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HomeMy WebLinkAbout0004 UNCLE JOES WAY - Health 4 Uncle Joes Way Hyannis A = 222 304 i W 6 1 x 0 h ' g Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City(rown 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. General Information on the computer, J14 use only the tab 1. Inspector: ` key to move your cursor-do not Ricky.L. Wright use the return key. B & B Excavation,lnc. Company Name 14 Teaberry Lane Company Address "' Forestdale MA k R02644 Q City/Town State Zip Code 508-477-0653 S14595 Telephone Number License Number B. Certification , MU 01 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r , R S 2/15/12 Insp&:tor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "*"'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official 41nspectionubsurface Sewagea/ /S 9 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Uncle Joe's Way Property Address P Y Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis -MA 02601 2/15/12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed. ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C Further Evaluation i. ) s 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 ass unless Board of Health determines in r y p accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health and Public Water Supplier, if an Y ( pp 9 Y) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and.SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less thanl6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This . system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary.to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ^ ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310'CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (gpd))� Detail: Sum pump?p p p El Yes ® No, Last date of occupancy: 2011 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow based on 310 CMR 15.203 g ( ) Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA . 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: tank is original to dwelling leaching upgraded•in 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection, building sewer appeared to be in good condition with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 3 feet Material of construction: ® concrete ❑ metal , ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 52"x 57'x 8,6° Sludge depth: 6" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 31 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 7 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection, septic tank appeared to be structurally sound no sign of back up or leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachuset ts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material f n o construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection liquid level in d-box was equal with outlet. D-box showed no signs of deterioration and solid carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 . page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of. vegetation, etc.): At time of inspection leaching was dry.Showed no signs of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'y 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 4,Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is-required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two.permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building: Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A ' ' r P�3 2R z. % N 6 a O 0 O O 3 1 3 = '4 -52- 37` " 133 4 -3'i= 3'4 j+" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 4 Uncle Joe's Way Property Address Bank of NY Mellon Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: >10 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Uncle Joe's Way Property Address Bank of NY Mellon. Owner Owner's Name information is required for every Hyannis MA 02601 2/15/12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 \ Commonwealth of Massachusetts W Title 5 .Official Inspection Farm Subsurface Sewage Disposal Systen-)Form-Not for Voluntary Assessments It w 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name k information is required for every Cannonsburg Pa 15317 5111/2011 page. Cityrrown State Zip Code Date of Inspection Inspection results must be.submitted on this form. Inspection forms may not be altered in any way. ` Important:When filling out forms A. General Information ' . on t he computer, use,to the tab key-to move your 1. _I nspector:, 14 (H 0 cursor-do not Dion C.Dugarl rt + use the return key. Name of Inspector Dugan Const,ruction '' I ran Company Name4 1543 Main St. c.. r Company Address ! -n Brewster MA 02631co " City/Town State Zip Cod - ' 508-896-9390 60 =^ cr Telephone Number License Number CO M, B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and-complete as of the time of the inspection_The inspection Was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310,CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority '001,f. llt/ ,l Inspector's Signatur 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 the system will perform in the future under the same'or different conditians of use. 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal S em-Page 1 15 �ss- Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owners Name information is required for every Cannonsburg Pa 15317 5/11/2011 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exis t. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent_ System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or breakout 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 4 UncleJoe's Way Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner owner's Name information is Cannonsbur Pa 15317 5/11/2011 required for every 9 page. Citylrown State "Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ 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 3110 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. .System will fail unless the Board of Health(and Public Water Supplier,if arty) 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. 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 c i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form:- Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technol y Dr. Suite 102 Owner Owner's Name information is required for every Cannonsburg Pa 15317 5/11/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis.must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ®, Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool ❑ ® Liquid depth in cesspool.is.less than 6° below invert or available volume is less than '/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 SAS,cesspool or privy is below high ground water elevation. ❑ N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 or 15 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name required for is every Cannonsbur required for eve 9 Pa 15317 5/11/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public welt. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] F ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large systemk 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 stud contact the appropriate regional office of the Department. 4 UncleJoe's Way Hyannis•03108 Title 5 Officiai Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owners Name information is Cannonsbur required for every g Pa 15317 5111/2011 page- Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or'rb'as to each of the following: Yes No Z ❑ 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? ❑ Z Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(ff they were not available note as N/A) ® ❑ Was the facility or dwelling.inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth,of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size,and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing_information. For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] 4 Uncle"s Way Hyannis•03108 Title 5 Official Inspection Fomr Subsutface Sewage,Mposaf System•Page s of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form Not for Voluntary Assessments a 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is required for every Cannonsbur 9 Pa 15317 5/11l2011 page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310,CMR 15.203(for example: 110 gpd x#of bedrooms): 457 gpd Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No µ Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes N No Water meter readings, if available last 2 'ears usage '10 85,720 gal ( y g (gpd)): 09 100,980 gal Sump pump? ❑ Yes ® No Last date of occupancy: 9/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)-' Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ -No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No . Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is required for every Cannonsbur 9 Pa 15317 5/11/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: pumped 6/13/2000; 6115106, 11/16/07 B.O.H_ Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was.quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank Attach a copy of the DEP approval ❑ Other(describe): Approximate age of all components, date installed(if known) and source of information: installed 1/29/04; >6 yrs. old B.O.H. Were sewage odors detected when arriving at the site? ❑ Yes No 4 UncleJoe's Way Hyannis•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is Cannonsbur Pa 15317 5/11/2011 required for every g page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 43" Depth below grade: feet Material of construction: El cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints are tight, venting is at the roof, no signs of leakage. Septic Tank(locate on site plan): 31" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑polyethylene. ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,000 gal Sludge depth: 5„ Distance from top of sludge to bottom of outlet tee or baffle 25" Scum thickness 4 Distance from top of Scum to top of outlet tee or baffle 9. Distance from bottom of scum to bottom of outlet tee or baffle s 6 How were dimensions determined? by tape and rod 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is Cannonsbur Pa 15317 5/11/2011 required for every g page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Covers built up within 6"of grade. Recommend tank be pumped next year, tank and tees in good condition, no sign of leakage. vrcaSc T raja'locate on site piah'- 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, structurar integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped.at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass' ❑ polyethylene ❑ other(explain): 4 UncleJoe's Way Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 or 15 P Commonwealth of Massachusetts Title 5 official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Uncle Joe's Way Hyannis, MA k Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is required re wired for every 9 -Pa 15317 5/11/2011 page. Cityrrown a State Zip Code Date of Insupec Lion D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. El Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches; etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0.1 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or,out of box; etc.): D-box was found level W/some sign of carryover or leakage; distribution is equal Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No ' Alarms in working order: ❑ Yes ❑ No 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is required for every Cannonsburg Pa 15317 5/11/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): IT SAS not located, explain why: Type: ❑ leaching pits. number: ® leaching chambers number 4 -500gal. drywells w/Zstone ' ❑ , leaching galleries number: ❑ leaching trenches number, length: El leaching fields number, dimensions: ❑ overflow cesspool number: FJ 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.): Four 500 gal. dry wells w/2' stone; wells were found dry at time of inspection; no sign of failure. 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.SolUtions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is Cannonsbur Pa 15317 5/11/2011 required for every 9 page. Cityf town state Zip Code UWe of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):, Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate,on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 1� Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 4 Uncle Joe's Way Hyannis,.MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is required for every Cannon sburg Pa 15317 5/11/2011 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. :24 00 = � l3 � D = 37" A ' 3 V 4 UndeJoe's Way Hyannis•03M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System-Form=Not for Voluntary Assessments w " 4 Uncle Joe's Way Hyannis, MA Property Address First Horizon Mortgage C/O Single Source Prop.Solutions 333 Technolgy Dr. Suite 102 Owner Owner's Name information is Cannonsbur Pa 15317 5[11/2011 required for every g page. Cityrrown State Zip Code [late of tnspecfion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Challo:M.nrallg Estimated depth to high ground water: >11.5' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole wittvn 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 highr groundwater elevation: By perk test on 12/5/2003; 11.5' deep no groundwater encountered; >4'separation. 4 UncleJoe's Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ;,1 r it CRAIG R. SHORT, P . E. 235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis, MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR SEPTIC SYSTEM DESIGNS, COASTAL&BUILDING DESIGNS SEPTIC DESIGN PROPOSAL PAGE 2 PROPERTY SURVEY,AND FLOOR PLAN SKETCH Please fill out this form,including the floor plan sketch, and return to us with the signed proposal and retainer. This information is necessary to properly prepare your Septic System Design. IF YOU ARE PLANNING AN ADDITION PLEASE INCLUDE THAT INFORMATION ALONG WITH THE FOUNDATION DIMENSIONS AND LOCATION FOR THE NEW ADDITION. J Total'of Rooms t`J Year Round Home !v� Seasonal Home Owner Occupied Rental #Bedrooms _Z✓�® Family Room/Den. C Living Room ITV DiningRoom !' '"• #Bathrooms Washer/Dryer- Dishwasher 1(,1 Garbage Disposal E'a Gas Service yG Town Water Ny. In-ground Electric Wires* ti In-Ground Oil Tank* 0-In-ground Sprinkler* Yr In-ground Gas Pipes* * Please note on sketch where located. Craig R Short, P.E.`assumes no responsibility if in-ground components are . damaged during Soil Testings, Inspections, Locations of and/or Installation of New Septic System. Cellar: V-Full Partial(Crawl) Slab Wells: , Main Use '9U � Irrigation Only (please provide location of all wells) PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs, trees,patios,electric lines,tanks,etc. IF YOUARE PLANNINGANADDITION,PLEASE PROVIDE THE LOCATIONAND FOUNDATION DIMENSIONS k -D R 'M� ���• IZM � � . ��,Ci11 «N TITLE V CALCULATION CHART (1995 Code) COMPONENT 3 BEDROOMS 4 BEDROOMS 5 BEDROOAMS 6 BEDROOMS Min.Required area for<5 mpi soil(1995 Code) 446 sq. ft. 595 sq. ft. 743 sq. fti. 892 sq. ft. SEPTIC TANK. 1500 Gallons 1500 Gallons. t 1500 Gallons 1500 Gallons ' DISTRIBUTION BOX Distribution Box Distribution Box Distribution Box Distribution Box SOIL ABSORPTION SYSTEM: Cultec Recharger 330's 4 (334 GPD) 6 (471 GPD) 8 (606 GPD) 9 (674 GPD) [NOTE:5 are not enough- JNOTE:7 are not enough- providesCultec Recharger 330's(with 2'stone surrounding SAS) 34 x 8.3 x 2 only 401 GPDJ prodder only 539 GPD) 71.5 X $.3 X2 49 x8.3x2 64x8.3x2 Cultec Recharger 330's(with 3'stone surrounding SAS) 3 (332 GPDI) 5 (490 GPD) [NOTE:4 are 6 (569 GPD) 8 (728 GPD) 28.5 x 10.3 x 2 not enough-providei only 411 51 x 10.3 x 2 60x10.3x2 GPDJ 43.5 a 10.3 a 2 High Capacity Infiltrators 4 (394 GPD) 6(461 GPD) 7(598 GPD) 8(667 GPD) H.C.Infiltrators(with 4'stone on sides,3'stone on ends and 14 inches underneath) 33 x 10.8 x 2 39.25 x 10.8 x 2 52 x 10.8 x.2 58 x 10.8 x 2 [NOTE: 4'stone is not recommendeed,more infiltrator unite are recommended) Infiltrator 3050's 5(331 GPD) 7(448 GPD) [NOTE: 6 9(557 GPD) [NOTE:8 11(665 GPD)[NOTE: 10 Infiltrators 3050's(with 2 ft.stone surrounding SAS) are not enough,only 399 are not enough,only 515 are not enough,only 631 341.x 8.2 x 2. GPD capacity[ GPD capacity] GPD capacity] 47x8.2x2 59x8.2x2 71x8.2x2 Infiltrators 3050's(with 3 ft.stone surrounding SAS) 4(345 GPD) 6(445 GPD) 7 (550GPD) 10(660GPD) 30x10.2x2 .39.5x10.2x2 49.5x10.2x2 60x10.2x2 Infiltrators 3050's(with 4 ft.stone surrounding S.A.S.) 3(335 GPD) 5 (443 GPD) 6 (551 GPD) 8 (665 GPD) [NOTE: 4'stone is not recommended,more infiltrator units 25 x 12.2 x 2 34 x 12.2 x 2 43 x 12.2 x 2 52.5 x 12.2 x 2 are recommended) 500 Gallon-C ambers 5 (417 GPD) 6(560 GPD) 8 (724 GPD) 500 Gallon,Chambers/Drywells(with 2'Stone) 31 x 9.1 x 2 46.5 x 9.1 x 2 55 a 9.1 x 2 72 x 9.1 x 2 500 Gallon Chambers/Drywells(with 3'stone on sides&ends) 3 (384 GPDI) 4 (477 GPD) 5 (574 GPD) 6(669 GPD) 31.5x11.1x2 40x11.1x2 48.5x11.1x2 57x11.1x2 500 Gallon Chambers/Drywells(with 4'stone on sides&ends) 2(355 GPD) 3(462 GPD) 4 (570 GPD) - 5(677 GPD) [NOTE: 4'stone is NOT RECOMMENDED,more chambers are recommended) 251 13.1 a 2 33.5 a 13.1.2 421 13.1 a 2 50.5113.112 Flow Diffusors(with 2'stone surrounding SAS and 12"deep 4(343.GPD) 6(485'GPD) 7(556 GPD) 9 (698 GPD) stone on bottom) 36x8x2 52x.8x2 60x8x2 76x8x2 Flow Diffusors(with 3'stone surrounding SAS and 12"deep 3 (340 GPD) 5(506 GPD) 6(589 GPD) 7 (671 GPD) stone on bottom) 30x10x2 46x10x2 54x10x2 62x 10x2 Leaching Trench 60' X 4'X 2' or(2) 80' X 4' X 2' or(2) (2)48 X 4' X.2' or (2)57' X 4' X 2' or 30' X4'X2' 40' X4'.X2' (4)24' X4' X2' (4)28'X4' X2' Leaching Field 446 S.F.(330GPD) 595 S.F. 743 S.F. 892 S.F. ALL MINIMUM S.A.S.SIZE REQUIREMENTS LISTED ABOVE ARE BASED UPON THREE ASSUYIPTIONS (1) No garbage grinder,(2)Class I Soil(0.74 GPD/S.F.),(3)No wetlands within 250 feet of S.A.S.and groundwater is greater than 14'below SAS 1:CHARTITV .. r - S Hazardous Materials Inventory Sheet Checklist (� Date Physical StreetAdd ress-C heck database to ensure it exists ' // `'Working Phone Number /-Actual Amounts -( ie. gas being used.to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? - provide a vehicle washing policy and explain it -note that it was given ��Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS?: : For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required bylaw. DATE.C L I E, Fill in please: R o v e K. YOUR NAME S: APPLICANT / QtS � „ .: BUSINESS YOUR HOME ADDRESS: Ll U c�� I! �t ' TELEPHONE # Home Telephone Number (So ti 5 s . NAME OF'CORPORATION: TYPE OF BUSINESS n r '' c _ NAME OF NEW BUSINESS a � -�`� cA� �` IS THIS A HOME OCCUPATION?---' ✓ YE NO ADDRESS OF BUSINESS ` l 1 MAP/PARCEL NUMBER -/19130 (Assessing) When starting a new business there are several things you mustdo in order to`be in with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the'informationyouu may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to lsgily operate your business in this town. _ 1. BUILDING COM ISSI ER'S Off IC This individu I n+Fr o m of y rniit requ'reme'is-that pertain,to this type of businessMUST.COMPLY WITH HOME OCCUPATION A ,hori _ Si na re** - RULES AND REGULATIONS. FAILURE TO MMENT p /' COMkY MAY RESULT IN'FIN S. rcx� on 2. BOARD& LTH f This individual � b en`'infor he peFmit requirements that pertain to this type of business.' C-���/1� -�C� MUST COMPLY-WITH ALL Authoriz&c Signature** r/ HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 4 4 / � '�� TOWN OF BARNSTABLE Dater TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF"BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: Aroj(2a yJ4 MA-tolfellC EMERGENCY CONTAC TELEPHONE NUMBER: _/58)J 6 ,o gsKn MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMEND TIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's " Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, / h Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, _ x Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials ' loc,vn eop�✓ . TOWN OF BARNSTABLE F LOCATION UlzL Dcs W 4 SEWAGE # VILLAGE ) ASSESSOR'S MAP LOT .INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 r SEPTIC TANK CAPACITY L6-W 941 "LEACHING FACILITY:(type), (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 6 CITZ. r s DATE PERMIT ISSUED: /c) g ^ ctl t DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No '� l / _ t I1 I, O - o Of� c N f y Fee �LJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pphrdttou for Mi =)Abandon( p�tem Com6truction 3dertutt Application for a Permit to Construct( )Repair( ) El Complete System O Individual Components Location Address or Lot No. y S �.S Owner's N e,Address and Tel.No. 9/�q� Assessor's Map/Parcel a e 3 0 q Installer's Name,AdktaS' MCO J Designer's Name,Address and Tel.No. 350 Main Street sh a r f Ft,(j W. Yarmoutn, MA 02673 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 3 gallons. Plan Date /,A ' B ' 3 Number of sheets / Revision Date dV _� Title !`o a c. L / ,` Size of Septic Tank Idoo 6 Type of S.A.S. L510 &c mkr7 2 e Description of Soil,___ /�P 6' lP/4 Y"1 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 Certifi- cate of Compliance has been issued by this Board of alth a Signe Date Application Approved by Date Application Disapproved for the following r ns Permit No. Date Issued Iq r No.. Fee THE COMMONWEALTH OF MASSACHUSETTS Enteredin m uter: _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS , 4' 01pprication for Migpo4al *pztem Construction Permit Application for a Permit to Construct( )Repair( /)'Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L_' V -e S J6 eS t-A Owner's Name,Address and Tel.No. Assessor's Map/Parcel a _ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .Sh Type of Building: _ Dwelling No:"o'f Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design5 c f Flow gallons per day. Calculated daily flow. �/'3 U gallons. Plan Date b - 3 Number of sheets 'Revision Date N Title ��e q 7 c r. 5;< Size of Septic Tank 100 19 Type of S.A.S. L4 )__5710 4( r Mb(, SA,_4 e Description of Soil /�P /�/4 v 1 Nature of Repairs or Alterations(Answer when applicable) 94 .� 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 Environmenta Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board off alth. f Signed r J ( _ ,Q �i'`- :vlr-1 Date r��l` Application Approved by ) f Je ��C��. '�-f- lJ. `{ kl/!'-), Date Ana Application Disapproved for the following reasons L v Permit No. Date Issued f '� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( c,,�"Upgraded( ) ~ Abandoned( )by at G� J/?( P . C C l v A; �!UY�1 7, 1 i has been constructed in accordance_ with the provisions of Title 5 and the for Disposal System Construction Permit No� 'dated -i�c Installer Designer r-- I� The issuance of this permit shall not be construed as a guarantee that the�� ste, w•il}}�f}}���nction as Vesigned. ( Date 3 -.5.- Q Inspector '.�_0�n14. �� PS A No. "7 -----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Migozaf *potent Conotruction Permit Permission is hereby granted to Construct( ) epair( pgrade( )Abandon( ) System located at y /J1 r I it eC -C-14k .�l�7ra i S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:C nstrucZ�n must be completed within three years of the date of this permit. Date: � Approved by /1. �l f TOWN OF BARNSTABLE c ocvn eop/ LOCATION /�C-�- D�J w'l SEWAGE# , ������� VILLAG92 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY-- LEACHING FACILITY:(type) ��� (size) �5 x x� No. OF BEDROOMS ,E PRIVATE WELL, OR PUBLIC WATER BUILDER OR OWNER CITZ ,J DATE PERMIT ISSUED: g`„ rV DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r �r 3 r ; o d o Q_ (Of �3 LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS G 0 U It D E R OR OWN ER- DATE PERMIT ISSUED _� _ � DATE COMPLIANCE ISSUED . �N 7 S C n i A N R� 1^ 1 L� No.. ISO ...?... ) V ^� Fps.. .. THE COMMONWEALTH OF MASSACHUSETTS --T- BOARD OF HEALTH ------...._.©G✓.tJ.... --.....OF.......6 Applira#iou for Bhgp ii al Works Towitrurtiou thrutit Application is hereby made for a Permit to Construct ()�) or Repair ( ) an Individual Sewage Disposal System at: Location-Address� or Lot No.� L r3 F�-%:._.��f�'......... ... !!...... .:. e.......... caner Address_- Installer Address d Type of Building Size Lot._&,..0A(J..Sq. feet Dwelling—No. of Bedrooms..............3_.__________-___-___-__--Expansion Attic ( ) Garbage Grinder (ND) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... .. W Design Flow............4�_._5�......................gallons per person per day. Total daily flow_______•._ ®....................gallons. WSeptic Tank—Liquid capacity.`a v_P.gallons Length-------7..... Width--.., ..__ Diameter________________ Depth.. {........ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........f......... Diameter........15..____ Depth below inlet........6......... Total leaching area._Z. ....sq. ft. Z Other Distribution box (X) . Dosing tank ( ) Percolation Test Results Performed by.__.0�.� _ .._._._L eQ,__ Date----- 1. .-. f7..... Test Pit No. i.C_Z_.__mmutes per inch Depth of Test Pit:_./ d'_. Depth to ground G14 Test Pit No. 2.4-_2__minutesper inch Depth of Test Pit--- _ _��_ Depth to ground water_�o0ita i..... Ix ....................................... ................ . ......._......... ---------•---......................................................... O Description of Soil_ _ `� .�_ —' lop �� w ,� <. -., Jai----•--------------- U Nature of Repairs or Alterations—Answer when applicable._-__________________________________•••.__.___-____-•-.----_-_----_-----_•-•----_-•_•••-_••-•-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T i'•1' the provisions of Y"I L7_1Ll, 5 of the State Sanitary Code— The undersigned further agrees note�_ o p heo'system in operation until a Certificate of Compliance has been issued by the boa f health. //V V . Signed ------.•--•-•--••••••-••---••--••-•--••---•-------------•--...-•--•••••. Date Application Approved By. = -�--•-•- ...---•--------•-••--:..•---•-----------• Date Application Disapproved for the following reasons_______________________________________________.....•--•.................................... •........___._ -•................................•-•-------•------•-----------------•---•---------------...----------------•-•---•--•-••--------••------••••----••••------------------•••---••••-------•--•--•-•••-•••- Date PermitNo......................................................... Issued_....................................................... Date No.c THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH U� ..... ---...OF......F .............................. Appliratilan for Bitipwa al Workii Tomitrnrtivit ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ................-...............................................................A......----•-... .....--••-•-•••-----.--G=...-....----- .......................................... �-- Location-Address or Lot No. ✓ . v' c Z-7�. /���1 S.....................e-T T:.. ----...�.... ....4v.',..' :.a- !'.'i:..........._... ... ........ .. .......-- FF�� • wner t/ Address. a !S r ................................. .......... F..f.._._.._. Installer Address Type of Building Size"tot../()f._U4..e?...Sq. feet Dwelling—No. of Bedrooms.............3................_.........Expansion Attic ( ) Garbage Grinder 00) p-I Other—Type of Building ..:......................... No. of persons............................ Showers ( ) — Cafeteria ( ) QIOther fixtures ........................._............................................................................................................................ W Design Flow...........i;`:5.........................gallons per person per day. Total daily flow_......_3. .9_.__............_._ lions. 9 Septic Tank—Liquid capacity/-�4 gallons Length._...-�1--...... Width....?��'µ___- Diameter................. Depth_._ -___........ Disposal Trench—N.o......I.............. Width.................... Total Length___....;_ ...... Total leaching area....................sq. ft. Seepage Pit No........ -tk .. Diameter...._._B......... Depth below inlet....'.6.... Total leaching area.Z.U6_....sq. ft. z Other Distribution box X) Dosing tank ( ) 4 Percolation Test Results Performed by.._G�_U�6.�........L`'UJ..._.. CU, Date..... 04 Test Pit No. 1 __Z.....minutes per inch Depth of Test Pit___ Depth to ground water.(/_1.....N fT Test Pit No. 2<... -..;minutes per inch Depth of Test Pit.144-_"__- Depth to ground waterc�v!`.. a =-----------------------------............... .............................. �9 -S/9-itJl�. U `.... ..�.."f 2. ..•--F- n A•L..S �tJ ------- /Z- �1 1 : .................. Zo�� . . w sr�!v------7 '......f -SAND. �' „ ,. - g jg � '! E Uv U Nature of Repairs or Alterations—Answer when applicable.______________________________________________•-•-________-_____._.------------•_--•-•••--•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE '1T/'1LE 5 of the State Sanitary Code— The undersigned further agrees no to ;�,�hL4 system in operation until a Certificate of Compliance has been issued by the boa of health. s Signed --------------------------••. -----••-----•-••-•-----• ................................ /f Date Application Approved BY ...... . - . .......................................... If tip.--- Date Application Disapproved f or the following reasons:................................................................................................................ .........................•••-••----•-----•--•--••---.....•••••......_----•--•-..................................--------------------------•------•-•---------------•------------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .fit.. L.............................................. --......./... -r.�.r�,<............o F.... -.rY•, (Irrtifiratr of Toutpli anre THIS IS TO CERTIFY, T t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ..... , =......••--------•-----•••----•--------•-•-•----•--•-•-----•-------------------------------•-•--••------•-•-•-•---•------•------------..... Installer A at••••--••4 ........ -ge--.� - f has been installed in accordance with the provisions of T ':. j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. Bo �>.3_j_____________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT SFA TORY. DATE...............•-......-••--•-•--•-•...•-� �. Inspector.----------- c --------.-•••-----••----------------- THE COMMONWEALTH OF' MASSACHUSETTS BOARD OF HEALTH �o NttJ�o.....� ....r.�,�,.3�w................OF.......... ,� .. ...s�.�+�.: !( f'............................... FEE .--............ Uhip t i al Work.5 T.1nitrnrtion rranit Permission is hereby granted........... --•-----------••--•••••------•-••••-••...•--•••-•--•••--•••••........................ to Construct (40�or Repair ) an Individual Sewage Dispgsal System atNo.. --------- --..2. + - •- ------_-------�, Street as shown on the application for Disposal Works Construction Permit No.___•.•:.---------- ated---------------------------------_------ . ° -- - d of Health DATE................... `�` _. --t1/ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 982 p " LOfI/? d LoF9r141 Suf35o/L 5u8.50/L 9�. 7 13 - ,73 22 r qt I ME7> MED , 7-7 S sHty0 �'i• /� p 4 9.� Sr3,vo 72 .. Pe�P 97.o + O vC 33 F// osf�tvZ> Leo 97&9 ,o S.a ao e �. peo \J) 98 GOr1 SSE i F/ tiE /o00 s T 00 M.ti 0. -57DNE 97.E 4#2 98®2 „'�'�. W BG.z 144 P�oP. Q fo00 G Q /V O GtJAT�,e EIIJ G OUAJT�,��Tj 'j TFE S F A-10L E ` /09. 89 , LOT �? E S UL T3 P E P_ 7-0 PV J'J R E-C OR D-S � z SOLE._ S �� L- ./ /S P P. M v fz.z i9 iJ / U 8x ?7-X 2, 5; 37'7� = 42 GPD :� S G^r f L o i .3 3 O GAL% � k o F=c7 SE D F � cJ/[. c. r mac.-✓ �' �. <:} �t.1: � �' E ! i. 5 14 f=-D D t--. - - k'O r- _:7- FS7- JG � d :A7/nor i I ` Y 't 24 CovE s i , r , 'k1 -D �-- 7 4 ,ti' wo `. P/TC f;M 1 �Z.O h A,_ ,A/r i v "1 n. Yi; ' �4 �Foor I IO"M,nr t\;� FO 00 4 X ! ` j FOOT �` 1 Q' CAY C 1 ln/RSN E 9%• c�0 1i , /000 Zoo 1 t I SEP7-/G2 , ANK I I ¢ , V. D/57 To P (O C-. o 7- pL � ti -Y- eOPPk DA 7._E. DE e / 9 8 O L.�.tl ,r.': %�.._ '`'i.'\!' ''. '-l.' C� K� E /;•°•_' =( f' e!'3 f�� _,1J- c MIfiCKi.EY <c nJ 7` G ! 5 7-,e C- D E. 4 s 1 1"30 PLF-�N 600K 3oz �16E 69 • �.� `a,r <-�►�'" e_�j / j� G ` ��dq! �'i�� S F P7`! 0 -7 k 7-G B E -7 /N1 f � r5 7 � C_/ D r= t� E� 1-7 F .U/�.!D 7 Ham_ 13u/L- vv uv �. �.. / - � t-lL J �-�% /`•- �� ''�' % ,`y .S �' 1 �=i t�l .5 �� - ;. ,5 EL� , �- �.� ,�-� ^-/�.J c G -,2' G/ti'1 �-=n �.1/4' ��1 T_.1 r:�;iv. '• i � ' �!v Cli"w��L�l �aoj 7E7 4 /� r / J 7- < ' r i -T' (�O�S ',M e,,\ ``t ty T Gj'; $ _._LJ r7 F 7—/ _— - U ; _ 1 C 1 rD . .'IG Sr- 7- 7-3 (_D %v' ? (3 —A-)5 771-'�8 L / /y��/,/!J • (_1 r: .Y .cam'- t',_) i ,,,,...._,•:max,......,... ....... ..-..�....+�ww .•...+,sw.e.aw..wu - .,.ns:.mn«rxw...w.... ww.+w,w+.,....�.+..•........a«._..a..;.,�..r.-,...»....eww,.. •./ ......awe. o.+w.w+wr.;.,...«,«. BENCHMARK FOUNDATION SOIL TEST TOP ON 20 FT. MINIMUM FROM CELLAR DATE OF SOIL TEST ELEV. = 100.00_ 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE CLEAN SAND SOIL TEST DONE BY �eR81_�t Rs SHQgTyP,,l�i (ASSUMED) CONCRETE WITNESSED BY 11. E. R_9fiIN QN• M__ COVERS 4" SCHEDULE 40 PVC PIPE LOAM AND SEED OBSERVATION HOLE 1 ELEV.= 100.00_ MIN. PITCH 1/8" PER FT. 2" LAYER OF PERCOLATION RATE _< 2 MIN./INCH AT 38_48_ INCHES 1/8" TO 1/2" DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 2,5' 4" CAST IRON PIPE 100.25 MAX. STO100.0 MIN. NE (OR EQUAL) MINIMUM x I " PITCH 1/4" PER FT. < 0-4 A LOAMY SAND 10YR5 2 NO ADDZABEL FILTE \ FLOW LINE M 97.25 PLUMBING TO BE RAISED 10" _ _ 4-24" B LOAMY SAND 10YR5 6 NO ELEV. = 97.5 MIN. ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ AND RE-PIPED 96.92 EVE 17.0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° MEDIUM TO LICENSED PLUMBER AS ELEV. = �__ LEVEL NEEDED ELEV. = 97717 ADDGAS ELEV, = 96.83 6" SUMP ELEV. _ _96�66 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ O ❑ o' 2'0 0BAFFLE 24-720 Cl COARSE SAND 2.5Y6 4 NO WITH GRAVEL DISTRIBUTION ELEV. _ ° ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° 0 ° LIQUID OUTLET BOX -+�+ - ° °° °''° ° ° ELEV. _ _94.50DEPTH TEE 4 FEET 14 INCHES (EXISTING) TO BE WATER TESTED 72-138" C2 MEDIUM SAND NO 5 FEET 19 INCHES IF MORE THAN ONE OUTLET 4-500 GALLON ORYW£LLS WITH STOIr'E 6 FEET 24 INCHES 1000 GALLON 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) IN AN 7' X J9� X 2' TRENCH FORMAT/ON ? t WELL N A NO WATER ENCOUNTERED AT __]L5_ ELEV. 8 FEET 34 INCHES SEPTIC TANK 6 ZONE N, Ate_ 3/4" TO 1 1/2" CLEAN SOIL ABSORPTION INDEX DOUBLE FREE OF FANES SILT SYSTEM SAS �' ADJUST DESIGN CALCULATIONS NUMBER OF BEDROOMS USGS PROBABLE WATER TABLE ELEV. = _�llA_ GARBAGE DISPOSAL UNIT N0, NOT Al I OWED SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = A_ TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV, = `,2Q_ (110 GAL./HR.1DAY X _ BR.) _�3Q_ GAL./DAY REOU/RED SEPTIC TANK CAPACITY 1000 GAL. EX/SANG ACTUAL SEPTIC TANK CAPACITY _10III3 GAL. EX/SANG SOIL CLASS/FICA AON I _ DESIGN PERCOLA T/ON RA TE :<5 _ M/N./INCH EFFLUENT LOADING RATE A_74_ GAL.IDAY/S,F. LEACHING AREA 457_ SO. FT. LEACHING CAPACITY 33A GAL./DAY 457 X 0.74 RESERVE LEACHING CAPACITY -SO/.A- GAL./DA Y NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 93 7 J. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 53.3 - 10 FT. OF DRIVES OR PARKING AREAS. J 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED 93.3 BIKE PAS �' IN PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ' �D _ ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH 9 U- � ' E`D- TE DETERMINATION FROM APPROPRIATE AUTHORITY. �' - - ' 73.22 98.91 6. UTILITIES-SHOWN'ARE APPROXIMATE UNLY, EXCAVATION CONTRACTOR IS TO 2 "�g _ r - CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO LOT\j COMMENCING WORK ON SITE. / I 10,049 f 4F. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE -fx gl4 I" 98.5 M CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE 99.2 ■ 99.3 BROUGHT TO" THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. I I 8. PARCEL IS IN FLOOD ZONE c 9. LOT IS SHOWN ON ASSESSORS MAP 292 AS PARCEL 304 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. x 99.2 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND OR REMOVED. 94f 7 I IK gg 3 " 92 5 co 12 A ZABEL A1800 FILTER IS TO BE INSTALLED. " 99,5 0 /„ 1.3.'`CONTRACTOR TO PROVIDE SHORING AS NEEDED TO PROTECT BUILDING AND // / 98.5 NC 99.6 $ ` r �� PROPERTY LINE. _ li Rill If' v „ 212�95.2 7 12$ / iCIVIL I APPROVED: BOARD OF HEALTH PA T%o 'T 100.3 C o x / l EX/STING , DWELLING . 98.5 ; / I . 99, 4 100.3 100.3 '3 ' 95,595.9 1 �# DATE AGENT y -\ EXIST. _ LEGEND: /Cg6) � w 99.5AldKC �1 ' cWo,100.2 v 23.4 PROPOSED SEPTIC DESIGN EXISTING SPOT ELEVATION xO.O / 96.2 `C9� '3�� BH. e FOR EXISTING CONTOUR . . . ----00---- / GRA DEL BARNSTABLE m FINAL SPOT ELEVATION . . . SHED HIGHWAY DEPT. N ANGEL ORTIZ FINAL CONTOUR -[QQ]- � 99 4 33 , " SOIL TEST LOCATION . . . 6 5 Bir�ORit/E 49 99'6 00. o TOWN WATER -W-W� /� � 99.4 " 99.7 �)1 0.0 S T S S. t 12.�5• ROOT O � LOC. '7 UNCLE JOE'S WAY / c�, z o Locus BARNS TABLE, MASS. CATCH BASIN .��� d 9 0 `�98)_ 100.0 GAS LINE G -G 96,7 GAS METER . . . . ® 109.89' BEL O H YA N N I S GAS VALVE .° R. SHORT, P.E. CESSPOOL CR&G. � � CLEANOUT 235 GREAT WESTERN ROAD ELECTRIC BOX . . . ® / a ELECTRIC LINE . -E -E �-E - 2 508 SOUTH DENONIS10MASS. ELECTRIC MANHOLE . . . . . ® 398-8311 02660 ELECTRIC METER . . . . .® a ~ FLAGPOLE . • . . . . . . . . . . r nz, DATE 8, 2003 SCALE 1 " 2 O HYDRANT • . . . . . DEC. _ LIGHTPOS MANHOLE . >�c REM 5 2004 1 -1004 MANHOLE O �� �RE � JOB N0. OBS. WELL . SEWER LINE. .-s ` -s -s - SEWER MANHOLE . . .QS TELEPHONE BOX . . . . m LOCATION MAP REV. �� [SHEET 1 OF 1 WATER SHUT-OFF .� WATER VALVE ® 01-1004 Ortiz r2.dwg 0 2004 CRAIG R. SHORT, P.E.