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HomeMy WebLinkAbout0080 SUFFOLK AVENUE - Health 80 Suffolk Ave Hyannis A = 291. 133 1 TOWN OF BARNSTABLE V LOCATION _ SUVrFcN—c SEWAGE # I I VILLAGE KYO,f jsJ\-t, ASSESSOR'S MAP & LOT��'13 INSTALLER'S NAME & PHONE NO. t-V0,Cglr (t-1,p st SEPTIC TANK CAPACITY 1,000 LEACHING FACILITY:(type) '-�' `"rS (size) 1,,000 NO. O DROOM PRIVATE WELL PUBLIC WATER BUILDER DATE PERMIT ISSUED:_t `��i DATE COMPLIANCE ISSUED*: ?n c1 VARIANCE GRANTED: Yes No dt i--TZO Q TOWN OF BARNSTABLE LOCATION BQ SvV�0\�<- (Ld SEWAGE # VILLAGE N IS ASSESSOR'S MAP & LOT IS i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �)�T EJ 6�toChlU�► si�e) �0© NO.OF BEDROOMS -� BUILDER OR OWNER DATE: '`L(�,�." COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table'„tb .u„ttom ofr e,, iag Parvilit-Y -��� , Feet Private Water Supply Well and Leaching Facility (If any wells exist. on site or within 200 feet of leaching facility) �1� Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by ���-'U -- r> � cw t' o 0 s Do (" Cl c� TOWN OF BARNSTABLE LOCATION !80 Sc .�rpt K Auc SEWAGE# 2019 - L/53 VILLAGE ASSESSOR'.S MAP&PARCEL 291 133 INSTALLER'S NAME&PHONE NO. kg EXCQ&LQA i on q l l- 0/ SEPTIC TANK CAPACITY /Opo LEACHING FACILITY.(type) SOO go-1 (3) (size) 13 x 33 x 2- NO.OF BEDROOMS OWNER PERMIT DATE: l( -$- 19 COMPLIANCE DATE: 2.3. 19 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well-and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY a Ai- z�s' AZ. 22 ' 3Z,25 REAR A3'3o' lc A g3. Z9 ' A4, 33�5�. 3 .. No. C/�V�� 1 y Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphfation for ]Disposal 6pstent Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System ndividual Components Location Address or Lot No.JO SuWo 1 K AVE Owner's Name,Address,and Tel.No.tJ �q�,,,;a Ooopc r Assessor's Map/Parcel �,q - �33 x vl n(j $o su4Tol K AvE Afc,nn i5 Installer's Name;Address,and Tel.No.S*13 EXQxVoa io& Designer's Name,Address,and Tel.No.FA I-1' 4 Env;na,,M 94 -T'ca=Sc.rr'cj w Fores4d0.lc_ q-jq-0G.53 ®•,BAc 331 �4�w��.1� Tty 994 !!l.L. Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures U Design Flow(min.required) +40 gpd Design flow provided % gpd Plan Date Number of sheets Z Revision Date 02-2- 19 Title Size of Septic Tank /ppp Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sigrye Date I Z-Z- 19 Application Approved by Date Application Disapproved by Date for the following reasons 7 Permit No. � �{j Date Issued 7_, p ! No. m Fee ter: Entered in com THE COMMONWEALTH OF MASSACHUSETTS ,. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for -Mieppeal 6pstem (Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.$O S u 'o 1 A VG Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2q G,V1 Vi/ f to Sumo 1 w ACE t4,(a n �z Installer's Name,Address,and Tel.No..B£ a 1 Q^ Designer's Name,Address,and Tel.No.r� ILI ccrrtA LQ fo�csidaJC_ c}-)'1.O�S 3 P-0.30)1 331 � ,rw�c�. '?`1499y 1ILG w 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) yy 0 gpd Design flow provided �/�� gpd Plan Date Number of sheets Revision Date� r Title Size of Septic Tank /0n0 Type of S.A.S. 'n✓-� n,, L I�- ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. SignedIn Date 7 -2- N Application Approved by Date L 2 7.0 Application Disapproved by Date for the following reasons ,Permit No. 7� � Date Issued ';?�I 174 t q --------------------------------------------------------------------------------------------------------------------------------------- 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 �XCatla-I QI\ at A06 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.4 7; dated Installer ,B s� fix:�,��a� n� Designer Cl,,,, #bedrooms 1 Approved design flow l D gpd The issuance of this permit shall not be construed as a guarantee that the system will function designed. Date Inspector (� --------- ------7 ------ - -- -------------------------- ------- --------- ----------------- - - ee Pow THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Misposal 6pstem Construction Permit , Permission is hereby granted to Construct( ) Repair V) Upgrade( ) Abandon( ) Systein located at 20 !S,or-Co or-Cop< k C or&viV 15 and as described in the above Application for Disposal System Construction Permit. The applicant recognized hislher_duty to comply with ,J- Title 5 and the following local provisions or special'eonditions. J> Provided:Construction must be completed within three years of the date of this permit. Date 12 1207,014 Approved by oL �� 'N� f �oTHL'� No. gd n L19 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpYitatiou for Misposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %0 S%A;o Ik AVe,. I-Iyo nnl5 Owner's Name,Address,and Tel.No.V iegi ,& lAoo pL•r Assessor's Map/Parcel 291 133 '00 5 of;o k /w o, F}� ipnn s vJ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.F I whir Ary f,t►V%r0rW 1 6�►3 rcxcwva��on Sos•y'�7•o�S3 >14 uj,., o o. I Po 60Y. 11% 114. 1ci • I lb to Type of Building: Dwelling No.of Bedrooms 3 Lot Size 20,000 sq. Garbage Grinder(No) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min:required) 330 gpd Design flow provided 348 gpd Plan Date I I to 120lot Number of sheets 2 Revision Date Title Si{-c and Se.w►wse Olo►. ;or. FXC0,gAA4Qg Vitk',nio 400psr Size of Septic Tank 1000 gallon Type of S.A.S.(2) Son Qwktoc% N•20 C)r-^n+64r S Description of Soil _%tA, pl me%S Nature of Repairs or Alterations(Answer when applicable)9n PAG C& 4 A-A Wu P,11 W t (4) S00 Qg«o n C5 mbl,('S . l)SL, Q,yG ISVI nIN 1000 0,OAO r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has.been issued by this Board of Health. Signed - Rai, Date Id I-1 119 Application Approved by �-' Date J I Application Disapproved by Date for the following reasons Permit No. goi `"' �� Date Issued /� r No. J� Fee i"" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 l' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS S 2ppfication for Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair(\4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. g p Su�r o 1 K /1v u�+r+�n1, Owner's Name,Address,and Tel.No.v Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.F r,4�e r Z l ,} A 0 rr, t Po (70� ��4 W�,w,ct r r= 11, , ri,A' I L1 L, Type of Building: Dwelling No.of Bedrooms Lot Size :_(, r,c,o sq.fti Garbage Grinder(q,)) Other Type of Building No.of Persons Showers( ) Cafeteria( ) +, Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date lit 1 1 c i cl Number of sheets 'Z, Revision Date Title c,,4 ,. ,< <,�, ,� r ,,� ,, f�,­. ti, 4 "I I Size of Septic Tank t000 Type of S.A.S.p,) Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ f V,�4, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in,., accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 1 Application Approved by - r Date / f Application Disapproved by r Date for the following reasons ti Permit No. goof-3d Date Issued - --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(vl) Upgraded( ) Abandoned( )by at 20. �,, �t�� kv e has been constructed in accordance With the provisions of Title 5 and the for Disposal System Construction Permit No. j6(j-43y dated Installer ( (�, f.y� G',u,. Designer n r n v, r r,rrye n�[', do C #bedrooms Approved design flow and The issuance of this ermit shall not be construed as a guarantee that the system wi 1 )ctt as desi ed. Date ZL Inspector 1 ----------------------------------------'--a - ------------------------------------------------------------------------------------------- 4.. No. �� l Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposat-b- pstent Construction Permit Permission is hereby granted to Construct( ) RRepair( ) Upgrade( ) Abandon( ) System located at 1�p Arse 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. 2�2 Date �� Approved by (-) - S l Town of Barnstable Inspectional Services 4 Public Health Division °M ' Thomas McKean,Director twld° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 12.3-IOt Sewage Permit# 2019-4 53 Assessor's Map\Parcel ZQ1-133 Designer: F' cr�c t_Envy 1-o wlc,rla.l Installer: _R Address: Q©, Bc)x 133 Address: 14'rca Li c r r- .4 L Yy On �Z-2-l Cxcavo�A i o.-,, was issued a permit to install a (date) (installer) septic system at $p S&Z2C'o 14Z ACE based on a design drawn by (address) Svc lal�cs--Iu dated I2 2- 19 :(designer) vl' I certify that the septic system referenced above was installed substantially according to the design, which may include.minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified'as-built by designer to follow. Strip out(if required)was.inspected and:the soils were found satisfactory. I certify that the system referenced above was constructed i ,with the to rms of the IA approval letters(if:applicable) A iC %1 / D. t FLAHERT' JR.j r (1 taller'7S' a ', NO, 211JT I,A'Zi esigner's Signatur (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. .\\toa\depts\HEALTHSEWERconnecA\SEPTIC\DesignerCertificotion form Rev.&14-13.DOC Town of Barnstable Inspectional Services Department BA ABLE 1039. , Public Health Division ,b AlfOya, 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0824 September 19, 2019 HOOPER, VIRGINIA 80 SUFFOLK AVENUE HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 80 Suffolk Avenue, Hyannis, MA was inspected on 09/09/2019 by Brett Hickey, 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: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas cKean, R.S., CHO Agent of the Board of Health Q:\SEP'I'IC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\80 Suffolk Avenue Hyannis.doc v �Y Town of Barnstable • • BAIM rasc.e. ,A 039, Inspectional Services Department rfD MA'S� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) /eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) } OTHER Repair deadline: 0:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form rj _ 0 Subsurface Sewage Disposal System Form Not for Voluntary Assessments ar 80 Suffolk Ave Property Address -' Virginia Hooper Owner Owner's Name information is required for every y H annis Ma 02601 9-9-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 61o. h on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number 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. 0 Fails Brett Hickey ���.00 �,,� �a�. a..�.�s 9-9-19 Lz 201900.10 12'.i94B LCYq 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 r 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 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 80 Suffolk Ave Property Address Virginia Hooper Owner Owners Name information is Hyannis Ma 02601 9-9-19 required for every Y page. City/Town 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave v� Property Address Virginia Hooper Owner Owner's Name information is required for every -Hyannis annis Ma 02601 9-9-19 page. CitylTown 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 ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form III I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y 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 0 ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ El 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts �e ,z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave v Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every Y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ❑ ' a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. 0 ❑ 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 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 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 ❑ El 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave V, Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y 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 ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ n Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑ Q 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: ❑ El 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)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave L Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 4 Number of bedrooms(design): Number of bedrooms(actual): NA DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: No design plans were available for property. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes El No Does residence have a water treatment unit? ❑ Yes ❑E No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 91 No information in this report.) Laundry system inspected? ❑ Yes F!I No Seasonal use? ❑ Yes 0 No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2018- 12,500gallons 2017- 12,500gallons Sump pump? ❑ Yes ❑■ No Current Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 80 Suffolk Ave u Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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: Date of all components is unknown Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 1'3" Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts. Title 5 Official Inspection Form '1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave V Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 311 Depth below grade: feet Material of construction: 0 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 1000gallons Dimensions: 12" Sludge depth: 2411 Distance from top of sludge to bottom of outlet tee or baffle 511 Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r; u 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: h 'Capacity: gallons Design Flow: gallons per day t5insp.d8c-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments \ � 80 Suffolk Ave V Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town 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): 0" 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.): The d-box was in working order at the time of inspection. t5insp.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 h- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I V 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town 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.): NA * 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: (1) 6'x6' pit El leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑' leaching fields number, dimensions: 4W' cesspool 0 overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts �s Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 80 Suffolk Ave Property Address Virginia Hooper Owner Owners Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit and cesspool both in hydraulic failure when viewed. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): see above 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.): In hydraulic failure t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c� Commonwealth of Massachusetts �w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.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 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every 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 4y_x � y br J9 s s u c_ ar l b P�` ia;µa bV4 any Y T V JJfV1�Piji+°t 7p J by -Hyan��i54 y Y d jx p't'o �o.Y'_ 1 .e� a"„p"`r &: c ; '} , t c " 4 i A,, + a a jr" v vt .��, `� �$'� ° 7`���r'2`v��.�r,`� � � Y`� ^n?. � ��,� r + -f � �, _ � fir✓r �. „ .E' uar .�aa°+ �s�^ Ohs..+ iar: ✓ xr;. t,.°,y:flr r .� �� Olt- , . '�'Y �' 't�t��� - g' 4 r } �tl�� F +�` l2 ��M�GI'�'�'S, ''y ���� . t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 r ' c Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Suffolk Ave V Property Address Virginia Hooper Owner Owners Name information is Hyannis Ma 02601 9-9-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ■❑ Surface water ❑■ Check cellar ■❑ Shallow wells NoGW@20' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Perk 4-19-99Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perk on file at the local Board of Health was used to determine high groundwater. 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 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Suffolk Ave Property Address Virginia Hooper Owner Owner's Name information is Hyannis Ma 02601 9-9-19 required for every y 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection For, �L, , Not for Voluntary Assessments `' BAR' ""„'L` Subsurface Sewage Disposal System Form �;({S FIEE _7 Pil I: 37 Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification 0 1'IV iv10N Important: When fining out 1. Property Information: forms the �dPI computer, r,use 80 Suffolk Ave only the tab key Property Address to move your Virginia Hooper c� cursor-do not Owners Name use the return key. 80 Suffolk Ave Owner's Address c Hyannis MA 02601. City/Town State Zip Code Date of Inspection: 12/13/05 Date 2. Inspector: Mike Hudson Name of Inspector Septic-wiz Environmental Services Company Name 31 Midway Drive Company Address . Centerville MA 02632 City/Town State Zip Code 508-367-5669 Telephone Number Certification Statement: 1 certify that I have personally inspected the sewage disposal system at this address andre-5 theti information reported below is true, accurate and complete as of the time of the lnspectior.4he inspection was performed based on my training and experience in the proper function anq..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: rW Passes ❑ Conditionally Passes ❑ 'ails -; ❑ Needs Further E aluation by the Local Approving Authority r; 4n 1/09/06 r"' M 41pe4ct0s ig at Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this.inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 i - Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y�. Subsurface Sewage Disposal System Form A. Certification (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 City/Town State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/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: I ❑ One or more system components as described in the"Conditional Pass"section ne ed to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass: Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 City/Town State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection 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 ❑ obstruction is removed '❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Hooper-T5 Inspection.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/09/06 Owners Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. i ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form A. Certification (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State ZipCode Hooper 01/09/06 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes. No Ej 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. Hooper-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 80 Suffolk Ave Property.Address Hyannis MA 02601 Cityrrown State . Zip Code Hooper 01/09/06 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a I design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments r Subsurface Sewage Disposal System Form B. Checklist 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/06/09 Owner's Name Date of Inspection 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? 01A b ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/06/09 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD, Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes Z No Seasonal use? ❑ Yes ® No Water,meter readings, if available last 2 ears usage 2004 304 GPD g ( Y 9 (gpd)): 2005 284 GPD Sump pump? ❑ Yes ® . No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ jYes ❑ 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): Hooper-T5 Inspection.doc•11/20014 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 8 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Homeowner- Pumping company Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 2,500 gallons gallons How was quantity pumped determined? VIA Pumping company-Macomber Reason for pumping: sludge, scum levels excessive 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). ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: est. cesspool 28 years old, upgrade to tank, d-box and leaching installed 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments r Subsurface Sewage Disposal System Form C. System Information (cont.)% . 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet - Comments (on condition of joints, venting, evidence of leakage, etc.): PVC pipe in good condition Septic Tank(locate on site plan): Depth below grade: 4"_811feet Material of construction: ®concrete ❑ metal E]fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of Yes ® No certificate) Dimensions: 1,000 gallon -8'6"Lx4'10'WX5'D Sludge depth: 34", 26"thickness Distance.from top of sludge to bottom of outlet tee or baffle -Scum thickness 1011 Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? meassured w/tape, stick& rag, . flashlight Hooper-T5 Inspection.doc-11/2004 Title 5.Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown state Zip Code Hooper 01/09/06 Owners Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Scum and sludge levels excessive system requires pumping, inlet and outlet baffles in good condition, structurally sound, no evidence of leakage Q 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.): I ITight 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): Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 City/Town State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection 'r I Tight or Holding Tank(cont.) N Dimensions: Capacity gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 10, even w/outlet 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 level, light carryover, structurally sound w/normal effluent levels and no sign of leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order ❑ Yes ❑ No Hooper-T5 Inspection.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 City/Town State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: (1)6' Radius, est. 3'stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: (1)6' Radius ❑ 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.): Soil condition normal, no signs of hydraulic failure, no ponding, damp soil or lush vegetation. Est. 3' washed stone surrounding leach pit, stain line 20"below inlet pipe Hooper-T5 Inspedion.doc•11/2004 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System Page 13 of 16 Commonwealth of.Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address City/Town State Zip Code Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow . ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Hooper-T5 Inspection.doc•.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not.for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 City/Town State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. W C 80 Suffolk Ave Hyannis, MA 02601 Rear of House A B 4 3 1000 Gatton H-10 O O O Septic Tank D-Box 1 2 6' (R=6') Leachpit A 1-21' B 1-28' O 5 2-26' 2-22' 6' (R=6') Overflow cesspool 3-30' 3-20' 4-56' 4-26'6' _ 5-33'6' 5-30' Ho6per-T5 Inspection.doc•11/2004 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 80 Suffolk Ave Property Address Hyannis MA 02601 Cityrrown State Zip Code Hooper 01/09/06 Owner's Name Date of Inspection Site Exam: Slope ht S kOVL , Surface water V\ Check cellar Shallow wells Estimated depth to ground water: Z O 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 1.50 feet of SAS) ® Checked with local Board of Health -explain: reviewed prior inspection report ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Reviewed USGS Hyannis quadrangle You must describe how you established the high ground water elevation: Observed site and soil conditions, reviewed USGS Hyannis quadrangle and USGS water resource map for subject property contour elevation and high water elevations Hooper-T5 Inspection.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 i= i CO\ ,' D\\\ ,AL,TH OF NLkSS.-%CHL"$=T TS E EC L T %"E OFFICE OF E\-�rIRONN'FNT.-%L. AFFAJR = � DEPART'I MNT OF ENVIRONMENTAL PROTECTION --- ONE: Ct ; STF,_r.. BOSTON \LA 0210, ?9Y.:;:;i, TRL7DI' CO\7 Secretary .ARGEO PA'-L CELL':CCI DAVID B STRUHS Governor Co:r.rnissicne: SUBSURFACE SEWAGE DISPOSAL A SYSTEM INSPECTION FORM '1U1 A-q I irs,3 CERTIFICATION Property Address: t-Ve �a Name of Owner NCVL%-N_S I 91021 3.� , ������� Address of Owner: 1�5 S��)� Date of Inspection: Ple�s� �1Vf ti51 CR �lZ'SG I Name of Inspector-.( n ) -DEC_KU am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: st�- NLAng Address:41a An ,, Lg�?--bl-tS N 4-C1 Teleplxx a Number: /_SCC, ) L f 3 s'z. /L- • Z-G CERTIFICATION STATEIMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ F ils L Inspector's Signature1A1_cQ r Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS R � 11'1AY 1 9 1999 E Z revised 9/2/98 Page IofIt Panted on Recycled Piper _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C CERTIFICATION (conbrxied) R 'roperty Address: Jwner: Date of Inspection: INSPECTION SUMMARY: Check A, 8, C, or D: A..l SYSTEM PASSES: 7� I have not found any information which indicates that any of the failure conditions described in 3'= C z1 15.303 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 o, repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If 'not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank,was installed within twenty (20) years pr,or tc the date of the inspection; or the septic tank, whether or not metal, is cracked. structurally unsound, shows substantal infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipes). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed J� R !;i' y.. C7 revised 9/2/98 Page 2of11 r• ' `1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contirwed) Property Address: Owner: Date of Inspection: 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' the system is failin_ to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 10 CMR 15.303 (1)(b) THAT THE SYSTEM. IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONMENT: _ or Cesspool privy is within 50 feet of surface water P P Y Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sa marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WA SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH D SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(S S)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 soil absorption system nd the SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption syste and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption syste and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water anelysi for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 'FORM PART A CERTIFICATION (continued) t property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as descri ed i- 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to det mine Ahat will be necessary to corre=t the failure. Yes No Backup of sewage into facility or system component due to an overloaded or ctcgged SAS or cesspoof`' Discharge or ponding of effluent to the surface of the ground or/surface waters oue to an overloaded or cloggez SAS c: cesspool. Static liquid level in the distribution box above outlet invert due to an overloadec or clogged SAS or cesspoo! Liquid depth in cesspool is less than 6" below invert or avpilable volume is less tnan 1/2 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 Soil Absorption System, cesspopf or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100�'ffeet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a 1/one I of a public well. Any portion of a cesspool or privy is withi 50 feet of a private water supply well. Any portion of a cesspool or privy is le •than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If de well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic co pounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes- or "No" to each of he following: The following criteria apply to large syst ms in addition to the criteria above: The system serves a facility with a d ign flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environme t because one or more of the following conditions exist: Yes No the system is within 0 feet of a surface drinking water supply the system is withi 200 feet of a tributary to a surface drinking water supply the system is loc ted in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply w II) The owner or operator of any su system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for fu er information. revised 9/2 8 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B • CHECKLIST r'roperty Address:G3 Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or 'No as to each of the following: Yes No )( Pumping information was provided by the owner, occupant, or Board of Health. -.. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N'A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) C-` [I5.302(3)(b)) The facility owner (and occupants,if different from owner) were provided with information on the prop ermaintenan"-af SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION 'roperty Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: (tL1 O g.p.d./bedroom. Number of bedrooms (design): Number of bedrooms (actual): s) Total DESIGN flow_ Number of current residents:Q Garbage grinder(yes or no):� Laundry (separate system) (yes or no :_, If yes, separate inspection required Laundry system inspected (yes or no Seasonal use (yes or no):_&,N Water meter readings, if available (last two year's usage (gpd): (y Sump Pump (yes or no): f--Z Last date of occupancy:7a'7-14's 6V\1. COMMERCIALANDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:( System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: t\41N.) S• - i3cn t r Sewage odors detected when arriving at the site: (yes or no)4� St- y revised 9/2/98 Page6of LI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) property Address: Bv Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction: _cast iron_40 PVC_ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: > (locate on site p n) Depth below grade::� Material of construction: Aconcrete_metal_Fiberglass _Polyethylene—other(explain) If tank is metal, list age_1Is age confirmed by Certificate of Compliance_ (Yes No) Dimensions: Sludge depth:_ i) Distance from top of sludge to bottom of outlet tee or baffle:11)k Scum thickness: Qt' 41 Distance from top of scum to top of outlet tee or baffle: xz. Distance from bottom of scum to bottom of outlet tee or baffle k�k How dimensions were determined: "Clj,!r A vl comments: (recommendation for pumping, condition of i let and outlet tees or baffles, depth of liquid level in relation to out t invert,.str ctural integn Y. evidence of leakage,etc.) ` v a Nv GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Rberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: _ nW Material of construction: _concrete _metal_Fiberglass_Polyethylene _other explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:41,S (locate on site plan) Depth of liquid level above outlet invert: �' u�oLTU a-'O �` Comments: (note if I vel and distribution • e ual, eviden of solids carryover, evid ce of leakage into or out of box, etc.) PUMP CHAMBER:4� (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,•condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 • r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM q PART C SYSTEM INFORMATION (continued) 'roperty Address:(�S`171P-�L<1- Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): 407, (locate on site plan, if possible: excav ion not required, location may be approximated by non-intrusive methods) If not located, explain: Type: , leaching pits, number:�tOJ��o leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: \- &jK:CV1c" Alternative system: Name of Technology: Comments: (note condition of soil signs of hydraulic failure, level of ponding, d p s il, condition of veget ion, etc.) AJ SD t k S tile' N ) i CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: 01 (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.) revised 9/2/98 Page 9of11 iV SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) d 'roperty Address: )wnera Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) �Z �► revised 9/2/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r C SYSTEM INFORMATION (continued) v r roperty Address: Owner: Date of Inspection: NRCS Report name - — --- -- Soil Type— — - --- - --- Typical depth to groundwater____._ -- USGS Date website visited (J- Observation Wells checked Groundwater depth: Shallow Moderate Deep ----_ SITE EXAM Slope Surface water„-1,0 Check Cellar 0" Shallow wells Al� Estimated Depth to Groundwater—ZOFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole. basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers XUsed USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) V S ~ 6O�L C.C;t�l N V j i�— revised 9/2/98. Page 11of11 No----- � F*s....3. ....'� THE COMMONWEALTH OF MASSACHUSETTS �� + BOARD OF HEALTH TOWN OF BARNSTABLE pot Applutttuan for Bhiposa1 Works Tnnstrurtion ramit v Application is hereby made for a Permit to Construct ( ) or Repair �Qj an Individual Sewage Disposal System at: ---- jQ FIFOCAC Location-Add ss I or.Lot No. �•...................... ...._................................ --•--•........................_.................---- Owner Address `1•_ a \AC`�4 � �C -• AtJ Sr C�. ...................•••--- ..... ............................... ..... 1:.. -•---- _ ....... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers (- ) — Cafeteria ( ) P4 Other fixtures -------------------------------- - . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._-__-.--_--_--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z . Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed-by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ----•-----•-------••••-------------•-•-----•-----•-•---•....----------------•-..._.......------............................................................. O Description of Soil - -- �Z z. ----------��....'�`.------.`--.�------.5 V .........•----------•-•-•-------•••-•--•....--------•-----•........................•--------------•-.....---•--•---•-•---------•---••------•------• ....................................... W N ture of Re airs or Alterations—Answer when an licable____rk.__....� 0CZ C^t -`� V-\ U P P k ---------------------------------- ------..-•------------ "� �` c .............................................e. ---- �. ��------. ......... )`\5��,,4._.....`strs( ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 3 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has been issued by the board of health. Signed ------- e,.k = --------------------------------- } Dale Application Approved By ........... ... ..-�. Application Disapproved for the following reasons- -------------------------------------------------------------------------............................................................ ................----- ..................--.-------- ---- ..........----...---........---...---------------------------------------.-........------------------------...-------------- ---------------- ..........----------- PermitNo. .......C---/-..-...----J_/------------------------------- Issued .........................................................Da[....... Date No.....A.. :..:f.. Fmc ✓ .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l TOWN OF BARNSTABLE Appliration for Dispasal Works Tonstrnrtinn rrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( j an Individual Sewage Disposal ----� System at: I CU FIF O(_\c- Wv -------------------- `._.. t`« ?1 5.... - ......---•--..•------------------------------ Location-Address or Lot No. t� ..... ---------7------------•-•------•------ .............................................. Owner Address ------------------------•-•----. .. ............................................................ =......... Installer Address UType of Building Size Lot_-------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers. — Cafeteria 0 Other- fixtures ------------------------------------------------------------•------•-•-------•---------•--••---•••-••-.........------ t`•- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W k Septic Tan —Liquid capacity............gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area-,----------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.---_._------------- Total leaching area------------------sq. ft. Z Other`Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ --•------------------------------------•--------•-----------------_.--------•---•---------•-........"--------•-----.*- ------------------. ----•---- O Description of Soil.......0...2 ......5 v +�------------------ c4 `'�'� r`' -�......-_S .................................. W ...*- r U Nature of Repairs'or Alterations—Answer when applicable....Y'M....... ------- w -•-----------. ...�-3 'r•��j-----•------ ,c ------C'-` �?-`J...... -5!wc -------`�1-!K.......:rO-------- x�5 �,, ........................ m 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 issued by the board of health. Signed + ......... Date ApplicationApproved By ----------- V------ --j--- ------------------------------------------------------------------------- --------------��V ?/ z Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------ -------- ----...--- --------------------- ------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- Date PermitNo. � .......a-1............................... Issued ........................................... ----------- ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#tftrate d C ontylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�+✓ ) by '�ck �tN�� ���' `� .---------- --------------- Installer at ---- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .........� ..-....�./............... dated ..../1............-..--.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GU RANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE.. �� - ...------------------------------------------------------------------- Inspector ... +�1 1,n.P..... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 11isplasal Vorks 0DIrn#rudimnn arAi# Permission is hereby granted.......'k4-`-�1�1`T.:...<,aw"'k-..e 0' ........... ........ = ------------- to Construct, (_ ) or Repair Pan Individual Sewage Disposal System at No..................................0 r �� b�..�. ....t'��p..nl.. ..S--------•---••-------•--•--------•.............................. Street as shown on the application for Disposal Works Construction Permit No��__W1... Dated.......................................... ----------------- •---- _ ......---------.......----.......---•-••...•--_...._ q Board . Health DATEI---------- --y.....-•t'/---------- ---------------------•--•--- FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services ' TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE (not to scale) INSP. PORT W I 3" OF GRADE + EL. 58.0' EL. 56.0' CLEAN SAND P.O. Box 33� ' 2" ofl,B' to Z" DOUBLE WASHED EL. 56.0' Harwich, MA 02645 PEASTONE OR GEOTEXTILE 774.994. 1166 4" CAST IRON or EQUIVALENT FILTER FABRIC MIN. PITCH 1/4" PER FOOT 4" SCHEDULE 40 PVC PIPE 4"SCHEDULE 40 PVC PIPE VENT IF REQUIRED FLOW LINE (fiist2'to be level) ` 31' 1.30 o EL. 54 8' 5' 1/o _ e o e •a•. '. t ..': ••• . .. eeeeeeeeeeeeeeeeee• —_ — EXIST. 10 14" o 0 0 0 0 0 0 •a C� 0-1 " �� 000 00o c —► 0 0 0 0 0 LJLJEZ3 O® �. �—r o°0°000°c •" EL. EXIST EL. 53.6' —� 0000000° ° 0000000 0 0 0 o O C3 O O C� 0000000°c EL. 53.03' o 0 0 0 0 0 0 0� Q� o 0 0 0 ' 0 0 0°0°0°0°000°0 C� C� C� 0.O C� C� 0 0°0° ° °e Z—D' EL. 53.2' EL. 53.0' o 0 0 0 0 0 QO �Q � 0 00000 GAS BAFFLE 0 0 0 0 0 0000 0 0 000c H-20 D-BOX 0000000000 000000 a 0°000000C o 0 0 0 0 0 0 <• a o 0 0 o EL. 51.0' ` STALL INLET TEE SOIL ABSORPTION SYSTEM 6" CRUSHED STONE OR 1"ABOVE OUTLET INVERT •: MECHANICALLY COMPACTED (3) 500 GALLON H-20 CHAMBERS 1000 GALLON SEPTIC TANK WITH 4' STONE AROUND IN A 5.5' (DATUM: ASSUMED) (EXISTING) 4" to 14" DOUBLE WASHED STONE 12.83'X 33.5'X 2' CONFIGURATION BOTTOM OF TEST HOLE EL. 45.5' 'EL. 45.5' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A A�/ENUE NTH VINEYARD V LOCUS LOT 55 Ave. 20,000 SF t BENCHMARK: MAP 291 L❑i 133 shire i, TOP OF FNDN LP 6 ,Vine1V-1 HaMPEL. 58.0' g�stol Ave' r 0 La I � N EXIST. S.T. P (� I EXISTING T1 NTS I v DWE LING �ytN OF%d 26.8 H-2 � V nyL — DECK O ..'� R (,JR. N DRIVEWAY STE`�� m J SgNlTAR%PN - - - l m 11.0 DATE:11/6/2019 REVISED:12/2/2019 56 LEGEND SITE AND SEWAGE PLAN FOR t B & B EXCAVATION, INC-/ �—�=b 6 GAS LINE - w W W WATER LINE VIRGINIA HOOPER E E E E E EXIST. ELECTRIC 80 SUFFOLK AVENUE 99 EXIST. CONTOURS n _ t (HYANNIS) BARNSTABLE, NA ————— 99 PROP. CONTOURS SCALE : 1 - 3 0 U�& U,'s kl"C UNDERGROUND UTIL. REF:LCP 14034-B PAGE 1 OF2 GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services P. 0 . Box 331 16 8 1. ALL PRECAST COMPONENTS TO BE H-10 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 4 774.994. 1166 DISTRIBUTION BOX AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OFA GARBAGE (110 GAUBR/DAYX4 BR) 440 GAL./DAY GRINDER. REQUIRED SEPTIC TANK CAPACITY 880 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER Q Q Q 12,83' APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION 1 CODES AND REGULATIONS, 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCH VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL./DAY/FT2 33,5' AND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR LEACHING AREA ASSUME ALL RESPONSIBILITY. (2)x(33.5'+ 12.83)(2) = 185 SF 6. INSTALLER/CONTRACTOR IS 33.5'x 12.83' =429 SF RESPONSIBLE FOR MAINTAINING SAFE 614 SF 0.74 =454 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(3)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO IN A 12.83'X 33.5'CONFIGURATION AS DIAGRAMMED CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY N/A THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS- (NTS) NOT TO EXCEED 3' PER 310 CMR 15.000 UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION OF FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 TPT#19-180 TESTHOLE#2 TPT#19-1805' AND REPLACED WITH CLEAN SAND. Evaluator- David D.Flaherty Jr,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS QAW yG 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 cP r BOH Witness: David Stanton,RS BOH Witness: David Stanton,RS WITH WATERTIGHT ACCESS PORTS D Date: October29,2019 Date: October29,2019 s' FUq,zp- j WITHIN 6" OF FINISH GRADE, 11.ALL SEPTIC TANKS, DISTRIBUTION TH-1 ELEV.56.0' TH-2 ELEV 56.0' BOXES AND PIPING TO BE INSTALLED �NITAR��N WATERTIGHT. 0"-9" A LS 10YR 3/2 0"-9" A LS 10YR 312 12.NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED LEACHING. 9"-31" B LS 10YR516 9"-31" B LS 10YR516 13.THIS IS NOT A CERTIFIED PLOT PLAN t AND UNDER NO CIRCUMSTANCES IS THIS 4s') Perc r l certify that on November 12,2002,l have passed SITE AND SEWAGE PLAN PLAN TO BE USED FOR ZONING OR the examination approved by the Department of FOR BUILDING PURPOSES. Environmental Protection and that the above analysis has been performed b me consistant with the p y IN B & B TION C 14.LOT IS SHOWN AS ASSESSOR'S MAP 291 required training,expertise,and experience described EXCAVA 31" 126" C MCS 2.5Y616 31"- 120" C MCS 2.5Y616 LOT 133. 5%gravel 5%gravel in 310 CMR 15.018(2)." VIRGINIA HOOPER 15.LOCUS PROPERTY IS NOT LOCATED 80 SUFFOLK AVENUE WITHIN AN AQUIFER PROTECTION (HYANNIS) BARNSTABLE, DISTRICT(ZONE II). G.W.ELEV.N/A G.W ELEV.N/A MA BOTTOM TH-1 ELEV. 45.5'1 1 BOTTOM TH-2 ELEV. 46.0' PAGE 2 OF 2 DATE:121212019 TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services EL. 58.0' EL. 56.0' (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 339 2"-of e"t0 Z" DOUBLE WASHED EL. 56.0' Harwich, MA 02645 4" CAST IRON or EQUIVALENT PEASTONE OR GEOTEXTILE 774.994. 166 MIN. PITCH 1/4" PER FOOT FILTER FABRIC "SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE VENT IF REQUIRED FLOW LINE (first 2'tobe/eye/) �• —` 31' 1.3 5' 1°Ao .. ;.:.'•: L.EXIST, 14" ® :• �® o°o°o°o° If EL EXIST o 0 0 0 0 0 0 0 0 0 0 • L.53.6' oo°o°o°°°° o o°o° ® o°oo°c EL.53.03' 000 0 0 00 10000 ®jL�} o00000'0C ° o°o°o°o°o°o° y� o°o°o°o°e 2.0' GAS BAFFLE EL 53.0' oococ000ca°000000 ILJJ ®L`-9 00000000c— (bN20D-BOX) 000°0°000 °00000 ;4' • .. •,'00000000e EL.51.0' j 6"CRUSHED STONE OR VA OVE AOVE OUTLET INVERT SOIL ABSORPTION SYSTEM 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS WITH 4'STONE AROUND IN A 5.5' (DATUM: ASSUMED) (EXISTING) ." to 1," DOUBLE WASHED STONE 12,83'X 25,X 2'CONFIGURATION BOTTOM OF TEST HOLE EL. 45.5' EL. 45.5' _ USGS ADJUSTMENT: N/A LOCA77ONMAP D AVENUE GROUNDWATER ELEV: N/A VINEYAR " TH LOT 55 *AVe .05' �h 20,000 SFt .'ZI BENCHMARK: MAP 291 LOT 133 TOP OF FNDN EL. 58.0' LP 6 0 �0 I W �D EXISTING O P T -1 NT3 I � 3 BR DWELLING o DAV' c�Gu EXIST. S.T. TH-2 . 26.4 DECK O. 1 s` O .t _ DRIVEWAY O •5. N►TA Et1 m P�. C m DATE. JJ/Q12019 REVISED: 100.00 e 11.4 LEGEND ' 56 SITE AND SEWAGE PLAN GAS LINE FOR B& B EXCAVATION ZNC./ �l W V—:F WATER LINE � r E—a-r 99 VZRGZNZA HOOPER EXIST, ELECTRIC f 80 SUFFOLK AVENUE 9 EXIST• CONTOURS 9———_— 99 PROP, CONTOURS SCALE : 1 I I = 3 o I (HYANNZS) BARNSTABLE, MA °•"'r "' UNDERGROUND UTIL, • REF.,LCP 14034-B PAGE J OF2 X ........... ................... .......... ............... ...................................................................................................................................................... ......................................................................................................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................... GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental Services 16 P. 0. Box 331 1. ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED, NUMBER OFACTUAL BEDROOMS 3 774.994.1166 DISTRIBUTION BOX AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OF GARBAGE (110 GALIBRIVA Y X 3 BR) 330 GAL./DAY GR1NDER. 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 25' - 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL.(EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION 5. INSTALLER/CONTRACTOR TO REVIEW& CODES AND REGULATIONS. DESIGN PERCOLATION RATE <2 MINAINCH VERIFY ALL ELEVATIONS AND DETAILS AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING RATE a74 G4L.IDAYIFT2 DESIGNER PRIOR TO CONSTRUCTION OR 0 0 12.83' LEACHING AREA ASSUME ALL RESPONSIBILITY. (2)x(25.0'+ 12.83)(29 =151SF 6. INSTALLER/CONTRACTOR IS 25.O'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SF x 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4,STONE (1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATION ASDIAGRAMMED CONSTRUCTION. Z ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLA HER TY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED 7ESTHOLE#1 TPT#19-180 TESTHOLE#2 7PT#19-180 'A OF AND REPLACED WITH CLEAN SAND. Evaluator. David D.Rahe*Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS 1 O.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 DAMI ti WITH WA TER 77GHT ACCESS PORTS BOH Witness., David Stanton,RS BOHWtiess: David Stanton,RS Date: October29,2019 Date: October29,2019 WITHIN 6"OF FINISH GRADE. F JR 11.ALL SEPTIC TANKS, DISTRIBUTION 21 TH-1 ELEV 56.0' TH-2 ELEV 56.0' BOXES AND PIPING TO BE INSTALLED 0..9. WA TER 77GHT, A LS IOYR312 0.-9. A LS 10YR 312 S 12.NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED LEACHING. 9'-31' B LS I0YR516 9"-31* B LS 10YR" 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS 7 car*that on November 12,2002,/have passed J4_9) Pero SITE AND SEWAGE PLAN PLAN TO BE USED FOR ZONING OR the examination approved by the Department of FOR BUILDING PURPOSES. Environmental Protwffon and that the above ana"Is has been performed by me consistent with the 14.LOT IS SHOWN AS ASSESSOR'S MAP 291 8 & 8 EXCAVATION, INC./ 31'-126' C MCS 2.5Y 616 31'-120' C MCS 2.5Y 616 required valning expertise,and expeifence desenbed LOT 133. V1RGZNZA HOOPER 5%gravel 5%gievel In 3 10 CUR 15.018(2). 15.LOCUS PROPERTY IS NOT LOCATED 80 SUFFOLK AVENUE WITHIN AN AQUIFER PROTECTION (HYANNZS) BARNSTABLE, DISTRICT(ZONE II). G.W.ELEV.MIA G.W.ELEV IVIA BOTTOM TH-IELEV. 45.5' BOTTOM rH-2 ELEV. 46.0' MA PAGE20F2 DATE:111612019 ............................................................................................................. ................-............. ........................................................................ ......................... ..... ................................................................................ ............. ........................................ ... .......... .............................. .............. ......... ....................... .. ..... ................. ..............................................................................