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HomeMy WebLinkAbout0054 SHADY LANE - Health 54 SHADY LANE, HYANNIS A= 269 131 a � ;r 0 10C Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments OU ,M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information t 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services c Company Name 29 Atwater Dr ' Company Address ("rr1 E. Falmouth MA 0 36 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the Its 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: 0 ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by t Local Approving Authority 6-14-08 inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system 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. r._ ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp•03108 v Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 54 Shady Ln Property Address National Default Servicing Owier Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: Y ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not "a 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. l System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): . ❑ broken pipe(s) are replaced ' ❑ obstruction is removed t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G9,p 54 Shady Ln ' Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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: 7❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 1 00 feet of a surface water supply or tributary to a surface water supply. i ❑, . . The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.' rr;k ❑ °_ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 ' Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or - obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within�100 feet of a surface water supply or tributary to a surface water supply. t5insp•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form I - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z 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. t5insp•03/08 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. �M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ®' Pumping information was provided by the owner, occupant, or Board of Health ❑ ® . Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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 I /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 CM 15.302(5)] t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 5-08 Date Commercial/Industrial Flow Conditions: Type of Establishment:` Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp-03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection'records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 42 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36"feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 Gal Sludge depth: 8 Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 0 Distance from top.of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape t5insp-03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15' , 5 1f • • Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition with baffles in place. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0, Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•o3/08 ' ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y rY �M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: , ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ 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 in good condition with no sign of break out. No visible stain lines. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): o t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. je, l 1=tu�1 t - � t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 54 Shady Ln Property Address National Default Servicing Owner Owner's Name information is required for Hyannis MA 02601 6-12-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: { ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no water at 10'. t5insp•03/08 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OpIHE r Regulatory Services &kRNSPABLE. Thomas F. Geiler, Director 039. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction.Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC OF BARNSTABLE.. LOC;aI0N y G�� SEWAGE AGE _ v a v►c S ASSESSORS Lam'f ro S- i 30 INSTALLETS NAME&PHONE sN-0- SF-Pnc TANk CAPAC /5-00.r 'Ca/ LEAC I2NG EACUITY: (tom) !/c,�e4�er,s (size) NO.O BEDROOM-S BUILDER OR OWNER Z ERWTDA. : COMPLIANCE DAM- Separation Distance Between the: Maximum Adjusted Groitnd%ater aablc to the Bottom of Leaching Facility feeE Private Water Supply Well and Leaching Facility (r.f any walls exist on site or within 200 feet of lemming facility) feet Edge of Wetland and Leaching facility(If any wetlands exist within 300 fee leaching facility) feet Furnished by 414 /lO, C�Cs cl . f uo 0-ISM Pet -E-00 6-E- i q /3-=F- 3ya" OA cov2.(':S F 4-H No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftprication for ;Migool OpMem QCongtruction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) O Complete System dividual Components Location Address or Lot No. (''21 S" L aja . Owner's Name,Address and Tel No 04" Assessor's Map/Parcel 7�6 �J/ 1 g n 1 A r1 Jv1A IA4t4er's Name, ddress,and Tel.No. [ J Designer's Name,Address and Tel.No. to r t ivy- BtB Exc 1\(Q+1on G _ ��.- { �. R,5. 1`l T�aberc- W Foresictci IE AA A sar_q z 7--1 P" Z Type of Building: Dwelling No.of Bedrooms - Lot Size lei 2�d sq.ft. Garbage Grinder(� Other Type of Building ,C� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow 3© gallons per day. Calculated daily flow �O gallons. Plan Date d` Number of sheets Revision Date Title Size of Septic Tank l S Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r � J_V O x<TxZ IV 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 Certifi- cate of Compliance has bee is by this B of He lth. i Signed J,07M a Date ''6 Ics;(0 Iff Application Approved by Date Application Disapproved for the following reaseliX Permit No. CU Date Issued r . . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VYes , ,PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS _ 01pprication for Migonl bpgtem Cougtruction Permit > - Application-for a Permit-to Construpt( . )Repair(grade( )Abandon( ) ❑Complete System 2 dividual Components Location Address or Lot No. __r4jrko A � j- /� Owner's Name,Address and Tel.No. I ct A.P I Assessor's Map/Parcel /3/ 5 had I_ry nnn►s MA taller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' Ebert I �F y� �313 Excnva f�o n G. . elou$1 `f 11enberr Iry Tvresida�e si7?, -Y Z 7 T P,� Z Type of Building: Dwelling No.of Bedrooms 3 Lot Size i Z w sq.ft. Garbage Grinder(/flo Other Type of Building CP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. C lculated daily flow �� gallons. Plan Date G(o _Number of sheets Revision Date Title <. Size of Septic Tank !k� Type of S.A.S. 2—-Y�t? 91 Gt*- f `f Description of Soil �^" �j 4;• .._. Nature of Repairs or Alterations(Answer when applicable) l 1Ci i 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 Certifi- cate of Compliance has been,,imped bythis Bo d of He lth. Signed o /1 Date <J I S(U Application Approved by C '. 07I Date 6�9 w• �� Application Disapproved for the following reas Permit No. �� Date Issued F THE COMMONWEALTH OF MASSACHUSETTS 2 6 �*/7/ BARNSTABLE, MASSACHUSETTS (certificate of Compliance � } THIS IS'TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) / Abandoned( )by +1�1 EK('A yot.I L at f < .&_ Z &,1 GcZ has bfen constructed in accordance with the ovisions of Title 5 and the for Disposal System Construction Permit No. dared Installer o hP_P T a ff LFC� v Designer ��� N C1( ( (�q 1 U n .. The issuance of this pe sh Il not be construed as a guarantee that thfe system will-funat'on as signed. Date i� � Inspector.. 1 � de�...�� �P No. 12 �/ Fee THE COMMONWEALTH OF MASSACHUSETTS �— Z 6 9_ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migozaf *pgtem Cong;tructiou Permit Permission is hereby granted to Construct( )Repair(r-Upgrade( )Abandon( ) System located at _5y JA a- L 1-1 Gc.n /w7 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi m st be,completed within three years of the date of his permit. f "pe c Date: Approved b / Town of Barnstable Regulatory Services Thomas F. Geiler, Director BAMSUBM - MASS. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax. 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# Assessor's Map\ParcelL_("/_�T Designer: (;t^ Installer: Address: 'I 1.ac, aj4_ Za,,e Address: On b fl.r kf()I was Issued a permit to install a (installer) septic system at 7 a4i tz,:_ based on a design drawn by _e7Zd—dress E_, dated (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. 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. ��A�-�N OF GLEN ERIC st�flePs_-"!Cn�_tm 0. HARRINGTON w" No.107 0 ,/� d'q�GI SSEPP� _ At A e ,A,n�t< ... e,i tamp Here} PLEASE RETURN To ...BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT11 THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST kBLE PUBLIC HEALTH DIVISION. THANK YOU. 1eajTh/,1,.,ep6c/Designer Certification Form 3-26-04.doc Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM ,'hereby certify that the engineered plan signed by me dated � Z D 6 ,concerning the property located at s� s(,-aL meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase inflow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation v +adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGNED : DATE: =E 3 o NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASepdc\percexemp.doc t UNITED STAT R— lCl;tr 3R _ w • Sender: Please print your name, address, and ZIP+4 in this box• PUBLIC.HEALTH DIVISIO`] TO'W'N OF BARN ST R—LE 200 MAIN STkEET 1-11YANNIS, MASSACHUSETTS 02601 a �tIla COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.f.. :A'$ignature item 4 if Restricted Delivery is desired. 23 X G ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Re -eked by(Printed N e) C. pate f Delivery ■ Attach this card to the back of the mailpiece, �� or on the front if-space permits. D. Is delivery address different fro Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: O No Mr,_'F tMest Bell 54_S$lady Lane -�' - 3. Service Type Hy Q.'nni s, MA 02601 ❑Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 [fill 1 11111 111111 1 I f 1 l Er N I � rt / p Postage $ '3 /Q ` ✓/�J Ll7 Certified Fee y -0 I Postm p7 Return Receipt Fee Here O m (Endorsement Required) � Restricted Delivery Fee C3 (Endorsement Required) 4 O Total Postage&Fees is �p I�- .-p Se To ��� --'-rn-e5 t------ ------------------------------ Streel Apt.No. �PO Ballo. C3 11 p __--' a Q -e" Crty, to ,ZIP+4I 117-i IQ topm Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece e A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. ` a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt.may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece to Receipt Requested".To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or .addressee's authorized agent.Advise the clerk or mark the mailpiece with the endtsrsement"Restricted Delivery". o'Slf.;a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail IMPORTANT:Save this receipt and present it when making an inquiry. m. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION F 6 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Shady Lane , Hyannis MA 02601 G %� Owner's Name: Ernest Bell Owner's Address: Same Date of Inspection: March 28,2006 Job#06-83 ;. Name.of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD W _ MARSTONS MILLS MA 02648 " } Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper 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 �_\ ..14qS Conditionally Passes •, ti�2 Needs Further Evaluation by e Local Appr ving Authority = AT �K Fails =g / •m —r =0 0 0 r� Inspector's Signature: --�-. Date: 3/28/06 % Q* 5 INSPE��o`��• The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of H� 11i N1q���� DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: liquid level in leaching pit is at bottom of inlet invert and has previously been full to top of structure. ""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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUR FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ` obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 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. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioningin a manner which will protect public p p 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X — Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X Were any of the system components pumped out in the previous two weeks _X_ _ Has the system received normal flows in the previous two week period? _, _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ — Was the facility or dwelling inspected for signs of sewage back up? _X_ — Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site _X_ _ 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? _X — Was the facility owner(and occupants if different from owner)provided with information on the maintenance of subsurface sewage disposal systems? proper The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X — Existing information.For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):No Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped 8 years ago. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 1980+/- Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: 2' Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance.(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:26" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank is structurally sound and shows no evidence of leaks GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Shady Lane,Hyannis ' Owner: Ernest Bell Date of Inspection: March 28,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions. Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFI CIAL INSPEC TION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. _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.): Liquid level at bottom of inlet invert and has been full to toa of structure CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool• Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): l f Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. ane y § , ater }rlveWay erVlCe Sl f VJ 2 O 16 53 25 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Shady Lane,Hyannis Owner: Ernest Bell Date of Inspection: March 28,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test will be performed prior to repair to determine groundwater elevation. ano- dik ' S x� �a� ��� c• ' !'`.a�`^-3zh",E�^-. -L 'a +r'r'4 '— "§i�F...r Commonwealth of MossoChusetts _F 5 Executive Othce of E'nviror'nerttai Affc �s :John Grace t D.E.P. Title V Septic Inspector -� Te_ - --�-- aticket; �MA 0253 eo mimt l Pa�ote gon _ (508) 564-6813: -- 4 SkJBSUIFACESEWAGE DISPOSAL SYSTEM INSPEr+TION FORM - � PARTA -r CERTIFICATION Property Address 54 Shady Lane Hyannis , j 3 fi Address of Owner ✓�Q, ` m. Date of Inspection:1010819s : (If different) ..Name of Inspector,-John GracF Brown:Box403 W.Hyannis Port Company Name;Address and:Telephone Number {� 'CERTIFICATION STATEMENT I,certify that 41 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate, and complete:as of the time of.inspection. The'inspection.was performed based on my.training and experience in the proper function,and maintenance of on-site.sewage disposal Systems.'The system: X_ Passes Co.nditionally.Passes Needs Furth r Evaluation By the Local Approving Authority" Fails. Inspector's Signature: ' Date: 1018/Qs F The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of'completing this inspections., if the system is a shared system or has a,design flow of 10,000 gpd or greater,the inspector and.the system owner shall,submit the report to the appropriate regional office of.the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the.buyer, if applicable and the approving authority. INSPECTION SUMMARY: ,. Check A, B,C,or D:.." 'A] SYSTEM,PASSES: X I have not found any information which_indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CDNDITIONALLY:PASSES: ' _One or more system,components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. - Indicate yes, no,'or not determined(Y, N,or.ND). Describe basis of determination in all instances: If "not determined", explain why.not.) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved ' by the.Board of Health - (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 001 L& .,.... Y,n,.:r .,.::t„ . .. •' x,,cb .« .: ., _a... 'fix .. r .:« _ . _ .eva«,. ,.. r+..z..' ,,, ~. r , � .`' Z 1 °! ` "✓ ! .7,.x �,yti' ' ' n a �� ( j- rra� ---�_ CERT1FfCA- N=�ca -PfQ�@ft, ArirnSc Sd srut,y Lane- CQWiteL Bro' Box 403 W Hyannis Part �, x x ;Date of lnspecfion 10108196 - ewage a box is due-to.a broken d {r+§t}t�aR b6X r"e seprsyill pass traction rfith approval of the Board of ea broken pipes)are replaced obstruction is-removed_ - w distri.butLon bbox is leveled or replaced _ The system required pumping more than four times a_year dine to broken or obstructed pipe(s)' The S systerrtwfll�pass inspection if(with approvafgf the:Board of Heaith) a A broken pipe(s'j are replaced l obstruction'is removed n. C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF.HEALTH =+ _ Conditions exist which require :further evaluation by the Board of Health in.order,to tletermine if the system is failing,to-protect the:publichealth, safety and the environment."; 1) SYSTEM WILLV`'PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT'FUNCTIONING IN.A;MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND v: SAFETY AND THE ENVIRONMENT Cesspoo4 or privy is within 50 feet of a surface water :Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES` THAT THE SYSTEM 1S FUNCTIONING IN A. MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE •ENV.IRONMENT:' _ The'system<has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary`to a surface water supply:: one 1 of a ubli'c wat er .<The system has a septic tank and soil absorption system and is Within a Z P supply well. The system has aseptic-tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 1 feet but 50 feet or,more from a private water supply well, unless a well water..analysis for coliform bacteria volatile organic compounds indicates that the well is. free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. _Y 3) OTHER D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR .15.303. The basis for this determination is identified below. The Board of Healthshould be contacted.to determine what will be necessary to correct the failure. Backup of sewage.in facility or system component due to an overloaded or clogged SAS or,, cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. , SAS is in hydraulic.failure. (revised 11115195) 2 b z gi ". u.Y+�.a -r s_- .,.M-, _-s� MINIMUM" - y R SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PTXR_ W 4 r �...w. � .. . rcERT11=1cgnoN_corrtan,xeal 5:..,._� r a.,,.. T`-. c 5 --'--+r,-+•,-a - �-•,-r-�n- ..mac.- s:.. r �� ,� .s :�a'--�-� ,.�.�-�'�' _i as Property Add[ess 5 'Shadyi ane Hyannis F, { Brown--Box 403 W Hyannis Port owner r :ya �,�..M c rye. >- ` � v.-.t, �« �•'-- -,-•� r -�r� .5: 'Y x�. v' ,:h'�..--..s -r .:�:. s ection=70LD8l96 DF-SY TEM Static itgartl fe�rel in the drstrrbution box above outleLinVert dueTto an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6 below invert or.available volume is less,than 1/2 day flow. Required pumping more than'4 times;in the last year.NOT due to clogged or obstructed pipe(s)_ Numbers.of times pumped ' Any:portion of the Soil Absorption System, cesspool or privy is"below the high:groundwater elevation Ariy'portion of a cesspool or privy is:within 100 feet of a surface water supply or tributary,to a surface water supply Any portion of a cesspool oCpnvy is;within a Zone 1:of a public weli. Any portion of a.cesspool orpnvy 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:_If the well has.been analyzed to be acceptable; attach copy of well water analysis for coliform;bacteria;.volatile organic compounds ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems ih addition to the criteria. The system serves a facility wfth a,design:flow of 10,000 gpd ol. r greater(Large System)and the system is a significant threat to public health and safety and the environmentbecause one or more of the following conditions exist: the system is withfn.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 11 of a public,water supply well) { The owner or operator of any.such system shall bring the system and facility full compliaartmence nt for further nfo the rmatio ent'program , requirements of 314:QMR 5.00 and 6.00 'Please consult the local regional office of the Dep . - 3 A (revised 11115195) ` a a4 pia J,ha4.th.`"s.P xa 1 ua . i �AW- k " ��Mr _' < - : - �.--�`' ,�, *.� � �'� �;'' �UBSUR�A:CESEW�LGE DISPOSAL S-YSTEM INSP,ECTION_;FORM - s _--?rvperty-Address 54_ShadyLaneHyannls �`" �� � f� �, s v _ — � -�Dateof-Inspec3�orr � - j F a �. r S } 4 Cl3eck if the follow, fiaue been docLe X Pumping information was requested of the.owner occupant, and Board of Health t X_ None.of the system components have been pumped for at.least two weeks and the''and the system has been receiving normal flow rates during that period: Large volumes of water have not been introduced into the.system recently or as part of this inspection:, X As,buiit,plans have been obtained and examined: Note if they are not available with N/ X , The facility or dwelling was inspected for signs of sewage back up. X The system does not receive non-sanitary or was flow., X The site was inspected for:signs of breakout X All system ' P 9 p y ated on the site.com orients excludm the Soil Absor tion S stem,have been loc X 7-7 The septic tank,manholes were uncovered, opened,.and the interior of the septic tank was inspected . — for condition.of,baffles or tees,material of-construction, dimensions,depth of liquid, depth of sludge, depth of scum. X The size.and location of the Soil Absorption System on the site has been determined based on existing information or approximated by.non-intrusive methods X The facility owner(and occupants, if different from,owner)were provided with information on-the proper.maintenance of Sub-' Surface Disposal System. (revised 11115195) 4 �4s y .. ,1 F...n.. :m._N{5Y.F.. :e c"_ ?C x.9 .l.Y,_.•el-Y:.F-S�'i'?li^'3_':-^ ..... __.-+-•-....� .._.____.._.. ._�-_..._....__ .. ._._. 1 _ 1 ` yyy." k, MEN,"x� ` + .� -C. '"^ i`"'�,s"''C' `' `F Pr `� ' L M ,•c ,e i.. ^•a,,�m ' � ...s-; -"- --• '''--x•, S"' .�>�`'i �',{E,. i'` '' "3' s --F-'r=�s "'° k`"' �. SUBS FB>=AC S> 1t ?�E OISPQSAI 5Y5 TEI9LiNSPECTIOFt-FQRM � �� y. YS E ViI YNFORMA -IQ14 ,. ,. e_, ��y. ` "sue-- '�'�-..-.._-• - �s�._ �`C r -�.� �, «� -.t- P._roperty lkddress 54 Shadytane:Hyanrt►s - _ �--> 7 � «r �' '` � �- T t R6SIDENTIAL• - - Designftow:'22a gallons Y Number_of'bedrooms: 2 Number of current residents 3 ` , Garbage grinder(yes or no) No ..� 'Laundry connecfed fo syste Seasona m(yes or M):.Yes n l use(yes or no); No" _ -Water metei:readings ifavailabTe Na Last date of occupancy: n1a COMMERCIAUINDUSTRIAL. s: Type of establishment rUa a aAons/day Geeasef trap presen9(yes or no) No Industrial Waste Holding.Tark present.(yes or no No Non-sanitary waste discharged to the.T,ifle 5 system (yes or no) No Water meter readings,if:available: n!a s... Last date of occupanc y: nla. P.: OTHER: (Describe)-,rda Last date of occupancy` GENERAL INFORMATION PUMPING RECORDS and source of information: stem has not been pumped in the last two years. System pumped as part of inspection`. (yes or no)Yes . If yes volume pumped: logo gallons Reason for pumping: Maintenance. TYPE OF SYSTEM X Septic tankfdistribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and-source information: Sewage odors detected when arriving at the site:(yes or no) (revised 11115105) 5 g -a � '-ems"Nwa.x�C �"" ',3'°^" zyC.'"''.,.y ._Y.. ..•a. -*, ti. ri -�- Y 1 " ^-•'av d _. ,e ,� ,C• .cg'- - .�-. t'C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ; PART C - 8YS_T:EM INFORMATION(corrtinded) { PropertyAddress 54'Shady-LaieHyannls;. Owner: - Brown Box`403 W.Hyannis Port Date of Ins action_:1o108f96 ; �SFPTLC 7AL1K..`X `(locate on srte plan) Lr Depth peTowgrade 2 — a Material of-construction X concreate_metal_FRP_other(explain) Dimensions<•L 8'B:H S'7"W 4'10' k SiudgeAeplh::.3 r °t Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness:2' ' 7 9 Distance from top of scum to top of outlet tee or baffle:5' Distance form'bottom of,scum.to bottom of outlet tee or baffle. 16' Comments; r (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relationto outlet invert structural integrity evidence of leakage,etc) Sepdc tank and all components are structurally sound.Recommend pumping system every two years for maintenance GREASETRAP .(locate on site plan) Depth below grade: Na ' Material of construction: concrete metal -FRP_other(expialn) aj Dimensions: nia Scum thickness:rda Distance from top of scum to top of outlet tee.or baffle:rda Distance from bottom of scum_to bottom of outlet tee or baffle: n1a .. ft Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert structuraHntegrity Evidence of leakage etc.) Na (revised 11115195). = 6 ,.. __ � -— r :: � a- ..� M--• r�T " �' .sue -�'x - ', +, ^F :- M',-: g AP MW . ors =F�i.*.- - - �.rr. NOW Qm- ; °' .w fo'e -87qT95S -5459.13dyLfleHyBIl819--3--`--'--?- -••--ri -^ram-^- ,� ',F y" -� - r '^ -� OwnQr `� Brown Boc4o3 W tfyannisPort _� �rt � r „� �,,� z _ -. �T1GkGG'QRtOLDtNG= Ai�tK (locate on siteplan) Depth below grade Wa, �--= Crete_metal FRP_other(explain) n Material of construction con }: Dimensions: nla Capacity ' .n/a gallons Design;flow:'n1a gallons/day Alarm level: ni - Comments: (condition of inlet tee,,condition of alarm and float switches etc.) Na DISTRIBUTION BOX:'. (locate on site plan) Depth of liquid level above outlet invert: Na Comments. (note if level and distribution is-equal;:evidence:of solids carryover, evidence ofaeakage into or out of box etc.) Na - - " e, -PUMP CHAMBER (locate on site plan) Pumps in working order:(yes or no) • Comments: (note condition of pump chamber,condifion of_pumps and appurtenances etc.) rva (revised.11115195) < F�3 _ r. MUM- WON,� �€zs'Y„ � , •crsE. �` ° eNy' Vy `'�38' „�.,' MP'!S a .�, .� A W"' •c:: l 't'F aw4: L7•AF"t 2 �M at wn„. [W ri ,✓ -Mkp"r^ .',Mr EC -�,. 'xi i��,�.�s_r`, v.�s� ,� `� z�a"Yr�a ,,ts '� t� ` '1�`,. �`r� ��z` 'G z» ,, � �'` t �.. c�.. �r,•.�`� � ,�'l�, �,^.+.,-x- »" ''"t`� -,-'a � `z�'� �„r��n`-� ,��,-a^ '•--+; iw. -..��Ax '""'"�'�t,ti.., `. a .� k gym, � y i r ; )4 �4 x f � r � ,�•.-•�.� � t'�s � ;}t•'...•�-a��-.. .may � �-�7.'�„�---'��"F ..�....:ne,�„tc._ _. 1• '• y _ .t "'r�-5 r _'•t-�x z... -,--SU`�SUR'F`k�E aE{IlfjgGE`D'tST+-OS�kT`SXS�EM INSPECTION FORM a � --,s �:"�� �- � =—� R ) �.L � � L-"-,1 y�rl�• �--e„�t�--•, — l*ne`' '�-tea k.�y�-'3•�.rux�,� T .�y�...j 4'c�... -�5.. G µme, ?��'-i'f�F"a'r.�'xit .,a '--Fvl�'$ mil`- , 4<-. ^s.`�_. v .-*- e - .ac aws 7 -•ems- .fit. -t-1-,t 'G£...."' '3"T"'....'y"K-. - � ,�Wf1er= Brown box 483 Yet�nnls Port�___,v,�•„�'_-' k �� � "�� t ` � '-*=*• 7 +� "-�- ,�C-- -'�'--^. —ro- �'�• -3.-�.,�.-Z '.fir- �r+,�-,�.*-= s � , s..s m--•+ a s `�` t=' "'�+.�- �,-: Date of Insoecfi n 10108196 t --^: -+f '� .��� t _-.m., r •T - .vim-6+ . � "SQIC AB'SORPTION-S'YST,E1111,{5!�`S}.,x- `� (locate on site plan if possible ,excavati.on notpe wired tiut ma pp y t•_ �c roximated,b non-intrusive methods) y If not defeFmined to be:presenf,-explain:..: Na Type leaching pits number (each Olt.. gallon(ea ptt. 5 leaching chambers,number:n!a t leaching galleries,_number:Na leaching trenches,number, length Na leaching fields, number, dimensions:n!a overflow cesspool, number:n1a Comments:(note condition of soil;signs of hydraulic failure, level of ponding condition of vegetation etc.).The leach pit was t12 full at time of the inspection.It is structurally sound and function in Oro pert P P rt CESSPOOLS (locate on site plan) ` Number and configuration:: n1a Depth—top pepth-top of liquid d to inlet inve rt.rf Na , _ Depth.of solids layer: n!a ' Depth of scum layer Na Dimensions of cesspool: Na Materials of construction:_. nla Indication of groundwater: rd inflow(cesspool must be pumped as part of inspection) , nla , Comments:(note condition of soil, signs of hydraulic failure, level of.ponding; condition of degetation, etc Na ------------ PRIVY: (locate on site plan) Materials of construction: nla Dimensions n/a Depth of solids:,nla Comments:(note condition of soil, signs of:hydraulic failure, level of ponding PrivyComments , condition of vegetation, etc.) (revised 11115l95) a - r e ?ter v .. .;. .T.- T,.rY:n`zE...at'+Trr,.+-gym:-++:--i,;...--�.-.. .•: i.♦ � f .. .M� l .. .. - .'j.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM = PART C SYSTEM INFORMATION(continued) - t. _ 7. — 41: Property Address: 54 Shady Lane Hyannis own Brown:-Box 463 W.Hyannis Port - Date of Inspection:.l0108196 SKETCH OF SEWAGE DISPOSAL_SYSTEM: ` include-ties:to at least-two-permanent-references landnarks or benchmarks locate all wells within 100' JI w r 4_ r - C A6 �� gJ " 9 Q 5 2 cc S3`� DEPTH TO GROUNDWATER Depth to groundwater:12 feet . method of determination or approximation: USGS Maps and Charts A, (revised.11115195) TOWN OF BARNSTA13LJr LOCATION SZI Sbadg LnJ- SEWAGE # VILLAGE ' Nc�a+np; s ASSESSOR'S MAP &LOT o24-9-/30 INSTALLER'S NAME&PHONE NO. EXCCk6CX)ion Sob• y77- DGS3 SEPTIC TANK CAPACITY L,; oa 9 0� LEACHING FACILTTY: (type) . C�a�-S rs t 2� (size)�3 x o�5 x a ,y NO. OFBEDROOMS 3 BUILDER OR OWNER • c r -! x c-cv ;v PERMTTDATE: - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet j Private Water Supply Well and Leaching Facility (If any wells exist • on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i ,I C 3 -G a o 13S •yo' Rises B Rcar O. C.6 A �k TF'ron4 I TOWN OF BARNSTABLE CLOCATION , .�Z shadq LnJ: _ SEWAGE # 0006 - a?/2 `VMLAG _ - ASSESSOR'S MAP & LOT o7G 9- 130 VE, INSTALLER'S NAME&PHONE NO. B _f3 EXCaucx-lian ,�SoB y77- DGS3 i SFPTIC TANK CAPACITY /SOO q C J 1EACHING FACILITY: (type) Q�QM.ScrS' L2) (size) 43 X a5 X A NO.OF BEDROOMS 3 BUILDER OR OWNER -k-b�to) ac-rnotrott, c 4 Xc.cv i v �i PER MTTDATE: '-S'DL COMPLIANCE DATE: �3 Separation Distance Between the: 4 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �Al- is ' .BZ •iy' y E 5er c 3`6a L3S •yo' Rises B O Rcar A .DccK " Fron-1 Q TOWN OF BARNSTABLE LGCATION `7t 61004d r� SEWAGE # VIL LAG ASSESSOR'S MAP & LOT L o OPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ✓? OWNER PERMTTDATE: �� COMPLIANCE DATE: Separation Distance Between thirl",`� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by TOWN OF BARNS'1'ABLE :.00ATION .i s 141R� /._ SEWAGE .TILLAGE ASSESSOR'S MAP & LOT -INSTALLER'S NAME. & PHONE NO. 6f45 /5ao'S. Geri. 69L SEPTIC TANK CAPACITY 660 LEACHING FACILITY:(type) Pt� (size) a 6 a NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER U6/.I<- BUILDER O OWNER, 'iwx DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No _�i {. , ��, � - �'� I s�, ��� • 's� �;�, ���� r -- ,� SITE PLAN w ° c N O SCALE. 1 =20 BENCH MARK ON WOODEN DOOR L ~ M,q�N ST THRESHOLD ELEV.=100.00 ASSUMED 97 S RFFT y N o /O ' L g �r Shady 9" 4, ON a ' .,,' ����'N `� Soo'` � SITE Rd 97 a Sauna Rd �I "HYANNIS" terlin Rd. o� o° B. LOCUS SCALE: AS SHOWN 99.47' O° �. Design Calculations O Number of Bedrooms: 3 Existing j OWk�STj Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN b Septic Tank Capacity Required: 330 gpd X 200% = 440 gpd ' g0.45' Septic Tank Provided: 1,500 gallon EXISTING PROPOSED SAS 41 dia.,,,, ,van+ ¢ �,� Leaching Capacity Required: 330 Gal./Day 1-25'L X 13'W X 2.0' D NG SAS TO BE . Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. leachingtrench using 2 9a74' 4f° OP PED AND BACKnu-ED Proposed Leaching Area Provided: 25 X 13 X 2.0 = 479 SQ.FT. LOT 56 Total Leaching Capacity. 355 gpd > 330 gpd. req'd. H-10 00- alion chambers gt143'with 4' of s one all around. o AREA= 250 Q.FT. '' GENERAL NOTES 1. ADDRESS: #54 SHADY LANE, HYANNIS 9t193' .` 2. ASSESSORS NUMBER: 269-131 t 3. DEVELOPER'S LOT: LOT 56 ' 7 Ce vna 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ? 6 ° r-s• 5 ON THE GROUND INSTRUMENT SURVEY. 69� G y4 b Q4� +y0 ..,••�:..•t,' 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. �� TH R1 Y�' 6. REFERENCE PLAN: LAND COURT PLAN 113288 - SHEET 2 ?�O+QO� y �o�� �-m'aw M $ 7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF SAS. 9z52' fro ti O „ 8. NO ABUTTING POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. 9&53' X O C O 0 34" 9. UNDERGROUND UTILITIES LOCATED PER DIGSAFE NOTIFICATION #20061406045. �s C3 C C3 0 �24" STEEL , �NFORM PRECAST CONCRETE 2 H-10 -O al. chambers END-SECTION -. CUNS T RUu IUN __N_0 I E5 I 1. Contractor is responsible for Digsafe notification �1s9 sy H-10 500 GALLON CHAMBER and protection of all underground utilities and pipes. NOT TO SCALE 2. The septic"tank istribuVon box shall be set level on 6 of 3� I 4 -11/2 stone. \O'QO USE ACME PRECAST OR EQUAL 3. Backfill should be clean sand or gravel with no O�"90 stones over 3" in size. PERK TEST & SOIL EVALUATION 4. This system is subject to inspection during installation 9e7a b Glen E. Harrington. R.S. DATE OF PERC TEST & SOIL EVAL.' APRIL 19, 2006 t 5. The contractor shall install this system in accordance TEST PERFORMED BY: GLEN E. HARRINGTON, R.S. with Title V of the Massachusetts Environmental Code EXCAVATED BY: JOEY'S SEPTIC SERVICE and the Regulations of the Town of BARNSTABLE. PERK RATE: USE 2 MPI FOR DESIGN PURPOSES IN C2 6. Provide an Acme Precast H-10 DB-3 DISTRIBUTION BOX and 2-500 gallon H-10 leaching chambers or equal. 7. No vehicle or heavy machinery shall drive over the Test Hole Test Hole septic system unless noted as H-20 septic components. No. 1 No. 2 8. Install gas baffle or equal on septic tank outlet tee end. DEPTH SOILS ELEV. DEPTH SOILS ELEV. 9. All existing inverts and site conditions shall be verified by contractor. 10. BOARD OF HEALTH AND DESIGNER ARE TO INSPECT AND CERTIFY INSTALLATION. A A 11. The existing SAS shall be pumped and backfilled. 10YR4A 101114/1 H 4 PVC vent with carbon filter as shown in site plan. 10• LOAMY SAND 7• LOAMY SAND 12. Provide one 4 dia. SC 0 C Bw Bw 7.51n4/e 7.sm4/6 27• 1 LOAMY SAND 95.75 S " LOAMY SAND 195.83 cl 56• Nome/4 2= 56• 1O1Re 4 REVISED: AY , 2006 PER BOH COMMENTS L,�,02 MW,° ��K�P AS PROPOSED SEPTIC SYSTEM UPGRADE eaW eaa _ f 2"5-7/4 251x7µ U L G PREPARED FOR HA ITN TO ---IPAUL BERNARDI, REALTY EXECUTIVES NO GROUNDWATER ENCOUNTERED 0. 1070 co AT *NOTE: ALL PIPES ARE TO BE 4• DIA. SCHEDULE 40 P.V.C. #54 SHADY LANE *NOTE. INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. LEGEND S,9 G�STE R,P to' min. from Provide 4' dia. SCH 40 PVC vent with carbon filter PERK TEST LOCATION BARNSTABLE (HYANNIS), MA house to septic tank Existing House tank cof ome u ed gradeFinished grade over system-2X slope away PREPARED BY: EX/51I of DST.Box °NErodnaaMa t be EXIStIrI Grade Elev.=98.5't O PUMPED D BACKFILLED -ISTING SAS TO BE GLEN E. HARRINGTON, R.S. D-in 8 of mast b. , 2._,,,•-,,r r mY,. 0 EXISTING 1500 GAL 9 L E DA ROSE LANE U + S-0.02' wRhN 0 of shed prods double-wosh stony •max , O O O 17 g G Lwa Tar 2' one Elev.=94.2 f H-10 SEPTIC TANK Cedar 1�10�C� 30, ' 13 ' X 104.46 DENOTES EXISTING MARSTONS MILLS, MA 02648 SEPTIC eAFFIE _ ' P= ' e o 0 0 0 24' SPOT GRADE Leach TEL: 508-428-3862 00 31e-111r 2s' Trench Elev.=91.65' s5 EXISTING CONTOUR FAX: 508-428-3862 Existin , DOULRLE-WASHED S EACH TRENCH 5.2'f (5' REQ'D-CONFIRM 5' OF PERVIOUS DEEP TEST HOLE e•aF 3/4•-II/2'STONE E=94 = SCALE: 1"=20' DRAWN BY: GEH MAY 2, 2006 E_ SOIL UPON INSTALLATION) SYSTEM PROFILE a•OF 3/ -1IIr STONE APPROX. LOCATION 4• Not to Scale IJOTTOM OF T.H. #1, ELEV.=86.5' EXISTING WATER LINE DATUM: ASSUMED FILE: KALWEITSHADY SHEET 1 OF 1 WVZS'13VL901919- 1. A0'dd INIH(TV SJNI113SGN'VS1NDHnooa 0-M-M