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0120 STERLING ROAD - Health
120 Sterling Road West Barns-fabYe A= 216-027 � y i i C I TOWN OF BARNSTABLE LOCATION ��-W�i��� SEWAGE# 201 27 2- VILLAGE r ASSESSOR'S MAP&PARCEL �7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER PA.KA LL K'S PERMIT DATE: "I 1�( I COMPLIANCE DATE: J l ` Separation Distance Between the: fI Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1 Tzy- o 1 y No.-_ 20/ Fee 6- \r� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes - tag ZIPPfitation for -bispoBal .pBtem ConstrULtion i9Crmit cary Application for a Permit to Construct( ) Repair( ) Upgrade(14Abandon( ) Complete System ividual Components Location Address or Lot No. ` J Owner's N e,Address,and Tel.No. Assessor's Map Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. LGM`l 77r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) l331,/ gpd Design flow provided '-7 gpd Plan Date 3' Number of sheets Revision Date Title Size of Septic Tank e of S.A.S. Z— Description of Soil — Nature of Repairs or Alterations(Answer when applicable) 2 Q�- C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f h G Signed Date 0 hlb Application Approved by s Date Application Disapproved by ' Date for the following reasons Permit No. Date Issued —f } "t No. .' r L z t Fee f Doi�t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �Lt` PUBLIC HEALTH DIVISION - TOWROF BARNSTABLE; MASSACHUSETTS Yes M, Zipplitation for Oisposal *pstrm Construction Permit � Application for a Permit to Construct( ) Repair( ) Upgrade(l4 Abandon Complete System ® ndividual Components 0 Location Address or Lot No. �Z (r J �j�- 1 Owner's Name,Address,and Tel.No. _ r7 Of- Assessor's Map/Parcel 4Pmedd' Akhhj Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers Cafeteria( ) Other Fixtures p ,r { ' Design Flow(min.required) �p� gpd Design flow provided _�y 4Y•� gpd Plan Date y��;,y_� Number of sheets Revision yD�ate -r— Title'l°' �'l�c� °.` ��`(f��/J�l� r��IIYp � �_�() �icjl0/�� •l!'C Size of Septic)Tank �,jP ttJ r� G/a Type of S.A.S. ( Description of Soil /hllhA' l ,(r/ �Okd _ bra i i° ✓ 1'. Nature of Repairs or Alterations(Answer when applicable) A ,rJAI N.d, //P u z All j Date last inspected: -•t , 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 Boardof 13ealth. Signed„- ,. v Date �cSI Application Approved y � ,� E Dated Application Disapprov(gdby t Date for the following reasons Permit No. Date Issued '" I " K x a THE COMMONWEALTH OF MASSACHUSETTS BARNST BLE,MASSACHUSETTS CPrtifitati of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by per] at �S /�QYJJ la has been constructed in accordance t with the provisions of Title 5 and the for Disposal System Construction Permit No. ` datedp InstallerAPA-h ,T- )Vawj #1 Designer #bedrooms _ Approved design/flow ya r V p g gpd 47 The issuance of this permit shall not bee.construed as a guarantee that the system wiII*function-as,d g ed. Date i t ! t.1 Inspector f No. 0/ 6� ca�- Fee 50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Mispo8ar *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(V°) Abandon( ) System located ati�. 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 comp`leted.within three years of the date of this permit,. Date 9 "" L (3 Approved by Town of Barnstable tiT Regulatory Services AR'N- A LE, Richard V. Scali, Interim Director B NI SS P�ublic .flealth Division Thomas McKean, Director 200 Main Street,Hyannis, MA..02601 Office: 508-862-4644 Fiv 50R-790-6,304 Installer & Designer Certification Form Date: l Scwrage Perrnit# ?J)Ik - 7-72- Assessor's klapTarcel Designer: rlq',-elCe r't n o) Wo r-k rl Installer: A I ,.5 x q44-i5 Address: 1 z W, C rc ss--C�e Address: 114A OZG4� A bf .I- 144 J� On waS issued a permit to install a ((late) (installer) sept1q,systei'll M based on a design drawn by ,F-C-i-e r —i , M c-G_.-,+-k. (addresj CJi:-L4_( /11C dated (designer) I certify that the septic systern referenced above was installed substantially accordlmz to the desifan, which may UICIU(te minor approved changes such as lateral relocation of`� ' I CII distribution box and"'or septic tank. Strip out (if IV(JU,ired) was inspected and the soils were found satisfactory, I certify that the septic system referenced above was installed with major chunge's (I.C. greater than 10' lateral.relocation of the SAS or any vertical relocation of any coni,ponent of the septic system) but in accordance with State & Local Regulations. Plan re\llslo.n or cortmed as-built by designer to follow. Strip out (if reqUil-CCI) was inspected .anal the Soils Wcrc found satisfactory. I certify that the system referenced above was constrUCt& nce with the terms of the I\.N approval letters (if applicable) % WENTIEE VIL (Install s Signature) (Designer's Signature) (Affix Designer , `.°tamp Here) PI-EASE RETURN TO 8ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSIJED UNTII, BOTH THIS FORM AND AS- BUIUr CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Scptic'�Designer Certificafloti Form Rev 8-1 4-13.doe Commonwealth of Massachusetts Title 5 Official Inspection Form kIZ56el Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 page. Cityrrown 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, ImportaftWing out Whenorms A. General Information on the computer, ```���.``•�`IY10F5,� use only the tab .1 Inspector: ��o?�� cy�� key to move your JA MES •N cursor-do not �; use the return .lames D. Sears _�; ��ARS -sa key. Name of Inspector Capewide Enterprises,LLC "_6\ , m Company Name r�� pt INS?,- S �- 0' 153 Commercial St Company Address Mashpee MA _ 02649 City/town State Zip Code 508-477-8877 S1623 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 ❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority 9-18-12 spector'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 some or different conditions of use. //Z/0 t5ins-11/10 Me 5 Olrid I pe Form,SubwAace Sewage Disposal System Page 1 of 17 cep -1 0 1 L u;1:-1 yp p.L Commonwealth of Massachusetts 1WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 page, Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ® 1 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 structuraly unsound, exhibits substantial infiltration or exfiltrabon 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): tsins-11110 Tile 5 Official Inspeelion Fomc submsfece Sewage Disposes System•Page 2 of 17 JCI.J IU IL V.7.LVIJ p,J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owners Name information is required for every Hyannis MA 02601 9-17-12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 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): ❑ obstniction 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 tailing 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 L%%s-11110 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 3 or V oep 10 1 c vy./-vp p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-_17-12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fain 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 l5 less than 6" below Invert or available volume is less than '/:day flow t5ins-11110 Tithe 5 Official hspeetion Forth Subswfece Sewage Disposal System•Page 4 of 17 ep w I c vy. I oa N. I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every . Hyannis MA 02601 9-17-12 page. City/Town 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. 13 ® 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 El 0 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.approphate regional office of the Department. (S ns•11l10 rye 5,Model Inspection Form:Subaurfac a Sews a 01 g sposal System•Page 5 of 17 'Dep 10 1 c uy.c 1 P p.o Commonwealth of Massachusetts 120 19 Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Steding Rd. Property Address Peter Thompson Owner Owner's Nance information is H annis MA 02601 9-17-12 required for 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? ❑PA❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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? ® El 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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ms•11110 Title 5 official Inspection Form:suosurtace sewage Disposal System Page 6 of 17 aep i c i t u&:,e i p P. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Sterling Rd Property Address Peter Thompson Owner Owner's Name requir efo is Hyannis MA 02601 9-17-12 required for every y page. City/town state Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal Precast tank and pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [f yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NADate Commercialflndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.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 I Water meter readings, if available: Wns-11110 Tias 5 ofricial Inspection Form:Subsudace Sewage Disposal System-Page 7 of 17 r Jep 1 b 1 L UV:-21 p p.ts t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is Hyannis MA 02601 9-17-12 required for every y page. Cityrrown State Zip Code Date of Inspedion D.-System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Note: Maint pump after inspection Type of System: ® Septic tank, , soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): esirm-11110 race 5 Offida9 nspedon Forth subs,rfa sewage Disposal system-Page 8 of 17 Jep 10 l e wi.eep P. a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 120 Sterling Rd Property Address Peter Thompson owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 page. CitylTown state Zip Code Date of Inspedion D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: 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.): Pipeing house to tank cast iron pipeing tank to pit 4" pvc sch 40 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 Gal 211 Sludge depth_ t51n>-I WO TIC 5 orricid Inspaaton rw=subsvAem sewage Oiapocal syatatn•Pago 9 of 17 Jep 10 I L Vy.Zzp P. IV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd Property Address Peter Thompson Owner Owner's dame information is Hyannis MA_ 02601 9-17-12 required for every page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 28" Distance from top of sludge to bottom of outlet tee.or baffle 40 Scum thickness 8„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" ffl How were dimensions determined? Tape-Sludge -Judge 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 and covers at 1', inlet castiron tee and baffle, outlet tee, Tank at working level, no sign of leakage, Note` Maint pump after inspection Grease Trap (locate on site plan): Depth below grade: feet Material of construction_ ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other fexplain}: 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 LRns•111110 Title 5 0ficlal inspection Form subswace sewage Disposal system•Page 10 oI 17 oep to l/-uy:ttp Commonwealth of Massachusetts Title 5 OfficiIN al UP al Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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: r 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 t4ins•1 t110 Title 5 Oftal Inspection Forth:Subsurface Sewage 01sposal System•Page 11 or 17 JGi.1 10 14 UV.40P Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Sterling Rd Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis annis MA 02601 9-17-12 page. Cityfrown State Tip Code Date of Inspection D. System Information (cunt.) 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: 151n5•11110 Tlrie 9 ORidal lnspa�ton Farm:Svbsurlaw Sewage Disposal Syaldn-PapA 12 0117 0ep 10 I/_uy:Z4p P.10 r > Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 120 Sterling Rd. Property Add Tess Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 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 1� F,4 5.1-A a i 0 I. o 3' t5ins-11110 Title 5 Officlai Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 bep "lu "I2 ua:csp p.16 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is MA 02601 9-17-12 required for every Hyannis — State Zip Code Date of Inspection page CityfTown D. System Information (cont.) Type: 1 ® leaching pits number: ,❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc_): Leaching is one 1000 Gal PreCast Pit, Pit at 20" below grade w/stain lineal 2'. No sign of over loading, solid carry over or high stain line 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 Title 5 Official Inspection Farm:subsurface Sewage Disposal System•Page 13 d 17 (sins-11110 pep 10 uy:tjp p.-14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name equiredfo s Hyannis MA 02601 9-17-12 required for every y page, CitrfTown 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.): t5fns•11110 Title 5 Official Inspection Form:subsurface Sewage Disposal system-Page 14 of IT VGi,J I V I L VJ.LYi.! P. I O Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner owner's Name information is Hyannis _MA _ 02601: 9-17-12 required for every State Zip Code Date of inspection page. City/Town D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar Shallow wells 2U+ Estimated depth to high ground water: feet Please indicate ail 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 Cabutting grope 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: Area high 20'+above pond across St. behind house Before filing this Inspection Report,please see Report Completeness Checklist on next page. (Sins•11110 Title 5 Offid3l Wispection Form:Sues,rrace Sewage Dispesel System•Pape 16 of 17 oep 10 I L Vl:L'4p P.I Commonwealth of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage Disposal System Fonm -Not for Voluntary Assessments 120 Sterling Rd. Property Address Peter Thompson Owner Owner's Name information is required for every Hyannis MA 02601 9-17-12 page. Citylrown 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 tsins•1 tlto Me 5 Offidal Inspedion Form:subsurtaoe Sewage Disposal Symen•Page 17 of 17 No. Zo I Zri 0 Fee $/00 0.:) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pphratlott for VspoBal 6pstEm Cottefturtlon Vertu Application for a Permit to Construct( ) Repair(v� Upgrade( ) Abandon( ) ❑Complete System [✓individual Components Location Address or Lot No. aZ0 S �r�� Owner's Name,4ddress,and Tel.No./oJ3-9.107_3?77 Assessor's Map/Parcel lln 2`67 Installer's Name,Address,and Tel.No.509-q71—F587-1 Designer's Name,Add as,and Tel.No. CAPtEWtD 19- a.Y 081jJ9ES c iC� 15 Type of Building: Lr e Dwelling No.of Bedrooms Lot Size 3 A :3=0- Garbage Grinder( ) Other Type of Building Res► 6L' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) tZ gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L—,1►1Q� C- �g Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signcd-- Date 8 IA Application Approved by Date l'1 — b �J' Application Disapproved byQ) Date for the following reasons Permit No. i ®�[ Date Issued . M No. Ze I� o Fee /W od THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, f,. application for MispoSal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System [✓Individual Components Location Address or Lot No. /a S-4 tom, Owner's Name,Address,`, nd Tel.No./p 3-y S�-3 g77 Assessor's Map/Parcel aLY" (� 'r 67 12-O 51-- "ye, S Installer's Name,Address,and Tel.No.506-4'jl- &g j Designer's Name,Add as,and Tel.No. Y Cr44t-Wtv E eQTt_X RISVS "G t 15 � ; 7lType of Building: (r J Dwellin No.of Bedrooms Lot Size �` 3 ` � Garba eGrmder g � g O Other Type of Building Res 1kyl- ,a t No of.Persons `'` Showers( ) Cafeteria( ) t Other Fixtures s "Design Flow(min.required) gpd Design flow provided j gpd o b Plan Date Number m f sheets Revision Date �. u Title Size of Septic Tank Type of S'A.S. fi Description of Soil a { Nature of Repairs or Alterations(Answer when applicable) 1, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. p Signe /""' Date 9 10 Ia Application Approved by Date q , Application Disapproved by Date for the following reasons Permit No. a "2 l 0 Date Issued / ` q y THE COMMONWEALTH OF MASSACHUSETTS C� BARNSTABLE,MASSACHUSETTS 1 Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V/) Upgraded( ) Abandoned( )by r.AOF"M &, ' Pki_ f,5:s ad at 1 S}Q-r , (?e�, uya-111( has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. C�0��' dated Installer CPEip(bC �1800. U� Designer � t / #bedrooms t' Approved design flout /V'• 4 gpd The issuance oft ''s permit shall not be construed as a guarantee that the system will fun) as desi ed. Date { I Inspector 1/ tit No. 00(Z "0�90 Fee IC90�o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(✓) Upgrade( ) Abandon( ) System located at 1,A 6 S r�r ��`1 'V Pya • ^ T and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by 1 Town of Barnstable p# �y� Department of Regulatory Services. r Public Health Division. Date 'Z Z l Y ;� a 1679• 200 Main Street,Hyannis MA 02601. Date Scheduled Time I Fee Pd. -ft � - ;—A - ppnn do:E Foil Suitability Assessment for S Performed By: P-cj-� A -z� k-k S C7' L5-4 Z _ Witnessed By: LOCATION& GENERAL INFORMATION Location Address C t l 5 _/ Owner's Name '' c> rl n J` Q t Address (/ •d wt Assessor's Map/Parcel: r —7 l Engineer's Name NEWCONSTRU►CTION REPAIR _ Telephone# ,5 - -7? Land Use.:-- I" �' �;liq Slopes(%) Z� Surface Stones /4J�Y6 Distances from: Opem.Water Body 1� ft Possible Wet Area Nd22e ft. Drinking WaterWeil ft Drainage Way 1�10 ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t 4 Parent.material(geologic) © 'Sv' Depth to Bedrock Depth to Groundwater. Standing Water in Hole: P Weeping from Pit FACe 1 y r Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed stai-idi g in abi;.ho!e: -- n. Depth it sail Depth to weeping from side of obs.hole: in, Groundwater Adjustment tt. Index Well# Reading Date: ]ndex'Well level..: Add.factor,,,,,_ ,_,,,_Adj.Groundwater l euel,— PERCOLATION TEST Dates._.___m. Time— Observation Hole# Time 80" Depth of Perc. Lo -51% /� y� �� Time at 6" Start Pre-soak Time Gt r Time(9"-6") End Pre-soak Rate MinaInch L Z Site:$uitability,Assewncat: Site'Passed Site Failed: Additional Testing.Needed(YIN) Original: Public.Hea►thDivision Observation I-Iofe.Data To Be Cornpleted on Back----------- If percolation test is to be conducted within 100' of wetland,you must first notify. the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEP7rI0PERCr-ORM.DOC. DEEP.OBSERVATION HOLE LOG Hole#„ Depth from Soil'Horizon Soil Texture soil Color Soil Other • Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones;Boulders.. on i ten ravel DEEP OBSERVATION HOLE LOG Hole# `Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,:Bouiders. Consi0ency.% ravel A Loam 5cAhis`1(L'� 1-- — 24, -DEEP OBSERVATION HOLE LOG Hole# Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stone,s,.Boulders. Cons istency.%Grave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders, onsi ten ra Mood Insurance Rate Map: / y_ Above 5(}0 year flood'boundary No_ Yes .y Within 500 year boundary Ird Yes, s Within 100 year flood boundary No.— Yes,. Depth of Naturally Oectirrina Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material?. r Certification I certify that on INQ (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 fining,expertise and experience described in 10 CMR 15.017. Signature Date Q;%S,EPTIC\PERCFORM.DOC p N z 00 z N Z® r ••- Q eI v)0 p mom x O 5 0 U <cr C) ='z Q Q -, to P 5 �Ld w z rz 0Q o ui W N c o ZQ 0'~ UU . 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W o 0 V) p Q F- - 0 Z w o w O J 00 Q X Q W Q N m f- Z wI.L. w lL Z C� O c9 g O 2 Q>0 Oz w� Q Z 0_ 0_ w w w W W 00 VI W C9 F z Z x o U Z o0J Ewa oQw V)M: m 0oa ° Qm= =o Lli z� oo �o wW a '�/� v O o N W Z w 0F� 0z Ld Z oU)O Cf)z z, -a- J OZ JZLLJ ~ I- ZZ 0 m2 �� (n LLJx of �Z � 0 v, CLLI � 0: W W w w O ►- m -� w2 QQw w-0 ��m O zQ0' 0_ U0 W O� 0w� C3m 0 WO OD W 0= v Q C0 W F J U U Z 0 �0 0- w (n a-m M F- W 0_� w 0 z(n Z U C) (/) O �- Z0 Y�0 QwW Z�� j 2F-(i 0 D Q00 JQ2 crQLLJ CrW gZ r, wQ ^, C d M m ( I W 2 OWE WCL OF..W W Wo Q Wow J�0_ WU U 0.0 Zg 0_w O `r p L q M O �Z W J 2 0_ Q W (n U W LL, W V- N Lo O �� Z UO_ �h-Q �ZCO U�Z W 0UJ W 0_ QwW (nJ LLJ Z W�� WO_ (n� W� !n� o � L. - 0) O �(' W JO �w0 20w ZD_Z J 22W Q 2 _j Of �20 2ZW QZ �O F2--N �O O L ` V n " I I 0 Qm NOJ F H0 Qww Q t_F 2 QQD -�U 3_0 _ o N r7 d co 1� 00 6 O N ¢ ca C 3 00 WW � n. its c" �!En ul J U4�10 in x WUVM CD U W CD CD x 1 - M S 62.54 25" co I_ 1� m ' o )• - 131.29 ring - -.�x- edge of Op x inrVEWA,Y:: .� CD 12.8' '.Pq VED I. cu .I:.,:o . 1• 1 s' N: N W ` W I: _I a oON ON Ln 0 1 Q Q 10a; 0100 I i� \ \ 1 U au I fa .<� CD I \ \ --0. ILn i 1 1(APPROX.) F mr ttru.v\W 1 1 I �- o Lu,%Z)\o 1 °�' 1 E Ln C� \Z\ co 1 \\ p 1 x CL �I Zoo x 1 rrn f `- W � „ Od ( o Z I . N \0 W? M. xI z 1 a I M cu N V x Ln a N 0 6uuoa x/ a6 a 0 I ~� � N /o �p o P o Q 0 v Y Lai CDN V p QO Z-,zc 0. . C ( coo Q Z p: Z ti-9Xq N I I w m M LU 0_ J z �- I Q �mZ N UFO ( Y� O z ci Q a- (LLJ n �qm 0_0 My MNz 0 Q Lu o Uo� zC)0 20. Q mw m a km-g 3 ao�M Z �o-g r b NOTE: TO PREVENT 1'BREAKOUT. FINAL GRADE !r4 SHALL NOT BE AT, OR BELOW, EL.=103.00 FOR A DISTANCE OF 15' FROM THE EDGE .SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET-& "INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=106.63f SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT �EX/STING F.G. EL.=106.Ot F.G. EL.=105.9f F.G. EL.=105.8t F.G. EL.=105.8t G HOUSE(#120) MAINTAIN 2% SLOPE OVER S.A.S. L = 20' _ BACK OF HOUSE ® SCH4 (MIN.) ® S-1%2(MIN.) ® S=1�1(MIN.) 2" LAYER OF 1/8" TO 1/2" h HE 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 6" DOUBLE WASHED STONE 10"I e® $ ee (OR APPROVED FILTER FABRIC) tk 00- INVERT 74" s 00eaaBa N N 48" LIQUID �-3/4" TO 1-1/2" DOUBLE � cV =103.90 LEVEL 4' 4.8' 4' WASHED STONE 30 ADD tNV.=103.17 PROPOSED INV.=103.00 o GAS BAFFLE EFFECTIVE WIDTH = 12.8' INV.=103.65 D-BOX r%) �,.�f • PROPOSED SEPTIC TANK INV.=102.50 2_500 GALLON LEACHING CHAMBERS L / MODIFY INTERIOR PLUMBING TO ONE SEWER SURROUNDED WITH STONE AS SHOWN ` PROP. S.A.S. EXITING THE HOUSE, INV.=104.30f H-10 RATED _ __ _ TOP CONC. ELEV.=103.3t NOTES: BREAKOUT ELEV.=103.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=102.50 eases SEPTIC LAYOUT INVERTS, PRIOR TO INSTALLATION. -DO•� as®®aa®®aa® 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.=1�ss0 TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' 2 x 8.5' 17.0' 4' SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' 310 CMR 15.221(2). PERVIOUS MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=95.8 4 LEACHING SYSTEM SECTION FE3 ® ®®® AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. F- EO®®® ®EO®®® 33"SEPTIC SYSTEM PROFILE N > ®®® ® ®®®® N.T.S. DESIGN CRITERIA SOIL LOG 102" DATE: JULY 26, 2018 (REF#15,732) 4" KNOCKOUT NUMBER, OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT 20" DIA. COVER ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH DESIGN PERCOLATION RATE: <2 MIN/IN 106.3 A all 106.4 `A o" 4" KNOCKOUT I-" 4" KNOCKOUT 58" DAILY FLOW: 330 G.P.D. LOAMY SAND LOAMY SAND DESIGN FLOW: 330 G.P.D. 105.8 a 10YR 4/2 6" IOYR 4/2 1os.9 a s" GARBAGE GRINDER: NO-not allowed with design LOAMY SAND LOAMY SAND 4" KNOCKOUT LEACHING AREA REQUIRED: (330) = 445.9 S.F. 103.3 C10YR 5/8 36" 103.9 C10YR 5/8 30" .74 PERC 500 GALLON CAPACITY, H-10 LOADING proposed SEPTIC TANK: 1500 GALLON CAPACITY 40"/58" CHAMBERS , PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-10 RATED N.T.S. M-C SAND M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 6/6 2.5Y s/s SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 120 STERLING ROAD, HYANNIS, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: Ronald Robbins, P.O. Box 242, West Hyannisport, MA 02672 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. 95.8 126" , 95.9 126" Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:.............................................................. 471.2 S.F. PERC RATE <2 MIN/IN. Engineering Works, Inc. N.T.S. P.T.M. 213-18 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 7/31/18 P.T.M. 2 Of 2