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I .�! .. �`. - .1��. . . . . ,.;. �.. ..I,I.� .� . I - .I. . , .. , 1 I . . I . i . . . ­ . -f . . ; ;, '�'11�.1 I.! . -�11.1_� 1_.'v*_:- , ,­ ........ - _-co_�:�"_��-,"_.-�:.-�..._�,��:� _! :,,-. ,i-,.' �: ._-.,- ., . - '. ­_.. .'. ...."'. _ ..., I ;:�_i,.�� . �,.�­,� ._�', �.;.:_ 4r .' '. . . � _:1 . .-�­__'. , .''.. . , .. . - _... ._ . -�-+i Commonwealth of Massachusetts asp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .% 4 Washington Ave. , Property Address Olson Owner Owner's Name information is required for every Hyannis Port tl/ MA 02601 4/22/21 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. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 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. ❑ Fails 4/22/21 Inspecto ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 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. J ❑ 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 I' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts l�3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 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 ❑ ® 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 t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u, 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 ❑ ❑ 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 �e ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown 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 aH inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ 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)] t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f , Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: At the time of inspection there were 5 bedrooms in the house and 2 in the garage, 2013 plan on file for 6 bedrooms, permitting for garage connection to the system is for a"conveience toilet' Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 264 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �o 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No recent pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2014 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, outlet cover to 12" of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" >2" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 cAN Commonwealth of Massachusetts Title 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.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 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 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): 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.): H-10 D-box is 3'6" below grade, cover to 2' of grade, no adverse conditions 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u, 4 Washington Ave. Property Address Olson Owner Owners Name information is required for every Hyannis Port MA 02601 4/22/21 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: I ❑ 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 Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown 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.): Chambers were video inspected, damp at this time, no indication of past hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ,�.p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •�; 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 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 C `( C 1 � DIN a_ k 3V,�, -7 L� S l` t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2014 NGW 144" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per 2014 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 37'msl and nearby surface water at 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth: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 4 Washington Ave. Property Address Olson Owner Owner's Name information is required for every Hyannis Port MA 02601 4/22/21 page. Cityrrown 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 j 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i Vq3 No. � Fee � r` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: LX PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpfiratiou for Misposar opstem Construction Permit Application for a Permit to Construct( ) Repair(i/upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2& Owner's Name,Address,and Tel.No. Ave) Assessor's Map/Parcel � / Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. <<'t�f� �( yl CC. oZ I` ��:✓1�'2�; /) 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs r Alterations(Answer when ap licable) 6 �_. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. .. - " ,® "'' '" �p 7 Signed �-�"'�Y Date ��� Date Application Approved by Application Disapproved by Date for the following reasons Permit No. Date Issued / `� � ,y,..^..,tit, m ti�.t4 r f. •rw-a,. r^a,-r,ryn,,,�....;,."�.:F��e."'..,G„ ,��Yr,^•t t� y µ�+• 1Nr•rG;n .•,�...,. :r" ,.-.. ,+"a..-.. rr 1.;. �,.....:...,,,;, ^t .r-.. r.ti,.. o. �­�d I Fee ( " V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1-7/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(L4pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Z$17 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 9 / ry G,f S� ��� fie, 14 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder,( ) p Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan •Date /6'/7 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) r e, 6evr C.CC, -7-7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and n'ot to place the system in operation until a Certificate of -Compliance has been issued by this Board of Health. ✓ ,,,.�'"'�-"'� y j'7 t� Signed / Date Application Approved by Date Application Disapproved by Date f for the following reasons Permit No. a.01 . L Date Issued 2— 2, N THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-sites Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ��^ '�►'1 /pJ E'W-U 6- j 0/C at---- � — (/"�'7fi iu ^�!` �r li C has been constructed in accordance with the provisions of Title 5 and the for Disposal System/C�nstruction Permit No. t - q 6 dated f 2— Installer 0111A74101,0 tQ° / � ✓ Gl r 7E N/!" Designer #bedrooms i►/ Approved design$ow gpd The issuance of this permit shall not b construed as a guarantee that the system wil ctio as esigned. Date Inspector n i_ No.------- --- - - -------------------- - - - ------ ------------------------- -- -- ----- ---- yLl3_ �� ' w _Fee THE COMMONWEALTH OF SSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposar *pstem Construction Permit Permission is hereby granted ,,to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at a/ e-S4 e I 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. 1 Date (�'� r3 e/j- Approved by G TOWN OF BARNSTABLE LOCATION Li 0 KS 4 bi) Ny C-r' SEWAGE# 020 "6®r VILLAGE��h►n 13A r I ASSESSOR'S MAP&PARCEL MA92 PY INSTALLER'S NAME&PHONE NO. ll cC le ey 6d)Sq ')17/ —1 iT9 SEPTIC TANK CAPACITY --LEACHING FACILITY: (type) 5DO eiry 14/S (size) 6 3)1 or/ NO.OF BEDROOMS OWNER 0,/ PERMIT DATE: 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leachin facility) Feet ;f FURNISHED BY 0 A f s 3 i lei' 6 q `� i i 91 ,'"l l� —•- D f No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS fltlfltation for Bisposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( /upgrade(�bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 Owner's Name,Address,and Tel.No. t-i7G.rw�Sl� r� � / Assessor's Map/Parcel t! 7 iot-t/ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms -✓ Lot Size --sq.ft. Garbage Grinder(IL Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issuADthis Boar f Health. d Tom-- A DateApplication Approved byDate Application Disapproved API Date for the following reasons Permit No. Date Issued No: / ,,, - Fee �^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS "Yes 01pplitation for Misposal 6pstetn Construction 3permit Application for Permit-to Construct( ) Repair( Xupgrade(✓�bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4 4?x��-.eye Owner's Name, ddress,and Tel.No. /G.nnc�s�lly v KE�n/l e y Assessor's Map/Parcel 7 t e Installer's Name,Address,and Tel.No. D ner's Name,Address,and Tel.No. (4t c k t-tv do a s� �ocJ Type of Building: Dwelling -No.of Bedrooms Lot Size ' sq.ft. Garbage Grinder(0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided k. gpd Plan Date Number of sheets Revision Date t Title Size of Septic Tank Type of S.A.S. i Description of Soil Nature of Repairs or Alterations(Answer when applicable) j Date last inspected: Agreement: ;t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the'system in operation until a Certificate of Compliance has been issued by this Boar of Health. ig ed �i 7�— e) Date y r J. Application Approved by //i Date Application Disapproved 14Y / Date i for the following reasons Permit No. Date Issued -= - - ------- -- ---------- ------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ./ THIS IS TO CERTIFY,1hat the On-site Sewage Disposal system Constructed( ) Repaired(V<---Upgraded( r) Abandoned( )by �A eo A sC at 9 W Qc��r.d Tt)uJ �y e has been constructed'n accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer IC k-ry- A&V777 Designer. cJn #bedrooms 6 Approved design flow 6 s gpd The issu ce pf this permit s 11 not e c nstrued as a uarantee that the system ' 1 ct. as d i ned. Date � Inspector ---------------- -- -------------------.-------------- ------- --------------------------------------- ------ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade(� Abandon( ) System located at 11 �J l \tt W C,i�v ACV 1= 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:Constru t mion t e co pleted within three years of the date of this permit. ` Date Approved by ) i , FROM :down cape engineering inc FAX NO. :15083629880 Mar. 18 2014 08:10AM P1 2- 'flown of Bao Tlitotonms F. Gel.ter; Director •��__m 9/ ��rrruas 1�[a.I�ea�n�,;19i�esa�uu� �QpQD aiii 1a1'�P"Qq Office: 508-11,52-4644 Fast: f0g-790-6304 • ;f�si:��la:n��e�¢ >m���:e�n��ro�n�an.€+sr�•rx�t ; 1lTmtre: :peP�u�l#+ Ury.��as.e�€� •' �ilru�o+11��Kr:ei... 7 y �e�a�lui��'• 11U W rt � _ _ !vl.�E�'3 n,! .N.�a���1��: � G .. � C1 4v On wail issued apE;uTittn n1I-LaL. 8. (date) I omtify -ffiat the septic, system.MefeCenced above,was :Rkstallod ;;distant ally Etta.0rd,,ng to •thc, e:esi.gn, tivideb.n ay iuekadc iriiaex alp.roved changn Such as ]aters:I reiecilliuri of-HtiJ• diAributi.on bux-and/or sepk LML I o'c.Xl:Lfy "hAt tl_le septic sygtcau Tefert:enced above "was iustafled Willi u+ajov Chang s (i.e. gleatn than. 10, 1flte;:al.relt,c:cticn of the SA,:,,0$ any v(mfirml.Telocatdon of any cumpo.Pult Of fihe titptir,.sy.,tem) but ill A.cco7d'ance with State&Lnc:al R';Til.aliuus. Plat,.j'evisiou rn: ceitiLe,d as-built by de igncr to tbllaar. or.1Wqj, oAni«L a. G, CIVIL in No.415a02 f y- 0 4; a t �X'S ,T F„�:!G��4 � �11��L� SIUNAI.FN f 1 ;C�4 -- @f il[;T.18S'3 52(_;TSrlCuie (.IA�1X f 3e�i.�uel''� �i,.inT,Neip) �1 F, Rk"fTTR '1's� la ; i'R�1L1E-,•g'11�3b,1a�A�lE_1�1,'1:4fl ��8.�1�'➢(oN. �L��1'➢_ B,'A'i'11 41� 4,��� r� racy v z.� NOT :� a,.ta�.'T-j, L,(yj,�:>i THIS �r �r.� :!U,$�.?u�,T CARD .A_ B_F, X0 .il gY!a.B T.ATL]E 1F QJBILr '137,.}gT,TFT HDl VISFIl0_6T, rl-T:fr�1f1(@rnfirll}nci vnP.r f:-rtifi G�ii{lil KCi�l.�-2Fi-�4-Li0 C �W Town of Barnstable �� _j? Department of Regulatory.Services R ZMM. , ]Public Health Division / Date /a Zd' 200 Main Street,Hyannis MA 02601 Date Scheduled 1me �l�Q. Fee Pd. Soil Suitability .Assessment for Se w is12 ® � Performed By: Witnessed By: 1 LOCATION&GENERAL INFORMATION /7 Location Address �•(� Owner's Name a✓1 �� Address I l Assessor's Map/Parcel: a Engineer's Name NEW CONSTRUCTION REPAIR eTTelephone# CJ ng a,� 3 6 Land Use: ��ir.1)PKz;_ 2 slopes(96) ..0-"�-�l Q Surface Stoaes I&7�r-leo Distance's from: Opcn Water Body B possible Wet Area_e --ft Drinking Water Well& ft .-Drainage WaY ft Property Une _Z,�ft Other ft SICETCJH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands•In proximity to holes) . 1 c!.ap 41 kL J 3� e c) >, ,,� `l�f7v wD Parent material(geologic) ffl.lThlMA' Depth to Bedraclt y Depth to Groundwater. Standing Water in Hole; ' . g � Weeping from Pit Fnee� .,.� Estimated Seasonal High Groundwater 77 .4 to DETERMINATION FOR SEASONAL IIIGH'4WA.T7ER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil moUles: In, Depth to weeping from side of obs.hole: --- -__.._ ..y 111. [7rnun�IwateP t OJL,s''t1Cnt -- Index Well# Reading Date: Index Well 1pvel____�___ Adj,Actor. _.,_.._ Adj.Groundwater Leval , PERCOLATION T +'ST Date- Thud,_ Observation Hole# Time at 9" __ Depth of Pare n �f0 Time at 6" _ start Pre-soak Time @ 1' 'C !� Time(9,14') End Pre-soak J( ® Rate Min./Inch Site Suitability Assessment: Site Passed Sitg Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test its to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to begionlug. Qt\S EPTIC\PER C FORM.D 0 C 1 DEEP-OBSERVATION HOLE LOG Hole# 1 v Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, onsisteripy,96'Cravell D- 1 -to- 60 G� N'S �0 ICY v 47' L o CA DEEP OBSERVATION HOLE LOG bole# - Y Depth from •Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en %Gravel) 411, �0 1 bw -71.! AA DREP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Ca i to c O e ------------------------------ ]DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, • Cositn ' y Flood Insurance Rate Map: Above 500 year(flood boundary No— Yes Wi thin 500yearboundary No 'Yes_' Within 100 year flood boundary No. Yds Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil.absorption system? If not, what is the depth of naturally occurring pervious matorlal? Certification , I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in�10 CMR 15.017. Signature Datb Q:\S.EPT1aPERCP0RM.D0C Fss.......$....2 0.:.0 0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town--..................OF.............Ba rn s t ab 1 e ..-.. ...... ...... . . . for DhipmFal Works Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair)(XX) an Individual Sewage Disposal System at: 4 Washington Ave. Hyannisport ................--................................................................................ .................................................................................................. Location-Address or Lot No. -Thomas-_K e n n e dy......................... .........'--......--------.............................................. --•- ---------••--•---------- -•-------------•--•-•---- Owner Address J.P. comber Tr,........................................... ......------------...._...------------------...-----..............------------------•----•..--•--- ..................................................•-- Installer Address Q Type of Building Size Lot............................Sq. feet U DwellingXXXNo. of Bedrooms___---_--_-4............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a 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 ( ) - �' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-___-____-____--_-___. a --•-•--•-••••...................•-•--•-•----------•------...•••---•----------------.......................................................................... 0 Description of Soil---------------------------------•--.9.aUa........._.._.....--- x W -------------------------------------------------------------------------------•-----•----------------•--•--------------•-------------•--...-------•--••-••----•••-•--••••......-••-•-•------------•-•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------------------------------------------------------------------------•-!-.1000----gal.1mi.- leackl...pi-t............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TyTL: y g g p y of the State Sanitary Code— The undersigned further reel not to lace the system in operation until a Certificate of Compliance has been issue Vtheboard of It Signed ' 3/1....8 9 D � 1 Date Application Approved By............. """"'.. -- ---------- -3 Date Application Disapproved for the following reasons:-----•---------•----•-••----•----------------------------------------------------------------------------------- ---------•-•---------•------------------•-------------------....----•--------- �p Date Permit No......X1._�� -...1.til........................... Issued....................................................... Dstz TOWN OF BARNSTABLE ✓' Loc ",T10Id SEWAGE Ll (_ VILLAGE v)tia /yori ASSESSOR'S MAP & LOT o�L?7-Q z INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 0 (size) NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER" BUILDER OR OWNER DATE PERMIT ISSUED: DATE. COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I 2 � Y r 2 J t`L c,� L THE COMMONWEALTH OF MASSACHUSETTS { BOARD OF HEALTH .......c_,:.> OF.............Ba:a•Tlsta'i�]. ApplirFatilan for Disposal Works Tonstrurtion rimmit Application is hereby made for a Permit to Construct ( ) or Repair _X) an Individual Sewage Disposal System at: ,(d .4.t r �va.,,3'::14nx�,s�n Ave. �Iya��.is�aort°, ................................. ..... - ........................................... 4� Location-Address or Lot No. ................................................. ...........•...................................................................................... 1. Owner Address ,-� ------------------ = ..-------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling. No. of Bedrooms............ .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( )-- Cafeteria ( ) 04 Other fixtures ............................................................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ r 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 b Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.._•______-____-_______ R+' -------------------------------------------------------------------••--------------------•---------------------------------...------------------------------ Description of Soil = Sal ...................•-----••----------------------------•-------------------- x W -------------------------------•••••---•--•---•--•...-•--••---•--•--••-••-•••-•••••••.....--•--•---••-----•---•--•••...........-----•-••-•••------•-------------•--------------------......---•------- U Nature of Repairs or Alterations—Answer when applicable......................................................._--------------------------------------- y. < v + s r ,t q Agreement: The.undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I:i s y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued the board of ealt Signed _ 3�... 4a Date Application Approved By------------ a-: - c�.. ••- Jl� /------•.......................... Date Application Disapproved for the following reasons:----•......................•---•------------------------------•-------------•--•----------•-•••----------------- ------•-------------------------••--•-•-----•--------•--•-•••---•-------------------........•-----------.--------•...•-•-••-••••-•-••--•••---•-•---•--•-----------------------------••••-•---......_.._. q Date PermitNo...... ---------------------------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tawn Barnstable ..........................................OF..................................................................................... (Intifiratr of TnntpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired t=y')fi by .`'.T4acom r..%r Jr. ..............••••-------•----...............------.......-•--....•-----•------•----••.•--•---------•••••-•-••-....... - Installer aIa fsAin to�i Ave II' c��'an1s :3.?"t:. at -----------------------------••-----•-•--------4-----•----------------- -------••----------------...----------•-------------------------------------------------------------------. has been installed in accordance with the provisions of T I TIE rj of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..--....E� ^_. .......... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.-:..--•............... 4-.::...�.2L ` . ......................... Inspector.....------------ ' ................................................... THE COMMONWEALTH OF..MASSACHUSETTS BOARD OF HEALTH Twm Barnstable ''�� .......................................... O F..... ....................................................................... NO.. .q..:--�.Y./-- .............................. ........ FEE...$.... J. 1` raI Ilifs#rudilanHyannisport �erntit Permtgsio'�i n ---•-----•-•--•----•----••-•---------------------••-----•------------•-•••----------•----...----•------•--------......................•-•...._ to Construct ( ) or Repair ( . ) an Individual Sewage Disposal System atNo.............................................................................................................................................................................................. as shown on the application for Disposal Works Construction Permit street Noft:- //.... Dated.......................................... .................................. ..'1 .1._............................_......................- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' J t 3 _ - GENERAL NOTES A1.01 ( ROOFTO REMAIN-FILL J013TSWRH_ _Roof ,� A1.02 3 — — 16'-6 1/2" a g1.p1 1)WHEN SPECIFIC FEATURES OF CONSTRUCTION ARE NOT FULLY SHOWN ON THE DRAWINGS OR CALLED FOR 20'-11/2" IN THE GENERAL NOTES, THEIR CONSTRUCTION SHALL e' 7-8' BE OF THE SAME CHARACTER AS SIMILAR CONDITIONS. — - - - 2)ALL DIMENSIONS ARE TO BE TAKEN FROM NUMERIC aoaloE scMLUETER -- --= f. DESIGNATIONS ONLY;DIMENSIONS ARE NOT TO BE _TRANVSTIONS AS REpU RED -- - _ %oPEAsaEoumEOTo SCALED OFF THE DRAWINGS. 1 =-f -/ _ ._- MEE GRAOE OR CPR I=._: TIE JOISTS(SEE STRUCTURAL) studio ARNDT architects / Thermal Insulation to Fill 3)ALL INTERIOR DIMENSIONS ARE TO FACE OF FINISH STRUCTURAL TIES R RREMOVAL Cavity.56 Gypsum Wall - _ UNLESS OTHERWISE NOTED. ALL GYPSUM BOARD _ — — _SEESTRI c URA_L I L� t_� -Board on Interim,Typ s SURFACES ARE TO BE 5/8"THICK UNLESS OTHERWISE —� — — 8'-0" u A IMin.R t3) — _ - 4 Longfellow PI.#1807 - A /// NOTED.ALL GYPSUM AND PLASTER FINISHES SHOULD Boston,MA 02114 BE SMOOTH,CONTINUOUS,FREE OF IMPERFECTIONS. (617)838-0083 _ v AND HAVE NO VISIBLE JOINTS. b 4 WORK6)ALL PLUMBING TO BE PREFORMED BY Consultants aD ` E — _ _' _ LICENSED PLUMBER. A1.01 7)ALL ELECTRICAL WORK TO BE PREFORMED BY Level 1_jl t Hardwood Floor Floated o ev self Leling Co ncr ete_ LICENSED ELECToatN ro eE}cw V - - 8)ALL EXTERIOR WOOD TO BE PRESSURE TREATED —I —III—III—I I— III—III—III III—III—I III—III a zwRam - - = WOOD&ALL EXTERIOR ANCHORS TO BE GALVANIZED. I=1 III III=III III=I I I—III=III=III=III III= -III —III—III III—III—III—III—III—III—I i III—III _ -x = MECHANICAL S Ct,RITY NOTES A 2 A1.02 MVM Ero"JosremRMnem-- -I —i. 2)PROVIDE NEST LEARNING THERMOSTAT AT NOTED _ z - LOCATIONS;FOR LOCATIONS,SEE FLOOR PLANS. Building Section B a — DHabsbbeP d M 3'Va4W tlP�aCaYry 4 1/4"=1'-0" At 01 - 3)HEATING AND AIR CONDITIONING IS TO BE PROVIDED —Roof _ _ _ FORCED AIR SPACE PAK HIGH---- -- -- BY HIGH VELOCITY — — — _ 16'-6 1/2" VELOCITY AIR CONDITIONING SYSTEMS WITH HYDRONIC - HEATING. ELECTRICAL NOTES 1)ELECTRICAL SERVICE POWER IS TO BE EVALUATED — """ ____=--_-___-__ m FOR MEETING LIGHTING DESIGN AND EQUIPMENT REQUIREMENTS.PROPER POWER LEVEL SHALL BE — — — — _ Oo PROVIDED.ALL NEW ELECTRICAL ITEMS ARE TO BE U.L. RATED. Level2 = — g_0 V — - _—_- 2)ALL ELECTRICAL PANELS ARE TO BE RECESSED INTO A WALL WITH A MINIMUM 4"STUD DIMENSION.ALL DISTRIBUTION PANELS ARE TO BE NEW. --------------------------- --- _- 6)ALL SMOKE DETECTORS SHALL RECEIVE THEIR PRIMARY SOURCE OF POWER FROM BUILDING WIRING " WITH BATTERY BACK-UP. 'I 8 sw"�sr�l amar slw, 7)MOUNT ALL OUTLETS,PHONE JACKS,AND TELEVISION � i _ A1.oz CABLE JACKS VERTICALLY AT 18'TO CENTERLINE ABOVE Le0vel- 1 FLOOR UNLESS OTHERWISE NOTED WHERE ,_ V THE FINISH ' E _ _ _ _ I I—III—� G�MePaas BASE AND TRIM IS LARGER THAN 9-1/2"TALL PROVIDE 6" C o —III—III —III—III—III—III—III—III—III—III—III—III III—III—III—III—III— `a III—III- CLEARANCE FROM BOTTOM OF PLATE TO TOP OF V III—I III—I I i—I i I—III=III—III—III=III—III—III—I i III—III—III—III=III .; I—III—� Lever BASEBOARD TRIM. III-III,,'II III III III—III III III-III III III III, III III III=III,-III i_ ,III-III; 1/4 At'02 8I MOUNT ALL SWITCHES AT 42"TO CENTERLINE ABOVE a 3 FINISH FLOOR UNLESS OTHERWISE NOTED Building Section A A1.o1 � o m 1/ 9)VERTICALLY ALIGN ALL SWITCH&OUTLETS IF SO POSSIBLE `o t j PLAN 8'-613/16" \ i - samPu sMRamle EXISTING WALL TO REMAIN 3P RmrnpwrN VeRral Ptkda® J ZI Ev A.4.T. ' EXISTING STUDS TO ��. T ARyo ' a s No. it STORAGE At.o1 NEW WALL 90STON k ( nl OF 10 GAS W OCopHipM%tea ARNDT A1.02 3 - 2 A1.02 it WATER Description Date /1 .ROOFING TO REMAIN-REPAIR I REPLACE AS REQUIRED INSUUTION TO FILL BEfW£EN JOISTS,MW R-30,TYP. DUPLEX OUTLET WP WATERPROOF OUTLET ` QUADPLEX OUTLET E)ROOFINGTOREMAIN-REPAIRIREPIACEASREOUIRED 1J -JIATIONTO FILL BETWEEN JOISTaMM.R-D.TYR g TV LOCATION Proposed Plans&Sections- STRUCTURED VIDEO Garage TH N ti ti THEROMSTAT LOCATION A1 .01 rl Level 2 LJ 1/4"=1'-0" nAl- Scale 1/4"=1'-0" v 3 a A1.01 — — Roof A1.01 — 16'-6 1/2" studioJARNDTJarchitects — — — — — _ — — — — — — — Roo-__f_n 4 Longfellow PI.#1807 16'-6 1/2" V Boston,MA 02114 (617)838-0083 I *U_VERF ORMAN WFTH NM UW OMATCHETING Consultants ?.�. ZT t, •� I ..� � (I�SHINGIESR TIOlIPDOED EETWEEN R�ON =( 1! �I - ; _Leyel2 n (E7 GHwG�s RPruc�aR®nlReo ns REwIREG 8'-0' I Mw Rao wsuuTaw nooEo eETwEEH m�sr oN L J t REPAIR AS REOU6� -L ..A.J. - ' TO REMAN 1 r.[ - 4 ' IES TRIM TO REM - (q 31wGUS - I!l I AW' _ I1. R�AIR AS RE9U REp LI t � i, I I a7 { _ 4 ( � PAINT eftEPA1R AS REQUIRED HIGH PERPORMANOE VISroN f J. 1 l 1 ❑ L i ( ('_ IGU-VWYLWINDOWWITHMUTIN TOR 1 _ 1 (E�g1wGLES R A EMAIN - TO MATCH-STING fPIRASRE 1I I P OR 1. Level 1 HGH ERFMANCE V SroN LH 0' :") ( 1 I 1... 1 t II ,:`, S IGU-VINYL WINDOW WITH MUTW a ....1...,: .:... ,-........ ....i , ,", ..:...I 1.:: TO MATCN—1. Level1 n 0'_p^ fEl NNO3ElE—NOATIOH r1 East Elevation ___ - n North Elevation a c¢ A1.o1 � � n0 c 0 — — — — — — — 16-sRoof i A1.01 V m I — — — — — — — R o o f 1/2" {s N o T` LL TO MAT Rw G MUiw A.'y ?1 7 ;7�. O _ J:� L 77 (E)SHINGlES REPIACEDfl REPAeIDASREOUilS-0 ..l -� f .1 T- T- c .1.;a 1- .. MW Ra81NS1RAT10N ApOEO RETWEFw mm ON � _ / r J r 8, 0„ — -_ �a Level 2 O I J / J 1 i PAWTB REPA ASWREOUIRED is � WTI (q TRIM TORE L _ ❑ 7la. z r r �. // a r c ❑❑ ❑❑ r / ❑ \ / ❑❑ \ REPAet AS REWII£O (RE AIRG REWREM4N IRM ( .v \ HIGH PERFORMAHOE VIGroN 1 Rm RAS REOURIRmw EO Ak i - 1 IGU-VW WWOOW 11MUTIN \ / \ / AS< Cfj�r TO MATCH IX NG `(;' Z'a: reAw a�i Rwc-wsu000RS To �e(, FAv4 FC, c ..::. \ Levell�1 r 0'-0" Level 1 n No. 11 OOORANOSIOELIGHT-PAWTEDTOI.NTO1 —0'-0' Cl V**O..STON 'n OF UP n South Elevation n West Elevation aaM�'aa�° °Aft" Description Date Garage Elevations ,f N A1 .02 0 Scale u� I� NOTES 1. DATUM IS NAVD 88 - 2. MUNICIPAL WATER IS ECG D - t - 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. •- _ - w - 4. DESIGN LOADING FOR ALL PROPOSED PRECAST ScJ�O r ` UNITS TO BE AASHO H-1.11 5. PIPE JOINTS TO BE MADE WATERTIGHT. j(. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE - oywo .1. - WITH 310 CMR 15.000(TITLE 5.) 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND - rNng NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. Nantucket - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4'PVC. - - Sound _ 9. COMPONENTS NOT TOBE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM HOARD - OF HEALTH. LOCUS MAP - 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233)AND NOT TO SCALE VERIFYING THE LOCATION OF ALL UNDERGROUND & •3B ,(---'�J//n�✓f OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ASSESSORS MAP 287 PARCEL 41 JAG_ OWN � 11. CONVENIENCE BATHROOM ONLY IN REBUILT - - - GARAGE. NO ADDITIONAL BEDROOMS PROPOSED. - I . 1 r - - 1 - EXISTING 6 BEDROOM SAS TO REMAIN - ZONING SUMMARY ^� LOCATION SHOWN PER ASSUILT CARD i - �$ —— ON FILE BATH THE HEALTH DEPT. - ENCHMARK: MAG NAIL 11 - ZONING DISTRICT: RF-1 RESIDENTIAL DISTRICT AT ELEV. 37.35' 11 F- r-T -1 1 I MIN. LOT SIZE 43,560 S.F. MIN. LOT 20' FRONT L_1—{J— —,11 MIN. LOT WIDTH AGE 125'-1— — L__ MIN. FRONT SETBACK 30' 11 ' ----- EXISTING --- DECK T AND MIN. SIDE SETBACK 15' Il 1 DECK TO 8E 3a MIN. REAR SETBACK 15' — LT E,,,A PROPOSED RE34'OF 4•SCH.40 MAX. BUILDING HEIGHT 30' GNS DN INV.OUT - PIPE O 2%MIN. . 1 pPAT 9 4 35.66- 11 GARAGE PLUM G .. /1 i v W Oµ1`1E TO BE CON - ��� SYS EMS TTEM a OWNER OF RECORD � 1 If pAT10 1 '0 L 4 WASHINGTON HYANNISPORT LLC - LqnNG 44 TEMPLE PLACE 2ND FLOOR i 31'S1 r`Di oNG BOSTON, MA 02111 Ex15T', W 11 DECK 1 11 E '1E1t INV.IN 7 -THE INSTALLER SHALL VERIFY THE 11 INN OUP 3 34.�,6• LOCATIONS OF ALL UTIUTIES AND ALL - 1 BUILDING SEWER OUTLETS AND - ELEVATIONS PRIOR TO INSTAWNG ANY REFERENCES -11 If PORTION OF SEPTIC SYSTEM 6 / �'-)'�/� � - DEED BOOK 29419 PAGE 40 1 bzDG jSr� PLAN BOOK 26 PAGE 95 � 10U P U C - 11 wEs� PAR L 4 1 1 1 17t S.F. e 35 �\ _ SITE PLAN 50.0O - _ � �- OF -- - -/ -_— -- 4 WASHINGTON AVENUE �6 j [�T m AVENU HYANNISPORT, MA ASjjj1 G + O E - PREPARED FOR .. 34 MICHAEL OLSON DATE: OCTOBER.17, 2017 „VOF�. V�pd„oF` c, - off 508-362-4541 02 NIEL °y o DANIEL I fax 508-362-9B80 D AA- � A .downcape.com.O _ JA 4 No 4083D "l down cape No 46 edgideering!iae, I - a .OJALA IL 9 c Sec,s,e °�`v °o ss,o O civil engineers Scale:1 20' ( -11-1 ) NP.I EN N` / land surveyors 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A.-OJALA, P:E., P.L.S. YARMOUTHPORT MA 02675 DCE ##>7-336 17-336 OLSON-DWG ALL SYSTEM COMPONENTS SHALL BE SYSTEM PROFILE MARK WITH MAGNETIC TAPE OR COMPARABLE MEANS FOR FUTURE LOCATION. NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS APPROXIMATE NGVD TOP FOUND. EL. 39.4' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING \ 38.5' ., MINIMUM .7J 2% SLOPE REQUIRED OVER SYSTEM OF COVER OVER PRECAST 3. MINIMUM PIPE PITCH TO BE 1/8- PER FOOT. Smifh PRECAST H-10 BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS (TYP.) PRECAST RISERS 2'0 4 OSCH40 PVC MORTAR ALL H-10 PIPES LEVEL 1ST 2' COMFONENTS INV'S F1 4'- (TYP.) 39A7' 4'- �ENDS 36.0' 5. PIPE JOINTS TO BE MADE WATERTIGHT. *37.3' si DES UNITS TO BE AASHO H-105G aO 4 P� 0 j1EE U 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10- 1500 GAL H-10 14" Enm= 0 m-L-0 --m m m 9! TEE SEPTIC TANK T mrim G WO M E�, 00, WITH 310 CMR 15.000 (TITLE 5.) MIN� mm 7EM,mm 11 37.1' 36.5 EE -o o?o 6 1 o.--? 1 2" M o-oo o_000�"�_ 36.30 0 0 6" MIN. SUMP GAS BAFFLE ;0;011 ?o'� ',gY 12 MIN INF o o,o,o >0000 000 c1F-_1MMMl71F= 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND F 000,o,o,c 33.17' NOT TO BE USED FOR LOT LINE STAKING OR ANY c)- 35.53' 35.36' C11 )o_o_000_o -o-o-o'o go�ck I 0 DIM. 4' LIQ. LEVEL (ACME OR EQUAL OTHER PURPOSE. rv, .,)ool);o;o;o;o;o;o;o;o;o;o;o;G;O;O;O;O;O;O-o8'L L 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC oo. , o o o o o 00000 o o H-tO 500 qAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. Q) 00000 o oo o �o2o?0000gopo"o? •oo o n n q o 0 r 3/4"-1-1/2 DOUBLE-­ WASHED STONE 4' (5) UNITS REQUIRED Nantucket 2 2 ? ALL AROUND PRECAST STRUCTURES MIN. 9. COMPONENTS NOT TO BE BACKFILLED OR Sound 6" 'CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 50.5, X 12.83' 'r, CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINED FROM BOARD 2 OF HEALTH. % SLOPE) (-!-% SLOPE) % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR 13' LEACHING LOCUS MAP FOUNDATION SEPTIC TANK 76' D' BOX 21' CALLING DIGSAFE (1-888-344-7233) AND 16' FACILITY 26.6' BOTTOM TH-1&2 NO GROUNDWATER FOUND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL WORK. - -UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 287 PARCEL 41 SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED 5' REMOVAL OF UNSUITABLE SOIL REQUIRED AND REMOVED OR PUMPED AND FILLED WITH CLEAN VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE AROUND PERIMETER OF LEACIIING FACILITY, SAND. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR DOWN TO SUITABLE SOIL LAYER (DOWN I BY HEALTH INSPECTOR APPROX. 80", SEE TH LOGS). REPLACE WITH CATI CLEAN MED. SAND, TO MEET SPECIFICATIONS 38 1 EXISTING PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED OF 310 CMR 15.255(3) p BY THE BOARD OF HEALTH REVISED DURING A PUBLIC II DWELLING HEARING HELD ON AUG. 4, 2009 2) FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO II SYSTEM DESIGN: FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED BENCHMARK: MAG NAIL \ II AND INSTALLED (10- OR GREATER ALLOWED). AT ELEV. 38.1' 75.00p GARBAGE DISPOSER IS NOT ALLOWED EXISTING DWELLING 38.13 DESIGN FLOW: 6 BEDROOMS @ 110 GPD = 660 GPD 38.03 USE A 660 GPD DESIGN FLOW INSTALLER TO PROADE 38 e) TH �rl 6' TEST HOLE LOGS SHORING AS NECESSARY II w SEPTIC TANK: 660 GPD (2) 1320 PE DURING EXCAVATIOF 4' A N- H. 0JALA,__ _, �SF ANID INSTALLATION .017- 15,010 GJ,------EiNGINEER--- R mum�.44' T!C TANK '40 MIL SYSTEM K _1 6 LINER WITNESS:, DONNA MIORANDI, RS AT 5' SHOWN 38.8 IN AREA SHOYM LEACHING: 3 .56 11/20/13 DATE: PAVED 38.J3 SIDES: 2 (50.5 + 12.8) 2 (.74) = 187 GPD Ld - < 2 MIN/INCH DRIVE EXISTING PERC. RATE GARAGE BOTTOM 50.5 x 12.8 (.74) = 478 GPD 14209 W (SLAB) CLASS SOILS P# TOTAL: 898 S.F. 665 GPD 38.56 91 38 �6 ELEV. USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ELEV. 6 Olo Ld -39,4-0-_x 38.35 WITH 4' STONE ALL AROUND Ofs 38.6' 38.6 0 CARPET AREA A A 39619 bi LS LS II 1 OYR 4/2 1 OYR 4/2 E EC 14" 14's 38.15 �0 Li TER EXIST. (D 39.59 DECK ff)(L .13 EXISTING B 4 38.36 DWELLING SL SL 38.83 INV OUT 38.86 EL.= 37.3, 1 OYR 6/6 1 OYR 6/6 0 4010 40" 000 II 38.73 39.39 2' 56 APPROVED DATE BOARD OF HEALTH MA . Ci Ci II EXISTING Ms MS III DWELLING FNDN 60" 1 OYR 7/1 60ts 1 OYR 7/1 TOP 8.45 EL-39.4' 8 II INV OUT 8.36 PARCEL 41 TITLE 5 SITE PLAN -7 C2 C2 37.14' 10.23 AC 5 SILT LOAM SILT LOAM 36. 3 25 OF 80" 1 OYR 5/4 31.9' 80" 1 OYR 5/4 3 1.9' II COVERED PORCH EXISTING .511 POOL 4 WASHINGTON AVENUE 3 .�4 C3 7,23 C3 7.22 3 HYANNISPORT 3 SIEVE ..4 7/ 7 MS MS PREPARED FOR 5.2 10YR 7/1 10YR 7/1 5 7 0.00 .96 HICKEY CONSTRUCTION 93 144" 26.6' 144" 26.6' NOVEMBER 21, 2013 3 4.,�2 NO GROUNDWATER ENCOUNTERED r off 508-362-4541 A"Fi4j, -362-9880 fax 508 DA\IIEL downcape.com @ WASHINGTON AVENUE DANIEL CJALA x Q CIVIL A. down cope engineering, /lie. 02� a �G � OJALA No.4 380 civil engineers T s \0 land surve rs Scale: 1 20' IDN YO S R\ql 939 Main Street ( R to 6A) 0 10 ZO 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 13-269 - ------ -- ------ 2'-8" 30'-5 1/4" 3'-7314" CL oo YrF III IT '19 - --- CV 1 3 B3 i I 1 62 11 4' - I00 I io FS oo oo JEL 2 it REMOVEFLOOR STRUCTURE TO CREATE SD O NEW ATTIC STAIR ATTIC aNa 1019 SF ECT NEY I If 1 ATTIC ` 1/4" = 1'-011 11-,£Z m " Y M - - �4 CV N M M <O o _ oLL Q tiEder a Z °° I � _ Li _ — - - — N M r P c9 71 co 1-1 rr — 9 1,101 on CQ 00 N - mu IY1 c0 M ao o (V ' W J v—I/V r AIL b-,£4 „61-X ,18/L 0-109 „6-,8