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Home My WebLink About0131 SKATING RINK ROAD - Health 1-31 Skating Rink Road Hyaniii A= 291 — 057 _ r n Tj • ° r u , , ' I : : Y SI r: .., ., �''.t `�' , '' .l • - '' it ',w � N � '�. . n i'�U v v a r , "+ 0 r Q , 1 1®®/6` P°�' 153113 hE n 1 _ ik : Vv D , p x d i C a . 1 to lO } a � k t s, a Q _ 1 A) —s e%�.A ,ion ,. L4-- Z4 v 0 o (XN cr , v 4 � i C P �` i i l � f � � ,� �' �� 1 �- T� � � Y � � t1 i , \! � � � � .� � a .�� , cjcm 1 r - r W TOWN OF BARNSTABLE LOCATION. 13 I S k 2+1�1p� n�C. �• SEWAGE# zD (z- d 4 4 VILLAGE H VQ flf11 S J ASSESSOR'S MAP&PARCEL X91 y 5-7 INSTALLER'S NAME&PHONE NO.-Bf B Ex r-Q YG►i 10(1 (5 o%) 4-1-1 -gb53 SEPTIC TANK CAPACITY 1500 LEACHING FACILITY:(type) (?!D D ArC. 36 (size) (Z)fTet1C e5 SDI NO.OF BEDROOMSrj OWNER PERMIT DATE: ,L-2,N'('Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist 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 dal" 31 &d Az- 39' As-32. ,B3' 114 ' REAR Ay' 3`{''Q A --' Bq• z7,44u a iO O 3 O No. �� THE COMMONWEALTH OF MAS.ACHUSETTS FEE BOARD OF HEAiLTH ---ro NN Q OF *13a('()s+ab APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (1/) Upgrade ) Abandon ( ) - [:)Complete System [:]Individual Components a —1 _R60(C. 1 � 131 s Na e Map/Parcel# 5 Dq ` 3 6 y r s CAVW �Lot DO VJ T ephone# r/ ns Ile's Name a/ JA C1 I �Dpsign is me —6 R- dr vi � DO ��(Y�V t ess Telephone# Telephone# Type of Building: 7ze� i C iply t. Lot Size Sq.feet Dwelling—No.of Bedrooms .s Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures c Design Flow(min requirt J�7 ® gpd Calculated design flow gpd Design flow provided `s0 gpd Plan: Date aa. Number of sheets Revision Date Title C-) 661 t� V 1 Cl o Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ��' Date � laq 11Z Inspections �J ��— FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 j.n"j,,.dw'ir'R.e'sr,r.,•.4y(t++'M� �.s�:.F'RfMr++'fi�,dr'.'�* ..... � .:_., �„ �.,,,,� _ f��n"n ,^ ykv �.::•.:.:..-+ � oq4 _ \ ,7 No. THE COMMONWEALTH OF MASS-4CHUETTS FEE � B O A R DO F A LT H�. `// " 0k/qn OF rn [(.W l , APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (`/) Upgrade jloAbAddon ( ) - ❑Complete System [:]Individual Components 31 S�dfina talc onl o n n I e <�an IQ,P J ij°Ce 1 5 7 131 5 Vn IM w `iSr?-K -Nvann Map/Parcel# /_ �/]Qddr s P i� Lo � lJ 7� (� `T1�7e�phone#. � i _�X«vQ �0 1 Oven C�.0 Ana npNina nst�al, ler.'s N e `��1�� l t f 1 'gn, t Telephone# Telephone# e5i Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms g ( ).� Garba e Grinder •,;;. Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures L Design Flow(min.arre uired� J6 0 gpd- Calculated design flow gpd Design flow provided 5S0 gpd Plan: Date a) . .( Number of sheets Revision Date Title i o l.P C) l IGn Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not�to "tmhe- m in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date � ►au 1 tZ- Inspections s i FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. ;o0-- 0-1 THE COMMONWEALTH OF MASSACHUSETTS FEE !_ D({)54"LC-BOARD OF .HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigne�d hereby certify that the Sewage Disposal System;Constructed( )-Repaired(Upgraded( ),Abandoned ( ( ) at 13 ( 1�1� 11 Q K, 1 L-L, i has been installed in accordance wit the rovisions of 310 CMR 15...0_0 (Title 5) and the approved design plans/as-built Tans relating to application N( - -B - dated a ' Approved Design Flow 550 d P g PP PP g (gpd) Installer' 1 oh c,(+- -(—Ik' I o �/ Designer: Dohm n ( / Inspectcz k��. The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 , r 'i No. TH" E�COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Re air (✓)} Upgrade ( ) Abandon ( ) an individual sewage disposal system at 3 K,Q I fla I ( f)(�(y f as described in the application for Disposal System Construction Permit No. 90 _OLl / dated Provided: Construction shall be completed within three years of the date of this permit.All local ccondilio Sstbe met. a - Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W Homs&WARREN TM PUBLISHERS- BOSTON FROM :down cape engineering inc , FAX NO. :1508362988o Mar. 02 2012 11:05AM P2 v `Si -Is•.'. F��E:�1 � ll'ii�?34�?ll li. Qv�ACtl'.T"; b T�1r'°CSiLal�' * 3BII.risFABL& Thumas McKean, Director �o. 1�ti9•/•;dry 7,00 Nbim °�43'E'T4,HyRunis,PU(126-01 Office; ..,,fP,-3G2 4F,44 QpTsitaa.VBtT- r :I14:$Emur Cerfi}IivaCt ) D FrnMr 1datiV : }J�Z t.�Y aR�9��1C l°a vTrtnA7;°i �0 4 .r4�sc��At1ti'' Ad[dress: `V3 Nl*►,a..s i3 On ti -�H - t-� -.� r!�? k��.I-_— watt It*--uad a porinit to -LL4stali a (elate) (in:,la'leT) . scptic system at—��i ka. ,-1,,t (� N,� a('� --I»5ed q�t x design.cirau��lxy (atclr_lrc:sa) I ce,tify that Lh.e svp& sy-s :au.Tu-.erenced was ➢astall.�,,d ;iubslanliall.y rt4 coi7tiiug to he, ,irsi>;T1, -Wl"ich may include rninrir app.znvd df rJ,9fE ;eS ,sucli as lat.eral relocaxLiuri of tb.e distribccalM box anti/or septic,tank. _ I c-eaL y that. #}lp. septic --y te.rn. a'efeA'ea,.P°i ;lbow 'vvis crlstaIjed with. majnr -harigc;s (i.e. ga:ai(ur tha.ri 10' la#.e.ta.t t'elocatiorr of thc: SAS or auy vcrtical a r:locati.on.of ally compunuait of tYle, septic: sys#e a) but in-a.ccorclarv"o withS#ati:&. Local.E:r �a,l.ztians. Plan.revi�:ion ur cei�if_ied a4:hrtilLby da; i.prrT�a to li�llr;w. (N OP DANI51..A. ��(Jjr,taeT'„ .figT ttr c: CA A No.46502 1 r� 41 'ONAL (T—h;Sigic-E'S i]1}?11,:t17Le) �L ix...lyc:slgjn.e)''`; Stamp l:issru) r i<t TITTclT 'TAD i—i4.�&.'CA-1..1L1E, , f'UBUC HIFAf:V'iH. D.IVI;�;ION., CE.1,71 ICA'1-E O %OMPLIIAIiCh `tit U,*f; NO O—v, %rip'➢.l, BOT F TM3 FO.TAi,k A"41) S,-Bg.>-rLT,CARET )177F4�F1fF;�]C?.BY'1'11R➢A,-RNSTABL1E1PUJ.T1g.BCFY_+,,,*T_THP�i�[510N, T AT/4KVQU., C�- 'caltb/Srp�z° e.;ianer cntficaiianPorm 2-6-0,I°,im Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 131 Skating Rink Road Property Address Bonnie Cooper a Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection �y IV ui W�: Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 6/fit ,/{,LZ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13640 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 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-14-16 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. ****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. ' I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. 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 FIND (Explain below): t5ins•3113 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 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less El ® than '/z day flow t5ins•3/13 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 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection B. Certification (conf.) 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. 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? ® ❑ 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): 5 Number of bedrooms (Actual) 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes M No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2014-82,280gallons 2105-58,344gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pump 2014 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Tank size Reason for pumping: maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Septic Tank(locate on site plan): Depth below grade: 1 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 Sludge depth: 5" t5ins•3%13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. 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 31" 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 15" 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.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank was pumped after inspection for maintenance. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is Hyannis Ma 02601 3-14-16 required for every y page. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �nM 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up or carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes. ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2) 50' (20 ARC 36's) ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection with no sign of 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-3/13 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 °.H 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•3/13 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 ^M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 001 Al 11 " B .1861 ;�. V 6 11 1 0 2' - 4! 4` " �, # t5ins•3/13 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 ^M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. Cityfrown 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: No GW @ 120" 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: 2-22-12 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 131 Skating Rink Road Property Address Bonnie Cooper Owner Owner's Name information is required for every Hyannis Ma 02601 3-14-16 page. CityFrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 BIKE 1�1 iDepartmont of).regulatory Services / 02 BARNITABI.6, J[�(��.J��tll� ]Date 200 Main Street,Hyannis MA 02601 �p 16 1-40--/ /00 Date Scheduled_ Time / Fee Pd. 6L ,foil Suitability Assessrizlent for SeMage Disposal 1'crYonned Dy: cow-0 tlnessed By.: � � - ][ O CATI ON & G]CN 1 RAJL I[NFORNU7 ION Location Address Q�l n//a�f h p Owner's Na6ie �O r t IJ K n � ,K/ Address At j Assessor's Map/Parcel; GCaL�`/�`1 Cngiucer's Namc 0 NEW CONSTRUCTION REPAIR Telephone It Land Use Slopes(%) Surface Stones Distance's from: Open Water Body 11 Possible Wet.Areq ft Drinking Water Well ft Draiha.ge Way V11rr ft Properly Line ft Other '�� t`t SKiE'd CH' (Street name,dimensions oY lot,exact locations of lest holes 8c pert tests,locale wellands'fn proxindly to Boles) /< to/ i. //v Parent material(geologic)of wASJ i— Depth lU Bedrejelt, Depth to Groundwater: Standing Water in Hole. Weepllig hill Pit RQU�ov Estimated Seasonal High Groundwater ]DE,T ERAIINATION FOR SEASONAL HIGH WATIER TABLE Method Used: f Deplh,Observed sLnr.ding ia,ehs_.h 4ole:. X �In. 'Depth iU541!Ikiutl li:- 11G" Depth to weeping from side of obs.hole: -__--._„_,hJ dYuulldWlttSY.AtI,f u9lhlent„a ._r- fC. r index Well 4F Rcading Datc: Index Well]IV., Ad.].6.wtoj, Aral,C roultdwater Isevel° �- IC'ERCOJLATIOZW rA')E ".Q' Vht4 77 A'luw WT •---- Observatimi Hole# Time tit 9" Depth of Perc T]rty at 6" wF R Start Pre-soak Time @ / 1 _ Time End Pro-soak A �� T Rate Min./Inch Site Suitability Assessment: Site Passed SiLG Failed: Additional Testing Needed(YIN) .N Original; Public Health Division Observation Hole Data To Be CoinpleLed on Back--- - ***If percolation test is to be conducted witirin 100' of vvetlland, you mU51t)[Illt'slt uaott,ty WC Y3arnstable Conservatioli TA-vision at least 011C (1) Week priCir to begitudug. QnsEPT1C\Pt RCrORM.DOC r ID11C1EII0ri2on I'']f�VA'J<'10N>C)<—OL—+ ]L G Hole # Depth from Soillinrizon ]l�®�� # Soil Texture Surface(in.) � :Sail Color Soil• �. (USDA). Other (Mansell) Mottlin g (Structure,Stones'; Boulders, Con ista c ra el C— C41 r -- DREP O_pS],_RVATjON H®]LV LOG Depth from Soil horizon ]F](ole # Z Surface(in.) Soil Texture Soil Color (USDA) Soil (Mansell) Mottling Other (Structura,Stones, Boulders. psis e c %Cravel Z y_ZU CW _ /1l cv n DIEI P OBS ERVA7 ION J[T®>[.,]E ]LOG De th from Soil Horizon ]6 ole.,# 5i�rface(in.� Soil Texture Sall Colo[ (USDA) Soil ) (Mansell) Other Mottling (,structure,Stones,boulders. (''00sistencV.9a t7nvell -- —_ — ]D)IEE11" 0]?,SJCq VA?I'1ONJl OLE1 ]LOG Depth fi•om Soil Horizon Hole# Surface(in) Soil Texture Soil Color (USDA) 5'0l1 ( A) Other (Munsell) Mottling (structure.Stone5; Boulders, Conslstenrw_ ay oravtL) --�.- Mood Insauu•aunce][fate M nji : Above 500 yearflood boundary No Yes within 500 year boundary No_ Yes ' Within Ioo year flood boundary No� De tl>I 0f&04 lrd9yeCIRKE1_92 NirvMous A4ata?rla� .Does at lead .Four feet of naturally occurring pervious material exist in all areas observed tlll,ouhout the a]-ea proposed for the soil absorption system`? g If not, what is the depth of naturally occurring pervious material? Cen tfflcnfcson A cerdt/ that on '•1YG q (date)I have passed the soil evaluator examination approved by the 1110 re Uired training, Environmental.Protection and that the above analysis was performed by me consistent with IPte segttired training, expertise and experience described in VO CAdR 15.017. Signatur �v L r Date � . . Q!\SQ.P—rCTJ]P CCORM.DOC ...._-,-....,.�-.-.-+r,`•�*•la....r+.".r->. .^. ,->�..r�'h..r.+r-•t^d,--..,.r.-+,err'""`+"-rvr:q.rtn.,n•--rs>,-•w'r'�r+a,.+':h^-.•-t:�+-.s'-.�e«ri..r...-..w�'.�"V..,r.�.-1--"` .. .. -T�-.�.._..m.w-+rtF. —e-�._... TOWN OF BARNSTABLE BAR-W 5904 Ordinance or Regulation WARNING NOTICE 1 done f � Name of Offender/Manager ��,�/�" J'Y�. ( Address of Offender MV/MB Reg.# Village/State/Zip , , ,enr .A 0 Swine°s:s=N=ameIrs....1.). ��a`;�r ��t�(n 1�nr��•r�t ,,tr�€��t�, �wtr��°P� �. 7��am/pm, on q1-7/2044 . Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense 15Y., 1N,, rr 51 A 44,1,0We 'ar41J". �r�� /)-0/1 -� J l' Enforcing ,D'ept/Division Offense 1o%�Jn a �„��r � /P �G p "+ 5kf6AP et aorbi'40 0-Jr,b�''Sl► t/ Facts �nr�raA fah K G�.�.spt'r'G� #!rl +,rxa lrL� 016 0A %jr i+, y tf497I/Zf10.a1te)/L1a.7 tfN Gw ^ AY� t F r+SA tl f rAf t/r,1 fiR?7i,rs �a.3 1 h`f4 ii I' , i ,�f ( k '�f. r J cr LI> This will serve only as afwarning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 15 90 4 Ordinance or Regulation WARNING NOTICE Name of offender/Manager /"'Ivc I' " Address of Offender 131 1ki, 4 -1 R MV/MB Reg.# -) 01 Village/State/zip I o j 6 am/pm,, on 9171 2.V,6 Business Address Signature of Ehforcing ,Officer Village/State/Zip L6cation of Offense 1"V 7 Z �" Enforcing D6pt/Division > Offense t r: roc Facts vl V ky This will serve only as a/warning. At this time no legal action has bebn taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result' in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG,-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT Ln Q' Ul In ru Ul I- Postage $ (yIs l(� rq Certified Fee Postmark O ReturnRecelpt Fee C� 0 (Endorsement Required) 1 Here O Restricted Delivery Fee JAN 4 2012 1 (Endorsement Required) O Total Postage&Fees $ s a vsp r M Ms Bonnie Cooper --------- -------- N 131 Skating Rink Road _________________________ Hyannis, MA 02601 Certified Mail Provides: 4 o Amailing receipt ` `- o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: , o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is i required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.,Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN.7530-02-000-9047 - i SENDM COMPLETE THIS SECT16N COMPLETE THIS SECTION ON DELIVERY. ■ Complete items 1,2,and 3.Also complete A S' nature item 4 if Restricted Delivery is desired. X C� ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we Can return the Card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or'on the front if space permits. D. Is delivery address diffe �7 s 1. Article Addressed to: If YES,enter delivery s below:,� N Ms Bonnie Cooper N 131 Skating Rink Road Hyannis, MA 02601 3. service Type ❑Certified Mall ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �� (Transfer from service iabeq 7 011 0470 0001 4525 54951 ; I .PS Form.3811,February 2004... Domestic Return Receipt 102595-02-M-1540 :,: is l : t;i i� i� UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I I Town of Barnstable ' Public Health Division 1200 Main Street Hyannis, MA 02601 I I I I N I I I I � FSHE T� Town of Barnstable BgrnStable Regulatory Services Department ffi;ca�j� RARNSTrABLE, D "Ass. Public Health Division ArF°MA+a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5495 December 28, 2011 Ms Bonnie Cooper 131 Skating Rink Road Hyannis, MA 02601 0 YOU HAVE BEEN RESCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, February 141h, 2012 at 3 pm in the Town Hall, Hearing Room, 2nd Floor 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic • system at 131 Skating Rink Road, Hyannis,MA The State Environmental Code Title V Requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Q:\SEPTIC\Letters Septic Inspection Failures\131 Skating Rink Rd.,Hy,BOH.doc COMPLETE •N 1; COMPLETE THIS SECTIONON• ■ Complete items 1,2,and 3.Also complete A. ature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date oyDelivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 12 D. Is delivery address different from item 19 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No If, �M';Bonnie Cooper 131 Skating Rink Road i .Hyannis, MA .02601 3. Service Type ❑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 labeo 7006 0 810 0000 3524 5539 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 " UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division t 200 Main Street Hyannis, MA 02601 i i Q" • m " ,n F .' t.r I Ln m Postage $ M O Certified Fee Crt ' Retum Receipt Fee �Cj~ Here (Endorsement Required) C3 Restricted Delivery Fee � (Endorsement Required) ^�®1 M Total Postage&Fees �' J 'C l � Ms Bonnie Cooper �� S 131 Skating Rink Road Hyannis, MA 02601 £ertified Mail Provide : (as�enaa)ZOOZaunf'008t�oJSd a A mailing receipt o A unique identifier for your.mailpiece ` a A record of delivery kept by the Postal Service for two years Important Reminders: is Certified Mail may ONLY be combined with First-Class Mall®or Priority Mail®. n Certified Mail is not available for any class of international mail. 4 NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. 17 For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811 to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Deiiveryt d If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt Is not needed,detach and affix label with postage and mail. _IMPORTANT:Save this receipt and present it when Iriaking ali inquiry: Internet access to delivery information is not available on mail addressed to APOs and FPOs. CF SHE Tp� Town of Barnstable Barnstable P� �°' RV Regulatory Services Department A°�"� cac + + � ISARNSTABLE, + MASS. Public Health Division i6�q. �0 ArFD NSA a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F:Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5539 December 7, 2011 Ms Bonnie Cooper 131 Skating Rink Road Hyannis, MA 02601 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, January 111h, 2012 at 3 pm in the Town Hall, Hearing Room, 2nd Floor 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 131 Skating Rink Road, Hyannis, MA • The State Environmental Code Title V Requires all failed septic stems to be repaired or q P Y P replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Documentl Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , M 131 Skating Rink Rd I Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the._ computer, use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number i 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. Thel-inspecion was performed based on my training and experience in the proper function and maintenance of on si sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 ob Title 5(310 CMR 15.000). The system: qL t ca ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Eva ation by the Local Approving Authority w WA 0 W 11/18/2009 Insp o Ig nV re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. L� l2 o t5ins•09/08 Title 5 Official Inspection Form:Sub rface Sewage Disposal System•Page 1 of 17 i F.� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601, 11/18/2009 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. .Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 1 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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•09/08 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 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. CityrTown 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 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i F Commonwealth of Massachusetts Title 5 Official Inspection Form _ 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. E] ® 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 1.5,000 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-09/08 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 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 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? ❑ ® 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 El available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I IN Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The septic system consists of one main cesspool,one overfloe cesspool and one leaching pit. Number of current residents: 2 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 ears usage NA 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11/18/2009 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-09/08 — Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 800 gallons How was quantity pumped determined? Measured Reason for pumping: System Full 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): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leaching pit installed 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' 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.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 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: Sludge depth: l5ins•09/08 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 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness I 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 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.): 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain_why: t5ins•09108 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 °M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. 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: 1 ❑ 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.): System is in hydraulic failure.Overflow cesspool and leaching pit were full at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 1 main and one overflow Depth—top of liquid to inlet invert 5" Depth of solids layer 5" Depth of scum layer 6" Dimensions of cesspool 6'x8' Materials of construction concrete block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. 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.): Cesspools were full at time of inspection. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 dap Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out In heR a A �, h• R K]1 J t r , ,♦ r X. 45.46 a ..3ti.•. b::S3' . Sh X 42:98 ' t4 .1 0 2,0 Feet -'- Set Scale 1" 20 I Aerial Photos I MAP DISCLAIMER r n—inhf )nor-')nOO Tn... of Rornefohln KAG All rinhfc recnnr, http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=291057&mapparback= 11/19/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. 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: Bottom of LP 28.2' 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: As-Built Card ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 131 Skating Rink Rd Property Address Bonnie Cooper Owner Owner's Name information is required for Hyannis Ma. 02601 11/18/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS R U I L D E R OR OWNER CDC DATE PERMIT ISSUED '' DATE COMPLIANCE ISSUED wow i cesspool irk ,�.�- 1/ L O CATION SEWAGE PERMIT NO. 44LLACE INSTALLER'S NAME i ADDRESS co rn t%T s_ 0 U I LL D_E R ON OWNER ® ATE PERMIT ISSUED DATE COMPLIANCE ISSUED' lo - - en THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair ( iv)"an Individual Sewage Disposal oc C.;io. ddress low or Lot No. Installer Addre"'S's... Other Distribution box ( ) Dosing tank ( ) Nature of Repairs or Alterations—Answer when applicable......... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provision s of'L I TL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued b the�Pard of health. Date Date Date --------------------- No................_....... `' .{► F�$.. s . ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q .'.......OF..... k efiw�F `.a p t-` ..............._.._..----•• AVVIirFatiun for Disposal Workii Tons rurtiun Virmit Application is hereby made for a Permit to Construct ( ) or Repair (p,'f an Individual Sewage Disposal System at: •----••-••--•-------------- � .....Yation=Address {� -;61elx ..........................•--••---...._._-or Lot No. �+ .....--• ------............................................... fi wngr { F Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling o. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers Other—Type g ---------------------------- P ( )--- Cafeteria ( ) dOther fixtures -------------------------------•---------------------...------------------ ----------------------------------------- .....----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank_Liquid capacity............gallons Length................ Width................ Diameter-_._--_--__..___ Depth................ Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------------------- .................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_-_-__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..:......__._.........__ Phi --- ................................................................................................. O Description of Soil.......... �' ..: ' = ..-•--------------------------------------------- U ---------------•-•----------•--•-----------••--•••-•----•----•---------------•-•-••---------------------•---•--•------------••---•--•---------•- W ------------•-------......................................................................................... ---- ----------------------------•-------------------- UNature of Repairs or Alterations—Answer when applicable..._____4_ .«!':_:::_Z........................................................ -•--....------•----•---••-----------------------•------------------•------------------------------.......--•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 by the hoard of health. P, Date. Application Approved By----------------•-•••---•-• ----••-------------•-•-••------ Date Application Disapproved for the following reasons--------------------------------------------------------•----------------------------------.....•............... -------------------------------------------------•------------•-----------....•---------••...-------••••------------------------------------•--------------------------------------------------••------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t c ..;.!..s ..:.:.............OF......-.:... aT.. ..r.....o � ....... ... . �..................... Trr#ifiratr of (funtpliFana THI, yIS,4TO ERTIFY, That the Individu�d Sewage DI sal System constructed ( ) or Repaired Install jej � � -- -•--•--------•--------------------------- has been installed In accordance'with the provisions of TITLE 5 of The Stat Sanitary Code as described in the application for Disposal Works Construction Permit No.......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FUWCTION SATISFACTORY. DATE....Z % ..............................--.--.--- ------.-.- Inspector.... .............................................-----••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE../O, 40 Disposal Works Tunsirudiu amit Permission is hereby granted . . '!` .....1`!....--% ..... ................................... to Construct or, air ( „) p ( 4 an Ind v1d Sewage Disposal ystem 5 Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... " ---------------•---------------•-----•-------•----------------------------------------•---•••----......_ Board of Health DATE................................;.......................................... FORM 1255 A. M. SULKIN,-INC., BOSTON i SYSTEM PROFILE NOTES ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NOT TO SCALE) PROVIDE MIN. 20" DIAMETER WATERTIGHT COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO �� s TOP FOUND. EL. 34.3 WITHIN 3" OF FINISH GRADE 2. MUNICIPAL WATER IS EXISTING ` c 0 33.0' 2% SLOPE REQUIRED VER SYSTEM 32.35' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. `Qc MINIMUM .75' OF COVER OVER PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST ISE s��>YP.j° UNITS TO BE AASHO H-M 2'0 31.46' 4"OSCH40 PVC o «, PIPES LEVEL 1 ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. Hyo E { *30.65 " 1500 GAL H-10 y. /em. Scen t( e t 29.35' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE s 5t. 10 t 4" WITH toc r{e� tlor 30.29' TEE SEPTIC TANK TEE 0.04' St. 000000000000 310 CMR 15.000 (TITLE V.) 3 Mitchells oil GAS BAFFLE: �4ogog000°o° 28.92' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 4' LIQ. LEVEL (ACME OR EQUAL) 29.12' 28.95' 0.9' z NOT TO BE USED FOR LOT LINE STAKING OR ANY w .:. 28.02' Cl- eo OTHER PURPOSE. `� o°o•o 0 0 0 0•o 0 0 0 0 0 0 0 0 0 0 0 0 0 0'o J�' m tlh N M 20 - ADS ARC 36HC CHAMBERS .. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. West Moin S. 5t. (NO STONE PROPOSED) 0 w *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL s' CRUSHED STONE OR MECHANICAL a a 9. COMPONENTS NOT TO BE BACKFILLED OR cJddel COMPACTION. (15.221 [2]) 0 a CONCEALED WITHOUT INSPECTION BY BOARD OF `' �e• UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS a HEALTH AND PERMISSION OBTAINED FROM BOARD F PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 5.67' OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP MIN. CALLING DIGSAFE (1-888-344-7233) AND (2__O X SLOPE) ( 6 X SLOPE) ( 1 X SLOPE) VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ' LEACHING BOTTOM OF TH1 22.35 WORK. FOUNDATION 18 SEPTIC TANK 16 D' BOX 5' FACILITY NO GROUNDWATER ENCOUNTERED ASSESSORS MAP 291 PARCEL 57 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE, PROPOSED LEACHING FACILITY. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND BY HEALTH INSPECTOR AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 99- EXISTING CONTOUR BY THE BOARD OF HEALTH REVISED DURING A PUBLIC SYSTEM DESIGN: X 99-1 Exlsr. SPOT ELEV. HEARING HELD ON AUG. 4, 2009 -{ -- PROPOSED CONTOUR FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO GARBAGE DISPOSER IS NOT ALLOWED FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED DESIGN FLOW: 5 BEDROOMS 0110 GPD = 550 GPD 198.41 PROPOSED SPOT EL. AND INSTALLED (10' OR GREATER ALLOWED). TH1 USE A 550 GPD DESIGN FLOW TEST HOLE 2� `S� T/11/(� 36 R, SEPTIC TANK: 550 GPD (2) = 1100 SLOPE OF GROUND 17 KR�iQ� USE A 1500 GAL. H-10 SEPTIC TANK UTILITY POLE 3.00 33.27 I - FIRE "HYDRANT 70.00' 33.52 ` 3 Y9�-- LEACHING: I �_ 32.69 7.79 SF/LF x 5' LENGTH = 38.95 SF PER ARC WM- NOT"LL SYMMS MAY APPEAR IN DRAMANG 33.7 A_40 BA24 36 CHAMBER IN FIELD CONFIGURATION R= 1 97, 550 GPD/0.74 GPD/SF = 744 SF LEACHING TEST HOLE LOGS \ 3.52 REQ'D 3 3.55 33.40 \9yF 33.27 33.8(�AVED DRIVE 744 SF/38.95 SF/UNIT = 19.1 UNITS 0 ARNE H. OJALA PE THEREFORE, ENGINEER: 33 27 ` (+ 33 77 3 59 33.47 USE GRAVELLESS SYSTEM OF 20 WITNESS: DON DESMARAIS �' 3 85 LOT 11 H-20 ARC 36 CHAMBERS IN FIELD DATE: 2/22/12 33.47 33.46 12,524 t SF CONFIGURATION SHOWN PERC. RATE _ < 2 MIN/INCH 3 20 UNITS x 38.95 SF/UNIT = 779 SF 779 SF (0.74) GPD/SF = 576.46 GPD (OK) CLASS I SOILS P# 13551 32.51 EXISTING DWELL. ELEV. ELEV. ^' TOP FNDN. - 34.3' w rn Q, FULL FNDN. b 0„ 32.35' 0" 32.35' °° SHED N -.� MA A A 32.36 APPROVED DATE BOARD OF HEALTH DECK LS LS 6 - 32.31 1 OYR 4/2 1 OYR 4/2 x 33.32 BENCH MARK - CORNER OF TITLE SITE (PLAN 6" 31.85' 4" 2.02' M x 33.0840 IL LINER �x 33.3 CONC. BULKHEAD EL. = 34.3 33 °° OF B B x32.17 OO Ls Ls 31 ,58 TM�' - 33 92 ' 6 2.24 131 SKATING RINK ROAD „ 1OYR 5/6 „ 1OYR 5/6 � 24 30.35 24 30.35 '` 0-'32.35TTMs HYANNIS ■ 4 62.1. PREPARED FOR ■ �N 2.29 4 PERC B&B EXCAVATION/ 0 48' g 111.19' PROVIDE 30' OF 40 MIL LINER AT 5' COOPER MS MS 10.00' OFF SAS IN AREA SHOWN. TOP AT ELEV. 29.35', BOTTOM AT EL. 25.35't DATE: FEBRUARY 22, 2012 2.5Y 7/4 2.5Y 7/4 6 lOF off 508-362-4541 a`�✓' icy �� xn\ fax 508-362-9880 RN E H. i f L �s downcope.com OJALA a. " Fes" CIVIL ' LA �/ Inc, 30792 �� No. I� .,I 1 ROW47 cape e/ 1ftd9efiag, idc. 120" 22.35' 120" 22.35' i civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' � �sv� fr" ` / ... land surveyors - 939 Main Street ( Rte 6A) >2-027 0 10 20 30 4o so FEET DATE ARNE H. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675