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0056 SMITH STREET - Health
56 Smith Street Hyannis A= 288 — 033 ' 001 1 TOWN OF BARNSTABLE LOCATION �� �C1 �� +•r M SEWAGE# O f O "VILLAGE ASSESSOR'S MAP&PARCELd& "33— f INSTALLER'S NAME&PHONE NO. � a 9 4 0( b SEPTIC TANK CAPACITY t S O6 (S"A' LEACHING FACILITY:(type) O e., t size) (o .3© -�Gwa NO.OF BEDROOMS OWNER W%I-e, r 'PERMIT DATE:T COMPLIANCE DATE: �a,I (� Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3Feet 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 1 300 feet of leaching facility) 1 Feet FURNISHED BY t l f' 9 0 , it 1 uj � 3 c k- , 3' Clt aG -C 1 No. Vt` �f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS appflta6on for' Vejosal *pstrm Construrtiun Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.�`�(p .5 ` s"r )4p%nk%) Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel Q 3 66 "i Installer's Name,Address,and Tel Nqq. Designer's Name,Address and Tel.No. S'LoA(`^ IPIL_ C I1� Cold u�ter.v�ri�. 5tcke_ 0-4..ws Pox I I. M Type If Building: c Dwelling No.of Bedrooms pp Lot Size �S'S`���i' sq.ft. Garbage Grinder(40 Other Type of Building 1 GI�K/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3.5"S, gpd Plan Date_- y a C, ®1 Number of sheets 1 Revision Date Title Size of Septic Tank 1 S`0u 6,L 4-4 1 b Type of S.A.S. L eo.Ck P►eld 16 x / (,max G T,cL Description of Soil . �) Cum J ZrCSC. QL41^ Nature of Repairs or Alterations(Answer when applicable) ;r,.n.n G n J S; ilk Icy 1 S+1 n& _��t f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. Signed Date p �n Application Approved by ne,%44 11,44-�P-5 Date Application Disapproved by Q Date for the following reasons Permit No. Date Issued � q.i,,,.--: Fee f . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication fa- I#lOsal 6pstem Construction Permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) Vcomplete System ❑Individual Components Location Address or Lot No. 5 ST /��/c�nn► Owner's Name,Address,and Tel.No. Assessor's Map/Parcel SC e,H G c.rO-e Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.�io. VrW�\/( ��� O(� 1t4��C��JI�,� (�� 16 {'soK 1 1 _ . Type if Building: Dwelling No.of Bedrooms 7? Lot Size f /sq.ft. Garbage Grinder(00 Other-� ),yType�of Bu�dipg.__ 4)y GI( y,, No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) gpd Design flow provided gpd Plan Date \ � f a(J .26 1 K Number of sheets Revision Date Title Size of Septic Tank 1. t i C,c t-( t b Type of S.A.S. Description of Soil �„� o � C, 1�< C ,n�4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: � •, rE,; r Agreement: �•, ?!}� � * ;r The undersigned agrees to ensure the construction and maintenance of on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place dsyat m in.operation until a Certificate of Compliance has been issued by this Board of Health. t Signed ----�-��"^ t JA Date Application Approved by ./ J Date 2 Application Disapproved by r Date for the following reasons Permit No.a 0 t `,a_Sf Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by /V to M tF g A.6A 04 at !�:X ,.A i�s1 W� �� , � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installet � -�,,,V( Designer l,t<,r r G #bedrooms Approved design flow — gpd The issuance of this pe it shall not be construed as a guarantee that the syste will funct si aed. Date. Inspector --------------------------------------------------------------------------------------------------------------------------------------- _ Noav__ ' �� � Fee THE COMMONWEALTH OF MASSACHUSETTS ` v PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( X Upgrade( ) Abandon( . ) System located at �` S MX.I Lt.�✓ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date if/f Approved by �� _ Town of Barnstable Regulatory Services Richard V. Scali,Interim Director �g - 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: 3 I 01 1 1 Sewage Permit# 61�/0"Assessor's Map\Parcei7- 3�' Designer: S ki l E1J X. hA Jk!>,PC Installer: 15 l-k �►�—�+��-" Address: tL Address: ll3 ®t. t�, YAeJ40V_r14 On b 1 5 5&Tr k— was issued a permit to install a (date) (installer) septic system at M based on a design drawn by (address) '" E�6:3J �fiFdated 1 a it ha b 1 r Q / (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. i t I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i. Ii.ance with the terms of the IAA approval letters (if applicable) a (Installer's Signature) l (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. ' THANK YOU. — QASeptic\Designer Certification Form Rev 8-14-13.doc y� Permit Number: Date: Completed by: HIGH GRCiUND-WATER LEVEL COMPUTATION Site Location: .l n ('11._Zlh_� r i \ �/►(,AALk ` > Lot No, Owner: Ads: Contractor: Address: Notes: STEP 1 Measure depth to water table _ Li • to nearest 1/10 ft. ................................................:.........................,.... .Date ` 1I , month/day/ ear STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: U1, Appropriate index welt............. r (�8 Water-Itvel range zone ............................... ... . STEP 3 Using monthly report "Current l Water Resources Conditions" determine current depth to 1 water level for index well ........................... month/Year STEP .4 Using Table of Water-level Adjustments for index well (STEP 2A),•current depth � . to water level fcr'index well (STEP 3), and water-level zone (STEP 28) determine water-level adjustment .................................... _ a STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) , from measured depth to water level at site (STEP 1) ....................................................... oFTKE r� Town of Barnstable Barnstable Regulatory Services Department j e'caC j Public Health Division m pTe°f"A�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9262 October 24, 2018 GARVEY, VALERIE 48 SMITH STREET HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 56 Smith Street,Hyannis,MA was inspected on 09/29/2018 by Sean.M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The'irispection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an + overloaded or clogged SAS or cesspool. The SAS is in hydraulic failure. You are ordered,to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\56 Smith Street Hyannis.doc Town of Barnstable " - ,.'"°" r _ ` Public Health Divisioni * 41C 200 Main Street �U gM P?STARE PAID " 9a'prFD MAC Hyannis,MA 02601 -, HY-4 NIS PORT,MA C 02647 CT 24 18 7015 1730 0001 4987 9262 P QM0Un1T 7 osrei 1000 .._ 02601 ��. / O is R2305K131865 10 V � fl 1i L I GARVEY, VALERIE 48 SMITH STREET RETURN TO SENDER NOT DELIVERABLE AS ADDRESSED 4 as sm a-a c+,L E TO r as n AIR' I EC; `0` 2501.14902t1�ai0 * C522-:17 400q2 -42 4-44 i„•i. [-�''^':.L3&': v, �7f0i�1 11 ]i I ii � 1�1�1,1 7�8 i t�i 3 1 �6�01�3138t 02601>40e ld!aoaa wnlaa ollsawoa £506 000 ZO-0£4L NSd S LOZ Alnr'L L8£wao=l Sd ! iaen1180 pe1014say faani!ea paiouisea uopmuyuoo aminft p 1 2926 Z 8.611 2 0 0 O E Z'L 5'L 0 Z VaU011eUU11UO3 aJn4eU61S❑ /aanl190 Papuisaa Nan!jap-ao iaalioa-❑ ildge�ao;nras wog as/sue71J aagiunN alo!iat/ Z 1� l /G8n10"9 !aa uo loallo 0❑ jo;de p1yne Un u ! Wpe3}Ja t-119ti EW P8JlNeCM I 0II£I I9IIbILII£I IZI£I0I 8 II6II9ILII£II IzI�0I t1I6�I0I�6II9I�6 Paa ❑ UPe3oueHIe n!!a0paiouisayeanieu6!s iinpv❑ ul!eW PajamBou El eanleu6!S.mw❑ ®sAx3.!eW/4uoud❑ edRl ao!naS I I•g W9Z0 VIN `SINNVAH 133a1S HlIINS 817 3JIHDIVA X3A JVJ I 9N❑ :moleq sseippe A amlep aelue'S3,k 11 ! sek El L L wet!tu04 lua'a};!p ssaappU/aan!IaP sl 'a (a!ogty •L i s}!uiaad ao`etls;i;uoa;-aye uo ao jtien!!ap;o alea p (aweN pa;uud)Aq Pan!aaay g 'aoaldlletu eqj 10 Nouq a43 of paeo s!43 4oall`d aassa�p y p nog(of p eo a41 uanlal uep am leyl os I WOW p X asaanaa a41 uo ssaippe pue aweu.InoA Mid e atnwu6!S d £pue'Z'L swan 9191dwo0 ■ 1-777 I Is Town. of Barnstable rnstable P It 1sg13 Department of Regulatory Services H ,AnNar�� a Public Health Division Date 0l171, .MASS. _._.. ra�v 200 Main Street,Hyannis MA 02601 � rEtt n+xt" Date Scheduled A/ Tune Fee Soil Suitability Assessment for Se e Disposalk. Performed-By: Witnessed Hy: LOCATION&.GENERAL INFORMATION Location Address S� �`,� �� -S Owner's Name °11f,y Address Assessor's Map/Parcel: ` �� / O l® v I Engineer's Name vk/-4-s NEW CONSTRUCTION REPAIR Telephbne# To a- Land Use• /'Z&5r.bc��-77 4—e- Slopes(96) Z Surface Stones Distances from: Open Water Body ®a'° ft Possible Wet Area / �'—Oft Drinking Water Well ft Drdlhage Way i ft Property Line >o ft Other ft j SKETCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands-in proximity to holes) • � /H Ko,vg f2vv7 MAI Is Parent materiel(geologic) Depth to Bedrock Depth to Groundwater. Standing Water In Hole: Weeping from Pit Fpoa Estimated Seasonal High Groundwater �.5 [ DETERMINATION FOR SEASONAL'HIGH WATER TABLE Method Used: vS 4 5 Depth Observed standing in obs.hole: In, Depth to sell mottles:In In.' Dolt to weeping from side of ob.hole: = In, Groundwater A&Atment dex Well-#Nr4i1-S Roading Dato. /o i 6 Index Well level -L A.dj,-factor Acj_Uroundwater-Levnt,. 7 PERCOLATION TEST DWO xYlnm /"; Observation Hole# Tinto at 9" Depth of Pero �y Time Lit 6' Ld Star Pro-soak Time @ �'�`� Timo(9"-6") Pro-soak L�S Rate Min./Inch L 7- Site Suitability Assessment: Site Passed Sitp FaIIcd: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conseirvation Division at least one(1) week prior to beginning. Q:ISEPTI0PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soli Horizon. Soil Texture Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stonet;Boulders. Consistency, vel) �(P L S I��� /2 3(, ,u01- � DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Sall Horizon Soil Texture.. Sall Color Soil 'Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency, t CP L S 3 LS lv �sl6 2 �° � ,L cif .• • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, omycl) Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification / I certify that on /t I y{F`f (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,a ertise and experience described in�10 CMR 15.017. Signature Datb Q;\SAFrlC%PBRCPORM.DOC �oFTr�r� Town of Barnstable Barnstable AHnRegulatory Services Department `���" g ry1 � BARIVS?ABI�, �` Public Health Division i639• �0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9262 October 24, 2018 GARVEY, VALERIE 48 SMITH STREET HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 56 Smith Street, Hyannis, MA was inspected on 09/29/2018 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an + overloaded or clogged SAS or cesspool. The SAS is in hydraulic failure. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health t Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\56 Smith Street Hyannis.doc Town of Barnstable a Regulatory Services.Department ED MA'l Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed ? pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑.Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: f"` , Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 033 -00/ Commonwealth of Massachusetts P Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street '{ W,:— - Property Address Scott&Valerie Garvey R Owner Owner's Name information is Hyannis Ma 02601 9/29/2018 ;^` required for every � page. City/Town State Zip Code Date of Inspection ice; 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. Inspector Information filling out forms 3 3� on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Lane �y Companypany Address Centerville Ma 02632 City/Town State Zip Code 508-658-3456, 774-248-4850 S14522 sean@smionestitle5.com license Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the local Approving Authority 4. ® Fails 9/29/2018 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 40 wl. . 1 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) 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): 15insp.doc•rev.7/28/2018 Title 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): 3) 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. a. 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: t5insp.doc•rev.7/260018 Title 5 Official inspection form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 56 Smith Street Property Address Scott&Valerie Garvey Owner Owners Name information is required for every Hyannis Ma 02601 9/29/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) System failure Criteria Applicable to All Systems: You must Indicate"Yes" or"No"to each of the following for all Inspections: Yes No ® ❑ 82CKup 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 t5insp.doc rev.7I28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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 Yz 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA 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 15insp.doc!rev 7I2018 Us 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .. 56 Smith Street Property Address Scott&Valerie Garvey _ Owner Owner's Name Information is required for every y Hyannis Ma 02601 9/29/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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? ® F] 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)j t5insp.doc•rev.7126120i6 Title 5 Vidal Inspection Form:Subsurface Sewage Disposal System•Page 6 or 16 Commonwealth of Massachusetts -- _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page, Cityr'rown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: uknown Date l5insp.doc-rev,1/EM18 Title 5 Official inspection form:Subsurface Sewage Disposal System-Page 7 of 18 Q Commonwealth of Massachusetts - - Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? ` Reason for pumping: 15inap.doc•rev.7r26P2018 Tine 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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: system repaired 1994 to existing tank, d-bo and pit Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 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.): unknown 15insp.doe•rev,7/Z8IM Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts == Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is Hyannis Ma 02601 9/29/2018 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. 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: 1000 gallons Sludge depth: M Distance from top of sludge to bottom of outlet tee or baffle W- 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? measurements not taken Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related'to outlet invert, evidence of leakage, etc.): Water level was at outlet invert. Tank appeared to be structurally sound. t5insp.doc rev,712612018 Title 5 Official tnspection Form;Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts --- Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name Information is required for every Hyannis Ma 02601 9/29/2018 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc-rev.M 2018 We 6 Official Inspedon Form:Subsurreaa Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts g Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �..` 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name Information is required for every Hyannis Ma 02601 9/29/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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 was cracked and rotted at water line. Box shows signs of past overloading. r 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ® leaching chambers number: 3 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number; length.- leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/018 Title 5 Official Inspedion Form.Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street. Property Address Scott&Valerie Garvey Owner Owner's Name Information is required for every Hyannis annis Ma 02601 9/29/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching facitlity consists of a precast pit and 3 Infiltrators added 1994. Pit was dry with stain lines consists with past hydraulic overloading. Infiltrators were video inspected and aslo showed signs of past overloading resulting in a fsailing inspection. 12. 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.): t5insp.doc•rev.7282018 Title 5 Official inspection Form,Subsurface Sewage Disposal System•Page 14 of is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. City/Town State tip Code Date of Inspection D. System Information (cont.) 13. 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.): 15insp.doc•rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts _ � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owners Name information is required for every Hyannis Ma 02601 9/29/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately A A2 3t 6 O Z 93 Z Aq aq 3s �s 36 3Z to 15in5p.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pago 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ 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: Groundwater elevation was established by accessing Town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 or 18 c Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Smith Street Property Address Scott&Valerie Garvey Owner Owner's Name information is required for every Hyannis Ma 02601 9/29/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev..712612018 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ` TOWN OF BARNSTABLE �� LOCATION 45, S✓rt° S`f SEWAGE # u.v�d 1 sld��/l VILLAGE � ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY ' S1`t ` \(-)00 LEACHING FACILITY:(type) (size) fib' NO. OF BEDROOMS � PRIVATE WELL OR PUBLIC WAT R BUttM --OR OWNER S��Z`' �d 17t t� DATE PERMIT ISSUED: - � DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No RA a r v 4 r. I'1 No....,1�,�.�_._�.l F�$... APPROVED T COMMONWEALTH OF MASSACHUSETTS Barns W e e Conservation Departm eRD OF HEALTH Signed Date N OF BARNSTABLE , pphration for Div-,Vn!3tt1 Workii Ti nwtrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SysteW at: ..... ............. y ---------- -------------------------------- ----..........--------------------.----------- ", �^ Lysion- d resS or Lot No. ......................_---- ---------------------- -----------------------'...----^---^---- --------------------------------------.....----------^-..._....__---...._._....................._ OwnN ddres wr = ---------------------------------------- - � � OZ 4.....0I------ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_____________12 _________________ _____________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) .< Other fi r -------------------- - - - ......- -------------- -------- W Design Flow.............. ______________________gallons per person ply.Total daily flow.-----5 ......_.......................gallons. R' Septic Tank—Liquid capacity--------_-_gallons Length---------------- Width---------------- Diameter---------------- Depth................ W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No--------------------- Diameter--.--.----.---.--.-. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit---_---_-_-__-_--_._ Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground'water.-..__-----____-_-----. a ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ x c.> .................................................---........................................................................................------------------------------------------------------------ w ----- ---------------------------------------------------------------------------------------------------------- ' . M. Nature of Repairs or Alterations—Answer when applicable.,l���-.-���.�-- .t --lid----- ---- .....5., -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State,Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d b t of nth. Signed .. 47_" '1 -------- `----- - ---- -------- --------- - --- --- --- ------------------- - ...... .... .:...... Dace Application Approved By --- ... --- -----l.J..-.. :.-.�.L/ Dace Application Disapproved for the following reasons: ...... ................ . ...............-- . .......... ... .. ......................... ......... ......... ........................... ....... ................. .... Permit No. ------- p-,L1- ----- 7 .. � 71... Issued ........................ - -- -... 6are - Dare Co d No...��, _'_.�/..1. .............. THE COMMONWEALTH OF MASSACHUSETTS ARD ,OF HEALTH TOWN OF BARNSTABLE �Aplilutttion for Diva i!ml lVarlai Toutitriartion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at d or Lot ...C.J_!....._....C. /•_v jimt ..\ ress-------•----------------------- ------------------------•----•-._.._................No......------.............................. nj af�'s`�l•/lj 4t'tal I er Address' 02_��J... UType of Building � � Size Lot___________________________S q. feet ,.., Dwelling—No. of Bedrooms-----------------------------------------___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a1Other fixtur S-------------------------------------------------------- ------------------------ ........gallons per erson er da�Total daily flow......-.a-'-.�-._Q_---__•------------------gallons. W Design Flow------------- 1:4 g P P P� Y Y WSeptic Tank—Liquid capacitv............gallons Length................ Width---------------- Diameter-----.---------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. -� 3 Seepage Pit No-_------------------- Diameter--------------.----- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ------------ ------------------•--------------------------------•---------------•----•----•--••'••-•......................................................... 0 Description of Soil........................................................................................................................................................................ x V •--••-•-•-•-----•-------------------------------------•------------•--•••----•----------------------••-----•----- --------------------•-••--•-------------•------------------------••-------'-'----••--- W --------------- U Nature of Repairs or Alterations—Answer when applicable.//7' C-f/..._l"____�_�'�........��� ...._"�.....5�` .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu6d b2y the boaof health. --- �.�ti "17 ---- Si Signed . /. -... Date Application Approved By ................. ��..,�„z ... ��........ ...----------------- ............._.... 1 .-..Dan, .--,9�L/ Application Disapproved for the following reasons: ............................ . ........ .. . .. ....... .-- .................................. ............................................................................................................................. ...................------------------------------- ........................................ te PermitNo. .......�Ll-----------�...�----------------------- Issued .............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF LL BARNSTABLE Qrti.lirate of Compliance THIS IS TO CERTIFY, That the Individual Sewa e Disposal System constructed ( ) or Repaired b@ 77 1. at ----------------------------------------------------------......-------------------- --------------------2..... --------:----------------f-----_.... -----------.....------------------------------ been installed in accordance with the provisions of TITLE 5 of The Sate Environmental Code as described in the application for Disposal Works Construction Permit No. ---- .y:__... .... '�. ..._. dated ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ON TRUED*"AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 14TISFAC ORY. DATE...... a".-.'. - -----^T--�-- ------- -------- Inspector ------- `-----'-- _,',/" .................. .. --------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. :.la'.' � FEE.?]. ............. Rapnoal Varkv Tonp#rufrtion rantit Permission is hereby granted------------------- l ('VII&L ----`------ --- --------- to Construct ( ) or Repair (bran Individual Sewage Disposal System / atNo. ---=�� ?/ ----.fir---•------ --------------------------------------------•--•••••...... Street �} as shown on the application for Disposal Works Construction Permit No. -_�,._�__ Dated...... /.-lr�••-•-.. •---•'••--•-......----'••-- ------ •• �}' Board of Health DATE.......LG�----------- `/ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ACCESS COVERS MUST BE WITHIN 9" MINIMUM COVER 6. OF FINISH GRADE O 101.22 FIRST 2' TO 4" PELF P f Pf 1 BE LEVEL 17` /00.5 2Ri'- .a. MIN 2' OF PEASTONF r' IAM PIPE OR FILTER FABRIC o j I' 99.8 � � 99.25 98.9 oedo000000' o e ~ o o 3/9" 1 //?' DiA. ONS cAs DN j 99.S r BAFFLE 99.07 $ END CAP 98.5 DOUBLE WASHED STONE sMI TH T 3 OUTLET 98.0 �y9 LD S �' D-BOX 30'x /6' LEACH FIELD �qo I500 GAL H-20 u, P SEPTIC TANK 6' CRUSHED STONE OR OF �A I ADJUSTED ti90 92I COMPACTED BASE GROUNDWATER. EL-93.0 0 p / j - OSSERVED p/ L_ A f /\ V� t E : NOT TO SCALE = cRouNOIrA�1 R EL-9a.5 LOCUS MAP 9A INVERT EL E VVA T I d NS : DESIGN CR i TER I A : GENERAL NO TES : INVERT AT BUILDING: 99.8 DESIGN FLOW: INVERT IN SEPTIC TANK: 99.5 3 BEDROOMS ATI10 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION INVERT OUT SEPTIC TANK: 99.25 BEDROOM EOVALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 9� INVERRT OUTOOX DIST.BBOX: 98.97 NO GARBAGE GRINDER "' 2. VERTICAL DATUM IS ASSUMED. FOR"BENCH MARKS .. SET, SEE S l TE PLAN. INVERT IN LEACH FIELD: 98.8 98lNVERT END LEACH FIELD: 98.5 SEPTIC TANK REOU/REO: v 330 G.P.D. X 200X - 660 GAL. J. ALL CONSTRUCTION METHODS AND MA TER I AL S AND 0 ?BOTTOM LEACH FIELD: 98.0 SEPTIC TANK PROVIDED: 1500 GAL. MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL ADJUSTED GROUND WATER: 93.0 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL OBSERVED GROUND WATER: 90.5 SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. 'BOTTOM OF TEST HOLE *1: 90.0 DESIGN PERC RATE f 5 MIN/INCH INDEX WELL M/W 29, ZONE B SOIL TEXTURAL CLASS > I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER 9� E7YisT1 o CtgyG NOVEMBER 2018 READING-8.2 ',. ADJ>2.5' EFFLUENT LOADING RATE - 0.74 GPD/SF REAS3SUBJECT ' IN DEPTH VEHICULAR CTRAFFIC OORWGREATER 330 GPD / 0.74 GPD/SF > 446 S.F. REOUJRED THAN STANDING H-20 WHEEL LOADS. � n ti L V T B PROVIDED: 30'x 16' LEACH FIELD, 6" DEEP/ AREA 48D S.F. x 0.74 - 355 G.P.D. / 5, ALL SEWER PIPE SHALL BE.SCHEDULE 40 .P-VC .OR 1 S. .535+ S.F. APPROVED EQUAL. ti 1 1 SOIL TEST PIT DA TA& INDICATES b INDICATES t -o �. 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED p 4 o N a PERCOLATION _ OBSERVED PRECAST CONCRETE OR APPROVED POLYETHYLENE. EXISTING N TEST - GROUNDWATER h SEPTIC srsrEM BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER i-.w TP :t P1*15e/3.. re 02 TESTED FOR LEVEL WHEN THERE IS, MORE THAN ONE O" HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR OUTLET. f '. LOAMY IOYR LOAMY IOrR ofjL A sANO era A sArw� 2r2 t _ _ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. 'OO FROM ED !6" -B SANDY - - -5 6R 99.2 !6' -B -SANDY- - - - IO R 99.2 1-888-DIG-SAFE SAND THE LOCAL WATER DEPT. 36" - - - - - - - - - - - - - - - 97.5 36` - - - - - - - - - - - - - 97.5 FOR -L OCA T ION O UNDERGROUND UTILITIES. C1 ME'DIW /OYR C/ MEDIum IOYR SAND 616 SAND $16 1500 GALLON 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE l I E,1-/ y'``^ SEPTIC 7ANK DWEs7fNG DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION L/NG I OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE 50' 99.34+ 100.49. CONSTRUCTION INSPECTIONS. BR/Cq' �.. 9. EXISTING SEPTIC SYSTEM TO BE PUMPED DRY AND N SM. CORNER STEP 20 MAPtE / i I I2 90.5 12 90.5 BACKFILLED. 16 EL fQa ,4-/01.20 I l 126` 90.0 126' _ 90.0 O-BOX •••• "�-� DATE: OECEMBER 4. 20/8 /0. ALL UNSUITABLE MATERIAL (A A B HORIZONS) TEST er: sTEPHEN rtAas ENCOUNTERED BELOW -THE -I-NVERT OF THE -LEACHING WITNESSED BY: DONALD DESMARA I S FACIL I TY TO BE REMOVED FOR A DISTANCE OF 5' i�::::.. TP / W PERC RATE: E 2 MIN/INCH - 99.34 :.: ..'4L ... ..:::::.: .. r ..................... + i .... ,;� AROUND AND REPLACED W/TH SAND IN ACCORDANCE J �� ti aF J4"lTla+ TITLE 5. TP 2 q' y l l �``-SOIL REMOVAL CB H FAO SEPT C SYSTEM DES ON LEACH FIELD �`"'' SEE NOTE l0. � a � i°° yOCE 56 SM 1 TH S ? BEET . MAP 288 PARCEL 33 / 1 98.81 /p ° 0` (ter/ f �! ice✓ ir•wr / �jj i �1 A • 99. 17 t� o f + 1 /YA 1�17 V 1 .5 L EMEND P R E P A R E CC.7 E Q R t i S ! E } k. k .. xi` .._.._. CO �1//j�Y� T CA \/��/I��111J��� (j//�Y���Y�\y/�J //(��Y �)Ty/ 0 CB CONCRETE 80UN0 ' BO � � - ---W WATER L I NE r ��0 HYDRANT CBO1.r FND SCALE : 1 20 D E C E M B E R 26 . 2018 G GAS ,LINE OHW- OVER MEAD WIRES S T E P H E N A . H A A S •# L IGHT POST ©o ENGINEERING -E- UNDERGROUND ELECTRIC LINE . O o x --T- UNDERGROUND TELEPHONE LINE �'�` S c> u t M D o n n i s , MA 02660 ^-CTV- UNDERGROUND C48LEV I S ION LINE rr� 1 1 • +40.4 SPOT ELEVATION ? SOS 362--8 9 32 ••40 • EXISTING CONTOUR fool__ PROPOSED CONTOUR 0 I0 2O 40 UP 34-10 JOB NO: 18-026