenced above was constructed infti with the to rms of th roval letters (if applicable) ��-0w F kASsq o?� iARLES T. G j = ROWLAND o UL nstaller's Signature) '� 52E A 4 FFSSIONA!4_� (Designers Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoMdeptAHEALTMSEWER connect\SEPTIC\Designer Certification Form Rev 8.14-13.DOC down cape engineering, inc. SIEVE SOILS ANALYSIS 697 SCUDDER AVE. HYANNISPORT, MA DATE OF REPORTA 1126/12, JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 697 SCUDDER AVE. HYANNISPORT, MA LOCATION: JIM LEBOUEF TEST BOLE SIEVE ANALYSIS Weight Sample(Grams): 309.1 SIZE :WEIGHT RETAINED %RETAINED %PASSED ------------ ...........(sum�-_..._... .�.. - — .......... 1„ 0.01 0.0%1 100.0% 31,410 0.01 0.0%1 100.00A 0.0 0.0%1 100.0% .._..............._..-._._..._..w._...._..>------------------- ----------------- 3!8" 0.0: 0.0%1 _ 100.0%° 45:8 ------- 14.8%1 ......._._._..85.2% 176.1 -57 0%1 43.00 _....._........._...67 3.6% .�.:--------------_.__ 0 283.0- 91.6%- 8.4% 0 300M2.---- ----971°k_. 2.9% -------------Y....._.__..___.__.____. ____ _......_.. .. _ ... 100 302.9 98.Q°/a= 2.0% 200 306.21 _-99.1% __ 0_9% PAN: .306.61 100.0%, 0.0/o SAMPLE: € 309.11 NOTE:TEST ON PASSING#4 ONLY, 8.7%RETAINED ON#4 <45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,FINE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #60100/6-100%o OK #100 011640% OK #200 0%-511/o OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN.MATERIAL NONCOMPACTED SOIL DESCRIPTION: FINE SAND t �ddf� � PA � �- ? I 'THE Town of Barnstable .�ti Inspectional Services BARNSTA13M 9KAS& Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 } January 11, 2019 Griggs, Ellen W. TR . T. G. REALTY TRUST 1280 Washington Street, Unit 401 Boston, MA 02118-21.51 RE Abandonment of,Cesspool at 69T Scudder Avenue , Hyanrls '; LL Dear Ms. Griggs, This letter is confirmation to you that the septic system located at 697 Scudder Avenue, Hyannis, MA, passes. Septic permit 2019-003 was issued and inspected by the Public Health Division. A certificate of compliance was issued dated January 3, 2019, confirming that the single cesspool was abandoned properly. This property is now in compliance with the State Environmental.Code, Title V and our local health onsite sewage disposal_regulations. Sincerely, Thomas McKean, R.S., CHO Director of Public Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\697 Scudder Avenue MAIN HOUSE Hyannis PASS.doc No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphtation for Bisposal *pstrm Construction J)Prmit Application for Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System /ndividual Components Location Address or Lot No. VO CAAI�oGC- Owner's Name,Address,and Tel.No. kLkC A 471-A -W Assessor's Map/Parcel p y r Installer's Name,Address,and Tel.No. �l eye Cd�:b� 4 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 Title Size of Septic Tank Type of S.A.S. Description of Soil 0. X�4� Se�T N of Repairs or Alterations(Answer when applicable) .4-AN e— ';,;a•e-. �(,� Date last inspected: t^IA N a , Agreement: 'S s�c: 'l J The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in V accordance with the provisions of Title 5 of the Environmental C d not to place the system in operation until a Certificate of Compliance has been issued by this Boar of H lth. } e Date — Application Approved by Date Application Disapproved by Date for the following reasons Permit No " Date Issued No: F:„ Fee THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF. BARNSTABLE, MASSACHUSETTS Tipplicatlon for !Disposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System dividual Components Location Address or Lot No. 6c%1 SC x1�6,c - Owner's Name,Address,and Tel.No. $- Assessor'sMap/Parcel Installer's Name,Address,and Ye.No. c n 4 i;bt��e t Designer's Name,Address,and Tel.No. i 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) L&) N wt� — n �1 o o +e 4 Lvt, i t. t y �� o Date last inspected: s_1,4 q L. -t o F t— Dr_:. q i 0CA�C.� k-4I�e I F Agreement: 1; f.< 4 C �Y�J� C o. L. L / The undersigned agrees to ensure the construction and maintenance of the afore describedoh-siteksewage disposa-1 system�n 1� l accordance with the provisions of Title 5 of the Environmental Co e-and not.to place the system in operation until a Certificate of Compliance has been issued by this Board of H alth. - e Date / Application Approved by Date Application Disapproved by Date for the following reasons Permit No Date Issued', t. : \7Ti�- ff t i �> ----- --------- THE COMMONWEALTH OF MASSACHUSETTS -C C BARNSTABLE,MASSACHUSETTS Certificate of Compliance fJ i l U.- ft `U➢t� �� THIS IS TO CERTIFY, hat the On-site Sewwage Disposal system Constructed( ) 0�'µRepaire"d( ) Upgraded Abandoned( )by .1�..n� �-, Pr.c'o Jr at. a r N'o�rL. has been constricted' accordance ; with the provisions of Title 5 d-the for Disposal System Construction Perm (t dated . (�?!'l ➢ . Installer fJ!`t r�N Designer ��V #bedrooms V Approved design flow A NAA,. gpd The issuan e of this permit shall not be construed as a guarantee that the system wil flan ton' desi� Date 1n �� Inspector t ---------------------------------------------------------------------------------------------------------------------------------------- No. t Fee 1420 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 9ppstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at / f G.J EL and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must b completed within three years of the date of this permit. ----— Date ((� I Approved by Barnstable Town of Barnstable C' Inspectional Services. Public Health Division m y MARS ..........' 1 19. A 200 Main Street,Hyannis M 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4989 0403 December 13, 2018 GRIGGS, ELLEN W TR T. G. REALTY TRUST. 1280 WASHINGTON STREET,UNIT 401 BOSTON,MA 02118-2151 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located of 697 Scudder Avenue,Hyannis,.MA, GUEST HOUSE,-3 was inspected on 12/06/2018 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00). The following option are provided: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by Cb;)-replacing the septic system component with an H-20 component beneath the parking area { Cor driveway; iid properly abandoning the discovered H-10 component,.(orriin the.case of,JI leaching pit,replacing the top of the leaching pit with an H-20 slab top);otrby,' c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P -11 ER OF THE BOARD OF HEALTH ' omas McKean,R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\697 Scudder Avenue GUEST HOUSE Hyannis,doc Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary. Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address G6-9 s Owner information Owner's Name is required for H annis ort every page. _� p MA 02601 12/6/18 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 1he boxes below: ® hand-sketch in the area below ❑ drawing attached separately V a - . �. LX`'r- 9� 3 L I t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 4/27/2619 Assessing As-Built Cards 4.-7 . AX_Z /a LOCATION /J SEWAGE P RMIT NG ;sL c/ INSTALLER'S N A D ADDRESS Al B U I'L DE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED c i https://townofbamstable-us/Departments/Assessing/Property_Values/HMdisplay.asp?xnappar=28706.2&Seq=1 tl2 . i� No. �1 ! 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mispo8al *pstrm �On6 Loon vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. ( pGu� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � ✓2— �-( / l �� Installer's Name,Address,and Tel o. 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) ,m_� ' 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(Answ r when applic ble) Date last inspected: �� > 0tv 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. tgne Date K Application Approved byl ------ Date Application Disapproved b Date for the following reasons Permit No. 1 oo 3 Date Issued i "� No. ( 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS Yes application forM.is qo I *pste111 ions 1 '011 Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No:O' M�c Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address and Tel.NO. Designer's Name,Address,and Tel.No. Type of Buil ' g: jt Dwelling No.of Bedrooms.,, I Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildin No.of Persons.(_ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets t^ Revision Date u Title ; ,y Size of Septic Tank Type of S.A.S. Description of Soil p` 45 Nature of Repairs or Alterations( r when applicable) 41;411 Answ J10 Date last inspected: �� f ��,f9� ov �L 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. 'gne Date Application Approved by Date Application Disapproved b Date for the following reasons ,�•y- Permit No. 7? Date Issued /q + --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH.OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS CERTIFY,that the On-site Sewage Dis osal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( by MIA at U P has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.&9—003 dated Cl Installer Designer #bedrooms 9 Approved desigrr-flow ' gpd The issuance of this permit shall of be construed as a guarantee that the systeEwillft!incStioidej,)��e . Date I Inspector t ----------------------------------------------------------------------------.-----.-.------------------------ - ---------------------- No. 4-V 1 rt+ 003 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposar Opstem Construction Permit Permission is hereby granted Construct ) Repair( ) U grade( ) Abandon(L'� System located at tfJ7 �V�Y� ✓��. U �(1lL�L. -t✓}-ti . I �' rC t_,/_✓)ter-,� I � � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by No. Q01 "7- 317 ag7-0THE COMMONWEALTH OF MASSACHUSETTS Entered incompuw. PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS Yes 2ppfitation for Disposal*psttm Constru on jermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel o?�1^p¢� H,144,VV1 Installer's Name,Address,and Tel.No. I Designer's Name,Address,and Tel.No. l7'�m L��oE'd F 77'r a�)o� O�v�p ,� lh•�J`o/►' iP J' Type of Building: Dwelling No.of Bedrooms Lot Size R sq. Garbage Grinder( ) Other Type of Building gore-P. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 990 gpd Design flow provided__moo/ Slid Plan Date Number of sheets Revision Date Title Size of Septic Tank --2000 r/Z TypeofS.A.S. Description of Soll 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 Heahh. Signed_ t� _ c, Date Application Approved by— L ll 5 Date It -c{ Application Disapproved by Date for the following reasons Permit No. 3 01 a,— L Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS _ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired upgraded( ) Abandoned( )by J & r,,g i' �y✓eC V at g&,*r PC &2e V/$Pq 7- has been constructed in ac�cor�ance with the provisions of Title 5 and the for Disposal System Construction Permit No /��'�^ d Installer 1� �atoCcSG.er Designer 4W414op Atff .b�/Sse+ #bedrooms Approved design flow +�0/rG gpd The issuance of this permit shall not by con7ed as a guarantee that the system will furM'lion ad- es' Date ! 1 r - Inspector O,_ 1. --------------------------------=------------------------------------------------------------------------------------------------------ No. _'T D Fee 1 THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal Opstem Construction i9ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) e System located at 41'e3 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. ! Date / r f � Approved by dr -- Town of Barnstable #�� 3t De grtiueut of Regulatory Services i F Public Health Division Date t�P / 20D Wa sbcu,Hyawls MA D2501 Date Scheduled_ /� �f Time. Fee Pd. B T Foil Suitability Assessmentfor Se a Disposal Perforated-By: ` ^ �t wtmetaea By: n- J �7 LOCATION&Goa INFORMATION Location Address .2 6/ T _X" Ownces Name AddressG�lnJJ,CG��B Assessor's Map/pareeL. � 00 Q O� 7 ,. m-�t� BoglneereNamee�d./d NaWCONSTRUCriON RBPAst wept one# Land Use: SUEce stones . Distances roa Open Water Body ft l'nssiblc WetAren ` ft DrinQng Water Well ft Drelhago Way t property Line. ft h Other- g SKETCH:(Street name dimensions of lot,exact locations of test holes&pare tests,locate wetlanda in proximity, to holes) Parent umtedat(geologic) Depth to satimck Depth to Groundwater. Standing Water in Hole Weeping Itom Pit Face Estimated Seasonal Hlgh Orouadwater DETERMINATION FOR SEASONAL EaGII WATER TABLE Method Used: Depth Observed stauding in obs.hole la, Depth to soll mottlast la. Dc�th lo'we`eping flue;etuo`oFoes:cot -- '�--- - in• Oroundxvter AdJtim., t In Index Well# Reading Data hidox Well ievol A�,f>•efor -AhiJ.Groundriater Leval�, PERCOLATION TEST Data,_,_.,, Time Observation Hole# I Tine at 9" Depth of Pere Tuna at 6" Start Pre-soak (/ End Pre-soak Rate WnJtach Site Suitability Assessment: Site Passed Site Palled Additional Tasting Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back . ***If percolation test Is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. I Q:NSEMC 1311CFORMDOC DEEP.OBSERVATION HOLE LOG Hole# - Depth from Soll Horizon Soil Texture Sdil Color Soil. Other Surface(n.) NSDA) (Munsen) Mottling (Structure,Stoned;Boulders. 1 ay.96'Oraven G C;r/16-r 4W.A4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soli Horizon � oil Color Soil Other Surfaco(la) (USDA) ('Mansell) Ivfonitng (Structure,Stones,Bouldus. Istency.S 0mven ,12 tj DEEP OBSERVATION HOLE LOG Hole#. " Depth from Soil Horizon Sell Tosturs Son Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. d ' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soll Texture Solt Color Soil Other S"rfis9°OoJ (USDA) (Mansell) Mottling (Structure,Stones.Boulders. - 1 Flood Insurance Rate Map., Above 500 year flood boundary No— Yes _ Within50oyearboundary No Yes t within 100 year flood boundary Na Yes�M Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery us 'terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of h rally occurring pery us material?. ^h K 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 pe firmed by me consistent with . • the required training,el. ' e e p ienca described in 410 CNII215.017'G Signatur Date Q:IQEPPIMERUORM.DOC �!Er .. • Im C3 OFFICI ;S )v �� Er ° iO Certified Mail Fee �) Er $ r Extra Services&Fees(check box,add fee as appropriate) ❑Return (hardcopy) $ l ��n N C3 []Return Receipt(electronlc) $ P tr2ark O ❑Certified Mail Restricted Delivery $ erect 0 ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ O Postage m Total Postage GRIGGS,ELLEN W TR $ T. G. REALTY TRUST �► Sent To 1280 WASHINGTON STREET,UNIT401 M1 BOSTON, MA02118-2151 City State,ZIP` ^� :�� r rr r•r•r. Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A.unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this_ delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®;First-Class Package Service®, available at retail). or Priority Maii®service, Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent with Certified Mail service,However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is I insurance coverage automatically included with accepted as legal proof of mailing,it should bear a 1 certain Priority Mail items: USPS postmark If you would like a postmark on in i •For an additional fee,and with a proper this Certified Mail receipt,please present your n endorsement on the mailpiece;you may request Certified Mail Rem at a Post Office'"for the following services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded pardon of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the maiipiece. -• electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your maiipiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2016(Reverse)PSN 7530-02-000-9047 SENDER: COMPLETE THIS SECTION COMPLETE T.HIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. �� v ■ Print your name and address on the reverse X ❑Agent I so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(,inted Narej C. Date of Delivery or on the front if space permits. D: Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No GRIGGS, ELLEN W TR T G. REALTY TRUST 1280 WASHINGTON STREET,UNIT401 BbSTON, MA 02118-2151 3. Service Type ❑Priority Mail Express® II I IIIIII IIII IQI I II I II II II I III II III III IIIII III 11 Adult Signature ❑Registered MailTM gAduk Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 4116 8092 9358 55 cen.fi d Mail® � pelivery ❑Certified Mail Restricted Delivery l�Return Receipt for ❑Collect on Delivery ��,// ��TTTvvAAAllerchandise �2._Article Numher_Cfranefar_frnm_�er+.; o r��,�n n c �'—*-^a Delivery Restricted Delivery 0 Signature Conflrmation7m I ?015 1?3 0 0001 4989 0 3 9? '�" ❑Signature Confirmation ` I l Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt - U �# First-Class Mail Postage&Fees Paid I USPS Permit No.G-10 I 9590 9402 4116 8092 9358 55 jUnited States FO Sender.Please print your name,.address,and ZIP+4®in this box" I Postal Service - i " °g .'own or.Barnstable I �O� Health Division I 200 Main Street I Hyannis, MA 02601 I I ii i3� j SENDER: COMPLETE THIS SECTION COMPLETE,THIS DELIVERY ■ Complete items 1,2,and 3. A. S' ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Pri ed Nam� V- 1. Date of Delivery or on the front if space permits. !' D. Is delivery address different from item 17 ❑Yes 1 If YES,enter delivery address below: ❑No I GRIGGS, ELLEN W TR "T. G..REALTY TRUST Ll WASHINGTON STREET, UNIT 401 TON, MA 02118-2151 II I IIIIII I'll IIII II I II II II III II III II III I II Ills Service e Priority❑dultS gnature ❑Registe ed Maipm s® [I Mult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 4116 8092 9358 62 tified Mail®er elMery eryCertified Mail Restricted Delivery eturn Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer fromm serviceJabel) . 0 Collecton Delivery Restricted Delivery ❑Signature ConfirmationTm jl ❑Signature Confirmation 7 015 17 3 0 0001 4989 0403 it Restricted Delivery Restricted Delivery PS Form 8811,July 2015 PSN.7530-02-000-9053 Domestic Return Receipt U G# First-Class Mail Postage&Fees Paid LISPS' --__.... Permit No.G-10 I I 9590 9402 4116 8092 9358 62 United States •Sender:Please print your name,address,and ZIP+4®in this box* j Postal Service Q Towm of Barnstable i I Health Division 200 Main.Street I' Hyannis, MA 02601 Ili11PI1,11ii1iiijijiill,h)1iiiji!IIIE Em .. • !4 I� c C3 c[3 Certified Mail Fee r $ Ga Extra Services&Fees(check boy add fee as app date) !D ❑Return Receipt(hardcopy) $� ❑Return Receipt(electronic) $ �.—/ - n7 ttP10 t nark OO ❑Certified Mail Restricted Delivery $ N J7 V ere 0 ❑Adult Signature Required $ MiTi I Sllll t ❑Adult Signature Restricted Delivery$ p Postage -- $ r-qTotal Postage and GRIGGS ELLEN UVVTR I U1 Sent to `-T. G. REALTY TRUST-- 1280 WASHINGTON STREET, UNIT401 Sfiee�andApCivo; BOSTON, MA02118-2151 I I City_State,ZlF'+44, _ Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this. delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or Important Reminders: to the addressee's authorized agent Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified! •Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a, certain Priority Mail items. USPS postmark If you would like a postmark on •for an additional fee,and with.a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.it you don't need a postmark on this -Return receipt service,which provides a record . Certified Mail receipt,detach the barooded portion of delivery(including the recipient's signature). of this label,aft it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT Save this receipt for your records. PS Form 3800,APO 2015(Reverse)PSN 7530-02-000-9047 tee, _HdClAh4 r J f down cape engineering, inc. SIEVE SOILS ANALYSIS 697 SCUDDER AVE. HYANNISPORT, MA DATE OF REPORT:11/26112 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 697 SCUDDER AVE. HYANNISPORT, MA LOCATION: JIM LEBOUEF TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 309.1 SIZE :WEIGHT RETAINED % RETAINED % PASSED ------ ...: (sum ?..................... ..:---------------------..... ...:_.....6......:........ 1 0.0 0.0% 100.0% __________p.......................................................>______-__________--_.y_______.__________ 3/4" 0.0 0.0% 100.0% --------------... ,........ .....;....................:-----------'---- o .-----------------p 0.0: 0.0 :: 100.0/0 ------------->..................................................... ,--------------------�----------- --o 3/8" 0.0; 0.0%' 100.0/o --- ---- .... .........---------------- ------------------- 0.0. 0 0%€ 100.0% --------------.....................................................>-------------------- .................................... 10 4 5.8 1 14.8% 85.2% --------------.......:........................................w..;------------------o-.............. ..............o. 0 176.1 57:0/o' 43.0/o ------------->.....................................................>-------------------- ..............._..................... 0_ 267,0 _ _86_4% '13.6% _ . .-- ------ .......... 50 283.0� 916%€ 8.4% ----------r,......................_..._........................>---------------------..................................... 0 .................... ......,..,... ...:.......... 100 302.9� 98.0%: 2.0% ------------- .....................................................>-------------------- --------------0 00 306.2 99.1%° 0.9% ------- _.................... ...................... . ---------------- ------------------- PAN: 306.6. 100 0%E 0.0% SAMPLE: € 309.1 NOTE:TEST ON PASSING#4 ONLY, 8.7% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR, FINE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE #4 100% (TEST ONLY MATERIAL PASSING#4) OK ##550.101/6-100% OK #100 00/6-20% OK #200 0%-S% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS I<2 MINJIN.MATERIAL 5k�3� tea NONGOMPACTED SOIL DESCRIPTION: FINE SAND " 4 .N�E:.A CGIL � lc"'rt�RC = s•`s 1 TOWN OF BARRNSTABLE LOCATION �� `f G � 0�'�°� -4 " SEWAGE# O @®a --?CPO- VILLAGE ASSESSOR'S MAP&PARCELo�<7 _6� INSTALLER'S NAME&PHONE NO. �/� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: - Ae 6 &-Area 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) I / Feet FURNISHED BY o � M O A o '\ `b ff NIP o No. f X 3 T _ ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rppl cation for ]Disposal 6pstem Co=stem permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Individual Components Location Address or Lot No.. e,4APe,0z a'e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel.2 Q > ,�F, C�� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. y 0,4 Pra .S A77-4't'Sq Type of Building: Dwelling No.of Bedrooms 19 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 41f e P e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5p?® gpd Design flow provided ®/ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank o9®®® 6r,4,1 //ae�o 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. Signed Date Application Approved by /i Date ct Application Disapproved by Date for the following reasons Permit No. 0��,— � Date Issued_ C No. , — ff 7- 3 Fee (371 , —8 THE COMMONWEATH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Fl - _ Application.for ;DisposaY-6pstem Construction Permit Application for a Permit to Construct Repair Upgrade Abandon Cm lete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. - o y Assessor's Map/Parcel #t h ',5 Installer's Name,Address,and Tel.No. 1 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size , sq.ft. Garbage Grinder( ) Other Type of Building //t Ff, No.of Persons t Showers( ) Cafeteria( ) Other Fixtures F Design Flow(min.required) gpd Design flow provided t,/© -10, gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank „2,n to ��/,��_ Type of S.A.S. _Pee Description of Soil ye s Nature of Repairs or Alterations(Answer when applicable) f' ti 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. Signed Date Application Approved by L- _ f,. Date Application Disapproved by Date for the following reasons f''c Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by 0�17j f L" oE-``�//c— J%edtlT/�C „PeS M at ,fy� J`C U/j jJ�s ��•�!" ,f per,,J has been cons ructed'n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ''' to ed Installer '1!� �� Q Designer464 #bedrooms 9 Approved design flow /� and The issuance of this permit shall not be const ed as aguarantee that the system will fu Cbon as es' Date / lD �-- Inspector ------------------ ------- ------------------------------------------------------------ No. / ,' p�. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH,DIVISION-BARNSTABLE,MASSACHUSETTS 33isposat 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at �9� �G 0��7�`e�.4�� /,:7a4e`;n and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date/ ��._ Approved by (!� A3- Town of Barnstable Regulatory Services . Thomas F. Geiler,Director 4 ! MUMSTA i • ` Public Health Division y ss.MnSS. �, 1 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: (Zi 2bl, Sewage Permit Assessor's Map/Parcel L57 b2 Installer& Designer Certification Form Designer: � �� , �,(,�,� Installer: —_T ml �(� Address: � � � �� Address: 1414LIS Mac �T_ '�G�cT� On � ''l i L � � was issued a permit to install a (date) / (installer) septic system at b ` p� , [based on a design drawn by T pp ,- I (address) J401� --✓' MA�^-t dated �� o (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local R '-tions. Plan revision or certified as-built by designer to follow. Stripout (if rP- acted and the soils were found satisfactory. OF N Mass D ID 9�? (Installer' Signature) /S T P (� esigner' Signature) PLEASE RETURN TO BARNSTABLE PUBL._ OF COMPLIANCE WILL NOT BE ISSUED UN i 1L Du i ti i tin WRM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsWesignercertification fonn.doc i TOWN OF BARNSTABLE LOCATION `r G �'�-4��`�SEWAGE# � '�CP a VILLAGE'/�yiYoJ' '��y- ASSESSOR'S MAP&PARCELo�<P. —cs.;7- INSTALLER'S NAME&PHONE NO. �,W SEPTIC TANK CAPACITY `� G O - " 6=.rLG 0.� LEACHING FACILITY:(type) rozcr.►�c,,�/fa�/1��(size) NO.OF BEDROOMS OWNER 6:-4CO o5r6-1P PERMIT DATE: a��/� COMPLIANCE DATE: /moo /oZ Separation Distance Between Ae g &.-,rG4 , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 i dr A S ' '4y ,�,, _ Oof ; � I 8 jZl1'd''? r o `- 3 r 1 !'` i Town of Barnstable Barnstable Inspectional Services nASMASS." Public Health Division 200 Main Street,,Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4989 0403 December 13, 2018 GRIGGS, ELLEN W TR T. G. REALTY TRUST 1280 WASHINGTON STREET, UNIT 401 BOSTON, MA 02118-2151 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 697 Scudder Avenue, Hyannis, MA, GUEST HOUSE, was inspected on 12/06/2018 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00). The following option are provided: a.) replacing the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component; or by b.) replacing the septic system component with an H-20 component beneath the parking area or driveway, and properly abandoning the discovered H-10 component,(or in the case of leaching pit;replacing the top of the leaching pit with an H-20 slab top); or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ER OF THE BOARD OF HEALTH - �omcKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\697 Scudder Avenue GUEST HOUSE Hyannis.doc KWE jT "� Town of Barnstable " ' 0.' Regulatory Services Department - rF� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground - - ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool y"conditionally passed systems" (broken cover, relocation of a pipe,relocation P� of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r; 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for c H annis ort MA 02601 12/6/18 every page. y p City/Town State Zip Code Date of Inspection f x 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 �36708 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylrown State Zip Code 508.272.6433 13010 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 maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority a lv--�' 12/6/18 Inspecto ignatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 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 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Citylrown 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 the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): The septic tank is of H-10 construction and approximately 8'of it is in the driveway. The leach pit is in the driveway and there are no records on file indicating whether the component is H-10 or H-20 I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. HY p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The Y q P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i 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 '/2 day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 ' 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a. design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/6/18 Cityrrown 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? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): See desciption t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. HY p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information Description: There is no engineering record available, system is typical of a 3 bedroom i Number of current residents: 0 i Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 33 GPD 9 ( Y 9 (gP ))� Detail Sump pump? ® Yes ❑ No Last date of occupancy: Seasonal Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/6/18 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: pumped 1 month ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. I� ® Other(describe): No d-box t5ins.doc-rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N yVOy`•� 697 Scudder Ave. (There are 2 homes on this.property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1979 per record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): I 3' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2 p g feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet cover raised to 3"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: trace t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityffown 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 >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Rom - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for H annis ort MA 02601 12/6/18 every page. y p Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No d-box 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: l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): The leach pit was video inspected and is damp at this time, it is partially in the driveway,there are no records on file indicating whether it is H-10 or H-20, it is 3' below grade, probing gives no indication of a raised cover, no indication of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils are compact and dry 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately � � f � 7 c � � LjI -- - t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hyannisport MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >12' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Design for main house 2012 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4'seperation per compliance on file ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, the site is 26'msl and nearby surface water is 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 1 bedroom guest house) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �*Y Town of Barnstable Barnstable HE r, Inspectional Services Public Health Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 a CERTIFIED MAIL#7015 1730 0001 4989 0397 December 13, 2018 GRIGGS, ELLEN.W TR T. G. REALTY TRUST C 1280 WASHINGTON STREET, UNIT 401 BOSTON, MA 02118-2151 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 697 Scudder Avenue, Hyannis, MA, MAIN HOUSE, was inspected on 12/06/2018 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Needs Further Evaluation by the Local Approving Authority" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Single Cesspool. Must upgrade to current Title V systems. You are ordered to repair or replace the septic system within two (2) years 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 OF THE BOARD OF HEALTH . Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\697 Scudder Avenue MAIN HOUSE Hyannis.doc 3 Town of Barnstable �"'� i639.'� s Regulatory_Services Department 9qj ,0� PrfD MA'l� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well'is free from pollution). WO 2 YEAR DEADLINE CRITERIA Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) O R Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r1°a M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) ' Property Address F• Griggs Owner information Owner's Name , is required for Hyannisport MA 02601 12/6/18 every page. �'• Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered id any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification f 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 ® Needs Further Evaluation by the Local Approving Authority 4111" 12/6/18 InspetoXSi6ma Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 City1rown 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: . ***2 systems were identified at this home. The one from 2012 is in compliance. The other sytem was found to be a single cesspool. Single cesspools are not in compliance with Barnstable regulations B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by . the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owners Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•�' 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/6/18 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: •e The single cesspool is not in compliance with Barnstable regulations 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 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. y p H annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. HY p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? S ❑ 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): 9 Number of bedrooms (actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Yes t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of W f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. HY p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 100 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 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 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for Hyannisport MA 02601 12/6/18 every page. Citylrown 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: Pumped 1 month ago per owner 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 El Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,.•�'' 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 11/30/12 per BOH record, No record of cesspool Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): 6„ Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): i I Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-20 tank is in driveway, Steel covers to 2"of grade " If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000g Sludge depth: trace t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Vj Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/6/18 Cityrrown 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 >12" Scum thickness trace Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M �' 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 d-box is in driveway, it is 4'6' below grade, cover raised to 6"of grade, no adverse conditions Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. HY P annis ort MA 02601 12/6/18 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 8 ❑ 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 chambers were video inspected and are damp at this time, H-20 construction per BOH record and in the driveway, bottom of chambers approximately 6'6" below grade, no indication of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 6" Depth of solids layer undetermined 1 Depth of scum layer Dimensions of cesspool undetermined Materials of construction brick and block Indication of groundwater inflow ❑ Yes ® No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 113 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils are compact and dry Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owners Name is required for every page. Hy p annis ort MA 02601 12/6/18 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 Ll to 3 i� ' 314 b t5ins'.doc-rev.6116 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave._ (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 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 d� Abe®© �- I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for every page. Hy p annis ort MA 02601 12/6/18 Cityrrown 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: >144"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: 2012 Da ❑ Observed site (abutting property/observation holes within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2012 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, site is 26'msl and nearby surface water is 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 697 Scudder Ave. (There are 2 homes on this property this is the 8 bedroom home) Property Address Griggs Owner information Owner's Name is required for p every page. y H annis ort MA 02601 12/6/18 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 z let L'0 CAT ION � SEWAGE P'� 7TNO. VILLLAGE 57cv./J;a� I N S T A LLER'S NANU i ADDRESS B U I L D E R OR OWNER l DATE PERMIT ISSUED ��_� DATE COMPLIANCE ISSUED �_ � � r' c', � � i� � °� .. �� • �� - S . r C �� -C -, ji. V 1. _. No......... _....... Fiz$...............J....... THE COMMONWEALTH OF MASSACHUSETTS �A. BOAR® OF HEALTH ..............OF.........LO.AA9VA::5 ,P. .MC..F------------------------------ for Mivoiial 18jarkii Towitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..../Q M! ........................Z,0%......... ............................................ Location-kddre s or Lot No. 1-------------------- ..........-------------s` .r,. .......................................................... Owner. Address a ......... . -- .......... 7 V............................... .... ................. ........... ....................... Installer Address �f dType of Building �Lo�r� Size Lot..q_1.260......Sq. feet U Expansion Attic (�� Garbage Grinder Dwelling—No. of Bedrooms_______________............................ Other—Type of Building ....IV_1A.............. No. of persons..--.........--......--..... Showers ( ) — Cafeteria ( ) aOther fixtures --------------------------------------------------=...-------------------------------------------------•---------------•------------•....---...---- Q Design Flow.........1CA..............:.... ....gallons per per day. Total daily flow............',c� _...._. .._.__._._.. -, f" W .. W Septic Tank—Liquid capacity e-�g g �- - yam- o� 6.... ...... allons Len th.�?..�..._.. Width....%®.-._-.. Diameter.. Depth_," ._... x Disposal Trench—No. _.................. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/---------- Diameter...eg.- ........ Depth below,in1e G ........ Total leachi �rea_ ��"8..sq. ft. Z Other Distribution box (e/S Dosing tank ( ) v e 7__ '-' Percolation Test Results Performed by. o r �t..D.....A:.._�.a_if eA-D....� ��--.. Date.._��.".��'�.>�_._.__.-.. `l Test Pit No. 1... .y.minutes per inch Depth of Test Pit... .?_.'------ Depth to ground water... a i, Test Pit No. 2................minutes per inch Depth of Test Pit--............--.... Depth to ground water........................ 1x ----•-•---------------------------------------------•-•---------......---------•--------•••--....--•......................................................... 0 Description of Soil-----4.-`---6- L-�s�_t2.f Str.C"3_S «.....9tg;��........... ---- U '<7 -........................................................................................................................................................................... W -----•-------------------- ----•-----------------•----------------------•----------------•---------------•-----------------.....------------------------------•-----•--------•------------•----------. Z. Nature of.Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'i LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the boa2l o ealth./- Sined..� � r-__ ...---------•-- ••------------------------•----- �t Date Application Approved By...... C '� �gZ%� ---------- .. . 7�...---------•-• Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------•-------------.--•-- ..... .........•---- Date r PermitNo......................................................... Issued...---.._..-`-------------...----•-----------•------- Date T No.........fi:.._....... _ ................... ........ G*° THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH --70-.W-A) .............OF........ ............................... t Apptiration for Diopo,iFal Works Tonstrnriion lbrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l 5...fr.t ....... Location- dr s r / or.Lot No. ........ .................... ........................ MF ............... .-• Owner Address WA * C F1l�ravt.,,{•--••.-- ---•...... ....... ••----••---•----•---•-••..---•- ---•-- ................................... Installer Address Type of Building "c I Size Lot_.'Q12.Ba......Sq. feet U Dwelling—No. of Bedrooms........... ............... .. Expansion Attic (�) Garbage Grinder j' 0.1 Other—Type of Building ...,V11l.............. No. of persons............................. Showers ( ) — Cafeteria ( ) ' a Other fixtures ----------------- ----- - W Design Flow.........//.0................... gallons per per day. Total daily flow........... ...............gallons. WSeptic Tank Liquid capacit pa.gallons Length.16--.. Width.`...'........... Diameter________________ Depth.-. ........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......,t�........... Diameter.._....__..... Depth below inlet....;---- -.---- Total 1 ch rea. ...sq. ft. Other Distribution box (t/) Dosing tank '-' Percolation Test Results_ Performed-by-P&0M.I-l).....i AD &Sf..... Date...�"•.."��'_�l� aTest Pit No: 1.. .. __.minutes per inch Depth of Test Pit 3."...._.. Depth to ground water- ; Gz, Test Pit No: 2............:::minutes per inch Depth of Test Pit.................... Depth to ground water----------------------- ------------ ------. ......................................................... D Description of Soil � !.?A x"1! 5 c..�3'Sxax � '...........4=10- -----------9 .......` --- COA S " (xj 5.rf.,V.D.................................. W •------------------------------------------------------•----------------•-----......-•-•------------------------------------------------------•....-•--•----•---••••--•--••......•-----•-•--------••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... i ..------•---•--------•---•---•-----...-•-----------------------•-•-----................................................................................................ .............................. Agreement: ` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of TITLE S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sined ------------------------•------------- ------------------.......------- Date Application Approved By. {:: � �'£d ' I D��' ate Application Disapproved for the following reasons:.................... Date ---------------------------------------------------- - --------------------------------------------•------------------------------------------------------------------------------ PermitNo...........................•-.._...-----...........-----• Issued.---.......__...-•••-•••------ ... Date THE COMMONWEALTH OF.MASSACHUSETTS BOARD OJT, HEAL ........OF......... .. - C�pr�ifir�a#r of �ont��i�anrr TH IS T CE TIFY, That t Individual Sewage Disposal System constructed ( or Repaired -- ( ) by �.._j......... .........................................-------------------------------------- ------•------•-------- Installer has been 1 stalled in accordance with the err s' ns of j f The State Sanitary Code described in the application for Disposal Works Construction Permit N _____(f'.=................... dated.-..._,�"'_.�_-- .............. THE ISSUANCE OF THIS CERTIFICATE SHA OT BE CONSTRUED AS A GUARANTEE THAT THE /SYSTEM WILL FUNCTION SATISFACTORY DATE....--•---......l..._.l_�.....7-..._..... ... ".:t .•----- .. Inspector --- p {n THE COMMONWEALTH OF MASSACHUSETTS BOARD W HEALTH F No........ .............. EE ............. Diopoti a1 Ivor T1,011trurtion,,Vanfit ' Permission is hereby granted_.... . to Construct ( ) or Repair '( ) an Individual Sewage Dis sal System at No ' Street L/ -1217 as shown on the application for Disposal Works Constructio rmit ................. Dated----/ .�-------.--_-.------ --••-•--...--•---••----......_ 2 oard of Halt DATE............................................... ........ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .. ._..�, ,._ ., ., .,., +_.„,, ,,,,,,,i.. . �•„4.'?'`. _ .. :;.mar; r.. �";R•`_'t'Y� �?rrs --•^zs..`�tfi'k'�'d�"5•.:.:�,m. .� +y:�;S�r3;a. '+ :.:� zc'` ... .a M' et,.._ Y+ - -�+h-7f:x�rt, ..'y4 "' F._.s ,5. :E 'r4s ee' _ „y .-�.e.:t• r, e'S4'a .- ,. �,,, ,y _;,*.rS - -. . :.• �,�,;••;, fr.r - a..a .'�d..,-e..,. ,u-s .t "�.�."�, •,�_`,a.,'s` ..h - _ -.s r•�.*� _�. `3,+... ,,:z<i r' '-'4. .s, :may+=,,'.� '. ;�?�.*•.-r#:''' a. t t- - ,•3.- - L" ar:•• j- f ,3 -•3`° - t;. 'r -' i,�s .t*`7c 4' ..'r# lu. .ir �-t' h '� i..� -f.s ,y,3 .i.' 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WWI Duval wotxm M A � f � r A } r M - � �W001rOMi r ,t+ -- ---- ---- -- --- -- �.. - _ �;% PERC TEST. 13,793 , s: PERFORMED BY:DAVE MASON WITNESSED BY:DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE ASSESSORS REF.: ? ♦ , � t� t a `1vovEMSER 19,2012 FLOOD ZONE: Map 287, Parcels 062 Zone X SITE PASSED Community Panel No. *� , s oy y s ee e��iF #25001 C0568J ZONE. z �'6 yF °berth M TEST HOLE-1 U.2Z s TEST HOLE-2 EL.2Z s July 16, 2014 RF-1 dew �s ExistingTank A:LAYER 10YRa/3. A.LAYER 10YR4/3. : . .. , • ............. Area (min.) 43,560 SF ROwN BROWN ........ i B , : \ to be Reused if " life .,.1.........LOAMYSAND.:........... 26.6 11 LOAMY.SAND 26.6' Frontage (min) 20 2000 Gallon Capacity, Zoo Width min 125' > .......BwLAYERl0YR.6/3.... ...: BwLAYER l0YR.6/3......... (min) �. \ 697 Structurally Sound 53 8 PALEBRDwN.....:.. BRowN.......:..... Setbacks. :.., ,, & H 20 Rated 1 •5 Sty WIF 29 .... .... ....LOAMYSAND.....:.:.... 25.1 29 .:...., ................. L.oA1►�I'SrkND: 25.1 Front 30 1 Cottage :CI AYE.R.1oYR6/1::... C1F,AVER.IOYR6l1:....:.... Side 15' GRAY... ..... .... . .GRAY.' :'::. .. ... .. . . Rear 15 ....... 2 _ Re 6 „ SIt;7',>fUAM:.. SST 1.�AiV1:. , . ... 2•) 84 :�::::..::..:.. .:.... .,: 20.5 60 '... •:•.:.:. ...,: 22.5 \ ti C2 LAYER IOYR 7/3 C2 LAYER lOYR 7/3 VERY PALE BROWN VERYPALE BROWN MEDIUM SAND MEDIUM SAND inse \ 1p8�9, gb SEE SIEVE ANALYSIS SEE SIEVE ANALYSIS . n n �s Shed �th B R 144' Class 1<2min/in 15.5 144 Class 1<Zmin/in: 15:5 ogChe NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED Location M a p l 1 Approx Septi` .� Proposed :''. System (BOH Oro)/ 2000 Gallon ` SB/bH Scale: 1"=2,000±' / j \ Find PERFORMED BY:JOHN ODEA,PE-SULLIVANENGINEERING Septic Tank a G QJ WITNESSED BY:DONNALD DESMARAIS,R.S. TOWN OF BARNSTABLE �T / MAY26,2020 S1.EPTIbC NUttLdes Shown on Tlus Flan Are Approx.At Least 72 Hours ' •� z \ ZV 7 �B j Prior to Any Excavation For This Prr ject the Contractor Shall Make 5.0 / { Existing Co{tage Min - / the Required Notification to DigSaf'i 0-888-344-7233)and contact VARIANCE: f Se tic tcy'Remain r, `\ t` \� 22 � Q�S \ 1 TEST 1YOLE-3 EL.26.2 Sullivan Engineering&Consulting ) 1 / Inc.ac. 508-428-3344. .::;:•A.LAYER10YR4/3.' `: � -Septic Tank Setback .................... 2.The Contractor is Required to Secure Appropriate Permits From Town p .......... .....BROWN. ......... Agencies For ConstructionDefinedlyThisPlan. 10' Required t0 Foundation SANDY LOAM......... 25.4 3.Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall ' q PPY 5 Requested .:Q) ...w LAYER.lOYR 6/8.........:... Be Constructed of Class 150 Pressur;Pipe and Shall be Water Tested to -Depth of SAS I f Z ......... BROWNISH YELLOW .:..... 1 j Gj � moo , `: •.. v._. i / ''� �w � ..... ....... Assure Watertightness. In General,Water Lines Shall be Constructed m , r Cleanout r \ 48 LOAMYSAND.::. 22.2 Coordination With Hyannis Water,and Shall beinAccordance 3 or Less Required ,I-Approx Septic 1 ,T Crawl r ,� \ .. .. - , C1.LAYER.lOY$5/4 .,. ...systei;, (eoH card)..l Y' � Space � � '� . ..:.: ... With 24scNnt 1.00-7.00&31ocTv1R 15.00. <6 with Vent & H-20 Requested P • i i / YELLQWhSIf 11RO 4.A Minimum of 9"of Cover is Requn ed for All Components. i Existing Be oo - i' w.,,. �' Full Foundation j 4)� �� 102 ....:...:'..'.'.:'.$HAM..:.: 17.7 5.All Structures Buried Three Feet or]41ore or Subject i Ex sty g \\ .: -.l O C2 LAYER OYR 7/3 I v Se tic S tem to e N E ,, LA 1 to Vehicular Traffic to`be H-ZO Casein 7t is the Engineer's "� •G 8 , I o /\ VERYPALE BROWN Abandoned Reed \ Recommendation thatH-20Alwa s be Used. t 2 i - 0 Y q� MEDIUM SAND „ as per 31(7 C 15 _ ...,,.,� ,c� � � . . P ;. � i ' 6.Install Watertight and Covers to Within 6 ofFinished Grade I _ Q 1 1 - SEE SIEVE ANALYSIS i� � 6 9 7 �� / Over Septic Tank Inlet and Outlet,D Box,and One Leaching Chamber. , 144 Class l<2min/in. 14.2 r� 2 Sty W�F , All covers are to be maximum 1811 for concrete or 24"Cast Iron. / NO GROUNDWATER ENCOUNTERED 7.Septic System to be Installed in Accordance With•310 CNIR 15.00& Dwelling yea 248 C119Z 1.00-7.00 Latest Revision and the Town'of Barnstable Q o<e _Q Crawl .� Board ofHealth Regulations. Bo -Aspace 8.All Piping to be Sch.40 PVC. Vent 9.D-Box Shall Have a Minimum Inside Dimension of 12,and a Minimum Sump of 6. 10.The Separation Distance Between the Septic Tank Inlets and Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend ` opOseq, \ \ `s J� a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" 17.3' \ Sqs 4 S �J Below the Flow Line,and Shall be Equipped With a Gas Baffle. DESIGNDATA Single Famil a, 8l Y 10 .03• ~ 7 1 ` \ -9 Bedroom Q 110 GPD No Garbage Grinder Total Daily Flow--990 GPD / p03 f¢ / i Use a 2000 H-20 Gal Septic Tank Rad°erica 17.3'�,�/\ LEACHING AREA %y Water Lin \ ( z 990 GPD/0.74(LTAR)= SF Required I to be a r Sidewall=2(12.83'+80.592'=373.3 SF i Relocated Bottom Area=OZ83'x 769=1032.8 SF eyien Total Provided=1406.1 SF 0040.5 GPD) 4p . . LEACHING CHAMBER DESIGN 5, Stripout \ All P� h Use: o to be Schedule 40. l ..: U P� N VIEW I PLAN _ ti 9 500 Gal.Leaching Chambers m a Y 12.83 x 80.5,Double Washed 4.0' SC a f e = 2 0 Stone Field as Shown. I I O. Fi \ 12.8' 9-500 A% Gallon , I O Chambers O 0' Vent I Crushed Stone { I Stripout within 5' of SAS of All ` unsuitable Material and filled with Clean J F.F. El. 27.5E 10, Min. F.F. El. 27.Of 7 ed�Sand as-per =CM�5.237cT - - - Floor Uneven Floor Uneven 80.5' SAS DETAIL VIEW See Note 6 (tyP•) F.G. EL. 25.5 F.G. EL. 26.2-2 F.G. EL. 26.t Crawl Space EL. 24.28 Elev. 24.8E Sco/e 1 1 Flow Equilizers EL. 23.23 As Required F11 Installer To 2000 Gallon Con firm Prior EL. 23.03 Septic Tank EL. 22.78 Top EL. 22.23 To Any Work H-20 -_- Required 21.88 H 20 _Box D EL. 21. 72 See Note 5 H-20 :.: 21.23 Leachin Finish Grade 9 To Be Installed On Chamber Stable Compacted-Bose - Bot. EL. 19_23 3,; Max. „ 111�W ,,. III i_ III � J=� ....... 9 Min Compacted Fill Filter Bedding,,,T„s, ....... • :::: :::::I:f::Errc:oun.tered: Remove::Bc::Re 7bce. ` Fabric Inspection Port, P .......... _ ........ . - & Boffels .....:. ......AIi. .Unaul.table Sorls:;:Wr.thm::5: of : + And/Or ......... ........:::,. ...... .......... ............. ............. „ as Per Title 5 - Thg:: uter::Perirrieter .o.f h: ::5 stem: :::.::..:. 17.7 2 1/8" 1/2" Pea Stone 3' H-20 3/4" - 1 112 5' Stripout LEACHING Double washed Fill Shall meet Specifications Groundwater Elev. 3t CHAMBER Stone &; of 310 CMR 15.255(3) per Town Groundwater Maps 11 DEVELOPED PROFILEOF SYSTEM Clean-Sand �. 4 - 10„ PREPARED BY.• I� 12' 10" - � F M,4Ss NOT TO SCALE ti \ CROSS SECTION F CHAMBER °EV"° CapeSury O O 8 . 526 NOT TO SCALE /ST4 toFt��-'�G\�`��' 23 West Bay Rd, Suite G Osterville MA 02655 LEGEND: (508) 420-3994 / 420-3995fax 0 CDT Cedar Tree www.copesurv.com NOTES: PREPARED FOR: PREPARED BY. . TITLE:HT Holly Tree Site Plan DT Deciduous Tree AW Engineering QCT Coniferous Tree 1.) The detail shown was located on the ground by & Proposed Improvements ,-- conventional .survey methods on (or between)- u ivan Inc. {, �-) utility Pole 19/AUG/19 and 01/OCT/19. ' consuiting, n AL-E- E►ectricJ Brian & Miriam 0 Neill -G- Gas 2. The property line information shown hereon was (508)428-33"•P.O. Box 659 .711 Main Street, Osterville, MA 02655 T� p 697 Scudder Avenue D• wetland Flag compiled from available record information. seci@sullivanengin.com•wwwsullivanengin.com Light Post 0 Hyannis (H c2/DH 3.) The datum used is approximate NAND '88, based 20 0 10 20 40 80 Draft: CTR �/annis Port Mass. LLJ LLJ oHw- overhead wires on. the Town of Barnstable-GIS mapping. I Review: CTR Comp.: CTR DATE: SCALE:-25- - Elevation Contour - Project: O'Neill Project#• 380034 May 26, 2020 17=20r f` ASSESSORS MAP : NOTES: TEST HOLE PARCEL : �-` 6z — ............ G FLOOD ZONE l/CTj / �'�:.lG , 3 SO L EVALUATOR; ► V�fJ M G� 1) The installation shall comply with Title V and Town ol55 wtBoard of C3r_ _. ____ _ _ _..... . WITNESS - E• ____ ,jy�/� 1 f lealth Regulations. REFERENCE: ,�^ft�/,D CCZ,�" <ne ---- 6_7` S� DATE: c\/• I O l 2) The installer shall verify the location of utilities, sewer inverts and septic - -- - --- PERCOLATION RATE: .-e_ hil / components prior to installation and setting, base elevations. - - VIM •�, 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first j 755 , two feet out of the d-box to the leaching stealI be Level -t �V 1v� _.r... ...._ . -- ..._ TON - not� q4 0 purpose other than the proposed system installation. f _.__ ,-__ ._ _________. 1t`� E� 5) All septic components must meet Title V specifications. +( L -9 LID 6 Parkin shall not be constructed over H 10 septic components. � ) g p p 7) The property is bounded by property corners and property lines. LOCATION MAP �ILT �p Gt �tT 8) The property owner shall review design considerations to approve of total lb 1Qb 11 D� design flow and number of bedrooms to be considered for design. Receipt l I� of payment for the plan and installation based on the plan shall be deemed �' W �N� approval of the design flow by the owner. '� Mom• 11'J pp � .� � 9) The existing leaching or cesspools shall be pumped and filled with material ,✓`°� / GZ b �� 7� per Title V abandonment procedures. Those within the proposed SAS shall 01fbe removed along with contaminated soil and replaced with clean sand per ` eJ � Title V specs. VO_y.,04p, L 10)System components to be 10 feet from water line. Sewer lines crossing the let water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if " -- - Pj Owrw .- applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintained in place. . I 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. c� rli FLOW ESTIMATE l 2)The installer is to take caution in excavation around the gas line if such �' BEDROOMS AT O GAL/DAY/BEDROOIA - � GAL/DAY exists. to p .� .� �'. .�- 13)The installer shall verify location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. ---- SEPTIC C TANK -_ ; -- 14)This plan is representative only that a system can fit on a property meeting Title V requirements. 990 GAL/DAY x 2 DAYS - GAL in O 2 USE . �GA LLON SEPTIC TANK (N00) "�1 t VBA -CC tiNOF ID S YtSON S I DE t!REA: Z ��°+ IZ, c ;3 X 2- ?C ID,-)'- - ZlcciZ,CJ`3 `' s o '' iBOTTOM AREA. X all /- off .__. SEPTIC SYSTEM SECTION 10 OF I C V W IUI et LLJ JI iq5 Li M , D-BU GALS �i �Zo SEPTIC TANK SITE AND SEW/-AGE PLAN �9 v,v PREPARED FOR : l � � �(, �'� � F, t9 Imo, W SCALE : DAV I D B . MASON DATE: 1) r DBC ENVIRONMENTAL DESIG143 W DATE HEALTH AGENT LAST SANDWICH . MA( S 0$ ) 3 3- 2 1 7 7 1 1� 1Z ::5 Zn12 1 0 W0-1—E