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HomeMy WebLinkAbout0069 WAYLAND ROAD - Health 69 Wayland Road Hyannis CP A = 271 229 _ J i i I i �I i I of �I TOWN OF BARNSTABLE LOCATION �c( ��� ���� V2c) SEWAGE# Zoog ©3k VILLAGE ASSESSOR'S MAP&PARCEL 7 / o1a9 INSTALLER'S NAME&PHONE NO. LB./K t.� �v�fee��► s e 5 YZ 5'y 8 SEPTIC TANK CAPACITY I Cx0 U l�- ►U ► S(� �-.n LEACHING FACILITY.(type) t 2 \� C"�.ln �►� 7►f�f(size) (1) NO.OF BEDROOMS 3 OWNER2ot� PERMIT DATE: 2-00 ��3 �� COMPLIANCE DATE: 3 3P 200� Separation Distance.Between the: �g Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility iva ?/ t.J 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 L• aching,Facility(if any wetlands exist within 300 feet of leaching facility). II-- __ feet FURNISHED BY e 4,e�►'CG 6iP q—.-,yes t v� a �'� ��� �� �� ''' �' � wN_ � � � � � � � W � � - _ .� � l �, No. Zoo q— d 3,5 .f Fee /UO O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphtation for Disposal *pstem Coustruttion Permit Application for a Permit to Construct( ) Repair K Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6CI W*4 Aqo 4 1Z.Q4, Owner's Name,Address,and Tel.No. F1 L ti Assessor's Map/Parcel 2'7/— 2-2-9 JrAA iuj Installer's Name,Address,and Tel.No. ,►:--J4 C-it • Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size IJ,11 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3D gpd Design flow provided 3 gpd Plan Date - L O 2.0 Vc Number of sheets Revision Date Title Size of Septic Tank l COO QSC"),h Type of S.A.S. Z S i ne`05> Tr4-,�L Description of Soil Nature of Repairs or Alterations(Answer when applicable) yu-c, _i3 OS� 5 >Ls� Date last inspected: �00 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 a th. Signed Date '2— 2 3 ^ZOa4 Application Approved by Date 2 ^ Z g^ Z Dq Application Disapproved by Date for the following reasons Permit No. ZOO Q Q 3 8 Date Issued 2-- Z 3— Z OGiol J I;I� �,,..w.----...r+Y',r^..+'...+r•--,.wrr..�wa+.isn�,�;;jiwq•.++•Rpsw •�4n"wr--r. -r.....—...�...,., Ky'.v..r..q.,..-..n�._ ., �,�. _�rryrsra..I7'F�. .p 7erl i'Y1..rt•`'�+.4iw•T"k•r.+-IrT't-...e' .v1t •. ^...:�i.-u. .,M r i 8 4 to //�� 3 No. Z fro g m V 3 �; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y4 e PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpficatiou for Misposai Opstem construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) '❑Complete System ❑Individual Components Location Address or Lot No. (.q W4-y J4 h 4 npa 4 Owner's Name,Address,and Tel.No. F14(,M Assessor's Map/Parcel Z'71— 2-49 414b yin Installer's Name,Address,and Tel.No.CAd e w',chi 6h iC^) Designer's Name,Address,and Tel.No. L� Ll0Zb �.J. 3a�Yc.3 s_j -27 Ty.pe,of Building: Dwelling No.of Bedrooms Lot Size S i I 1 I sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided 3 y b . 3 gpd Plan Date Z-2 O - to o-r Number of sheets Revision Date _ Title Size of Septic Tank Type of S.A.S. T l Description of Soil i Nature of Repairs or Alterations(Answer when applicable) P_X'S J-i, r,t -��,, ,t YO Date last inspected: Zt7o� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage ydisposal system in accordance with the provisions of Title 5 of the Environmental Code-a`ndnotto place the system in operation until a Certificate of Compliance has been issued by this Board of a th. Signed Date 72- Z y O t Application Approved by ip Date Z _ Z -S" Z 01311 Application Disapproved by { Date for the following reasons Permit No. Z-00 - Date Issued _ b ------------ ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k) Upgraded( ) Abandoned( )by Cgo¢.e.t�� ( t����R� (,l-- L at (a6l L km,_l tl!�, N has been constructed in accordance with the provisions of Title 5 and the for Visposal System Construction Permit No. dated Z 3- 7- Installer �,pt,..��,�� tQ't )E) Designer . L, t—'1 #bedrooms Approved design flow 176 gpd The issuance of this permit shall not be construed as a guarantee that the system will-functti(o as-designed. ' l �)_ -- Date Inspector`"a, ��1 -�/� `''� ---- - - - _ - --- - - ---- - ------------------------------ No. 00 C- O Fee /PU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair(Q Upgrade( ) Abandon( ) System located at Av d YLA'A l )qn. !!, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 2 06>q Approved by / i^ )�_7. J , j S fowln of barnstabie y Regulatory Services spa eases. j Thomas V. 4eiler, Director ;t Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-962.4644 Fax; 50-NO-6304 In$tgr & Desl�ner C_,ertlf#�atron,Form Date: .Desigper: _ �- c►r�c�eeccc►�; �,c Installer: C;c, w,�. GrtnEer,�rlst�y Address: 16.51t Gcctnoocccr�y_t4`�Welx_ Address; ►►c� 1�or��__.—.._ On Z� 23-2-,01 w� tU art. 40 Was issued a permit to install a ( ate) (installer f of septic system at_ ,9 tt Af14,)A 4,10 '�� based on a design drawn by {address) �4 � ch ere'r7cj ; :1706, dated 2uaQ / (designer) y I certify that the septic system referenced above was, installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e greater than 10 lateral relocations of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Focal Regulations. P1au1 revision or certified as-built by designer to follow, ef. c;y iOH 14 r n ( taller's S1gri e) iR (Designer's t e) Affi esigner's tamp Here PLEASE TU 'T L L VI TIN' ATE OF L L NOT ' )fi<' RECEIVED BY THEI you. sY lr. Q: Health/Septic/Desiper Cotiificatioil FntTn TO -d L9F0 2_9 Z 209 "WTNggWTnwqnr WH RT 7 An AnR7-QT-NH1.1 Town of Barnstable P# �TttE l� Department of Regulatory Services Public Health Division Date r fo639. ��s� 200 Main Street,Hyannis MA 02601� / /vwOv Date Scheduled Time Fee Pd. �— Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By:. SE yo eA t tf LOCATION& GENE; t INFOR IA'I'ION Location Address j(� /'�Q �/ g D Owner's Name f OUA f, R©ME 10B / m00&A �j / VV/�r JJ / '1/��rf J� Address 69 Woylcnd Qd, !'1-nats, !114 ,v / Assessor's Map/Parcel: �/ p � Engineer's Name T C tg1Sq)ee_r n3, T_nC• NEW CONSTRUCTION REPAIR Telephone# j o 8-Z7 3-Q 3 7 7 Land Use SzoSie- Ccw• [l Y J red Aev►lta( Slopes(%) p ( Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well — ft Drainage Way ft Property Line 7 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sze- At4ikt^ecl �lan Parent material(geologic) r7 a Sin Depth to Bedrock 7 t 3`o _ Depth to Groundwater: Standing Water in Hole: 7 1 b(ott Weeping from Pit FaOc _. '7 t 3� Estimated Seasonal High Groundwater 7 13 i MTERMINATION FOR SEASONAE.HTOT�`W�T��TABLE. Method Used: A rt'e C Olnset do fi'a p Depth Observed standing in obs.hole: 7116 in. Depth to Boil mottles: _ _ In. Depth to weeping from side of obs.hole: -2.13 b in. Groundwater Adjustment 7 t 3 6 ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater bevel PYWCOLAT O N-TEST bate 2 7Cltue ��`A Observation _ Hole# 1 — Time at 9" Depth of Perc Time at 6" .� Start Pre-soak Time @ P•i i A/f Time(9"-6") End Pre-soak ©' I q Ad Rate Min./Inch. L 2- Site Suitability Assessment: Site Passed 7 e S Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division T Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Bole# 1. . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel l.0ir3j1 b-26 L5 !l) rr 5/6 — 26-06 C 5r6/(-, z DEEP OBSERVATION HOLE LOG Hole# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 5A -G5 2-5!64 - loose- DEEP ORSERVATION HOL LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil —Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEVO$SERVATI'ON HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,Yo Gravel) Flood Insurance Rate Mau: Above 500 year flood boundary No_ Yes.._V Within 500 year boundary No Yes Within 100 year flood boundary No Yes 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? Y e S w If not,what is the depth of naturally occurring pervious material? Certification I certify that on 10-2,-7 (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 xperience described in 310 CMR 15.017. Signature > Date Q:\SEP'rlC\PERCFORM.DOC I l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp C/O Tim Waldron Realty Executives Owner owner's Name information is 1330 Phinney's Lane Hyannis MA 02601 December 29, 2008 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out U forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address 48 Marstons Mills MA Zip Code rim City/Town State Zip Co SI 508-428-1779 Licennsese Number Telephone Number License 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 December 29, 2008 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 aithority. ****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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 08-310 Freddie Mac.doc•08106 tl Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 0169 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp C/O Tim Waldron Realty Executives Owner Owner's Name information is 1330 Phinney's Lane Hyannis MA 02601 December 29, 2008 required for State Zip Code Date of Inspection every page. Cityrrown 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 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. 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 break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 08.310 Freddie Mac.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron Realty Executives Owner Owner's Name information is required for 1330 Phinney's Lane Hyannis MA 02601 December 29, 2008 every page. City/town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 08-310 Freddie Mac.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron Realty Executives Owner Owner's Name information is y required for 1330 Phinne 's Lane, y Hyannis MA 02601 December 29, 2008 every page. Cityrrown 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: m q D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow a ® 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. 08-310 Freddie Mac.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 15 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is Y�s Lane, required for 1330 Phinne Hyannis MA 02601 December 29, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. 08-310 Freddie Mac.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is required for 1330 Phinney s Lane, Hyannis MA 02601 December 29, 2008 every page. Cityrrown 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)) 08.310 Freddie Mac.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron Realty Executives Owner Owner's Name information is required for nneY Y 1330 Phi 's Lane, Hyannis MA 02601 December 29, 2008 every 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): 330 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 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 4-6 weeksDate 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): 08-310 Freddie Mac.doc•08/06 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 a,.•'' 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is Y Y required for 1330 Phinne 's Lane, Hyannis MA 02601 December 29, 2008 � every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,.date installed (if known) and source of information: Compliance date: 12/24/81 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-310 Freddie Mac.doc•08/06 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 �M 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is YY required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 4 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 9 How were dimensions determined? Measured 08-310 Freddie Mac.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is yY required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every page. CitylTown 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.): Liquid level was found at bottom of outlet invert, solids on top of outlet tee indicated tank had been full to top. 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.): 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): 08-310 Freddie Mac.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is YY required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every page. City/Town State Zip Code Date of Inspection 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: ❑ 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 11 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.): PumpChamber locate on site plan): ( P ) Pumps in working order: ❑ Yes ❑ -No Alarms in working order: ❑ Yes ❑ No 08-310 Freddie Mac.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron Realty Executives Owner Owners Name r information is Y� Y required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every 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): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit found empty with high stains to top of structure indicating pit is in hydraulic failure 08-310 Freddie Mac.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron Realty Executives Owner Owner's Name information is YY required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every page. Cityrrown State Zip Code Date 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.): I 08-310 Freddie Mac.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 15 X, Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O_T_im_W_ald_ron,_RealttyExecutives Owner Owner's Name information is y �required for 1330 Phinne s Lane, Hyannis MA 02601 December 29, 2008 every page Citylfown 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. Wayland Road Water Service 24 24 { 8N. . 49 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 69 Wayland Road, Hyannis MA 02601 Property Address Federal Home Loan Mortgage Corp. C/O Tim Waldron, Realty Executives Owner Owner's Name information is 1330 Phinne s Lane, required for y Hyannis MA 02601 December 29, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/Afeet 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: 08-310 Freddie Mac.doc-08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 15 e Y EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON 9/9/2008: Variance — Food Establishment: I. Hearing — Septic: Celia Freitas, ownerEQ9�.Wayland-Ro'ad-;=Hy._annis, Map/Parcel 271-229, 0.35 acre lot, requests an extension on a repaiof-septic failure until October 31, 2008. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board approved the extension of septic repair until October 31, 2008. The Board requested a contact name and number at the mortgage company, who will be doing the repairs, be submitted. �-�-�� �i�C��c� �.�� �/ ,�,. - .�--- _ ,� � ��� ry . �����. Grp ;2��" l 0 ����`���' Celia Maria Freitas 69 Wayland Road Hyannis, MA 02601 August 7, 2008 Thomas McKean, R.S., CHO Town of Barnstable 200 Main St., Hyannis MA 02601 RE: Certified Mail# 7006 2150 0002 1041 9532/ Order to Comply With State Environmental Code, Title 5 Dear Mr. Thomas McKean; I am writing to you today concerning the above referenced letter that was sent to me and dated May 23, 2008. As you stated in your letter the septic located at 69 Wayland Road, Hyannis MA 02601, inspected by David D. Coughanowr, a certified septic inspector for the State of MA., failed, under the guidelines of the 1995 TITLE 5 (310 CMR 15.00). This failure of the septic system made me as the legal owner at the time responsible to repair/replace the system within 60 days from the date (6/11/08), when I received the above referenced letter. The 60 days will expire on August 1 Ith 2008. At this time I would like to ask that you and the Town of Barnstable to please give me until October 31, 2008 to comply, without out being fined 100.00 per day. Due to the following reasons: 1) 1 did have a buyer for my home and the signing was to take place on July 22, 2008,the buyer backed out of the buying of my home. 2) I can no longer afford my home and have turned it over to the bank,.they have recently listed my home as a foreclosure. . 3) The burden/responsibility falls upon the bank at this time due to the circumstances. I am asking for the extension for all the above reasons and also to give me time to find a rental for me and my son, so we do not become homeless. Thank you for your consideration for my extension request and also for your time and patience in this matter. Sincerely, (Celia M. Freitas 26. MORTGAGE ' In order to help finance the acquisition of said premises,the BUYER shall apply for a conventional bz CONTINGENCY or other institutional mortgage loan of $ 160,000.00 at prevailing rates,terms and conditions. If desl CLAUSE the Buyer's diligent efforts,a commitment for such loan cannot be obtained on or before July 3,2008, (omit if not BUYER may terminate this agreement by written notice to the SELLER and/or the Broker(s), as agen provided for in for the SELLER,prior to the expiration of such time,whereupon any payments made under this Offer to agreement shall be forthwith refunded and all other obligations of the parties hereto shall cease and th Purchase) agreement shall be void without recourse to the parties hereto. In no event will the BUYER be deeme have used diligent efforts to obtain such commitment unless the BUYER submits one completed mortgage application conforming to the foregoing provisions on or before June 12,2008. 27. CONSTRUCTION This instrument, executed in multiple counterparts, is to be construed as a Massachusetts contract, is ti OF AGREEMENT take effect as a sealed instrument, sets forth the entire contract between the parties,is binding upon an enures to the benefit of the parties hereto and their respective heirs, devisees, executors,administrator; successors and assigns,and may be canceled,modified or amended only by a written instrument executed by both the SELLER and the BUYER. If two or more persons are named herein as BUYER their obligations hereunder shall be joint and.several. The captions and marginal notes are used only., matter of convenience and are not to be considered a part of this agreement or to be used in determinii the intent of the parties to it. 28. LEAD PAINT The parties acknowledge that, under Massachusetts law, whenever a child or children under six years LAW resides in any residential premises in which any paint,plaster or other accessible material contains dangerous levels of lead,the owner of said premises must remove or cover said paint, plaster or other material so as to make it inaccessible to children under six years of age. 29. SMOKE/CARBON The SELLER shall,at the time of the delivery of the deed, deliver a certificate from the fire departmei MONOXIDE the city or town in which said premises are located, stating that said premises have been equipped wit] DETECTORS approved smoke/carbon monoxide detectors in conformity with applicable law. 30. ADDITIONAL The initialed riders, if any, attached hereto,are incorporated herein by reference. PROVISIONS The Seller and Buyer agree to a$7,000.00 holdback from net proceeds at settlement for the upgrade o Septic system to Title V requirements. Review of purchase documents-Indymac Bank has the unlimited right to revoke this short payoff appr within 30 days of receiving purchase documents. FOR RESIDENTIAL PROPERTY CONSTRUCTED PRIOR TO 1978,BUYER MUST ALSO HAVE SIGNED LEAD PAINT"PROPERTY TRANSFER NOTICATION CERTIFICATION" NOTICE: This is a legal document that creates binding obligations. If not understood, consult an attorney. SELLER Celia M. Freitas SELLER .BUYER Deborah K. Gray BUYER Cape Cod R.E. Corp d/b/a Century 21 Cobb Real Estate Broker Strawberry Hill Real Estate , O K Y I Crocker, Sharon From: Crocker, Sharon Sent: Friday, July 18, 200�AM To: McKean;Tho Subject: Ph a ca 69 Wayland Rd, Hyanni Melissa had sent out ailetter to aad,dr�ss -a ailed system (Per Inspection Report). Replacement of system is required within 60 Days. The person, Celia Maria, may not speak English. Her friend, Cleanice (Ms) called and asked for an extension of a few months as the owner's wife is leaving for Brazil in two weeks and will be back in two months. She would like a call to discuss possible extension: Cleanice (cell) 508-367-5738 failed system by David Coughanowr, --Backup of sewage into facility or system component due to overload or clogged SAS or cesspool. �6 cC�l OYU- � 1 � / r al I s � . �r oFz�r� Town ®f BarnstableBarnstable P� Regulatory Services Department ;ed"aC j UARNSTABLE, b : Public Health Division MAC A 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO May 23, 2008 Celia Maria Freitas 69 Wayland Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at699_Wayland Road, Hyannis, MA was last inspected on May 21, 2008, by David D. Coughanowr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Back up of sewage into facility or system component due to overloaded or clogged SAS or cesspool. `You are ordered to repair or replace the septic system within,sixty (60) days from the date you receive this notification. Failure to repair/replace the'septic system within the deadline period will result in future enforcement action. PER ORDER HE B ARD OF HEALTH o as McKean, R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1041 9532 Q:\SEPTIC\Letters Septic Inspection Failures\69 Wayland Road.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form �6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Wayland Road �� —2 2-CY Property Address Celia Maria Freitas Owner Owner's Name information is H annis MA 02601 May required for y y 21, 2008 every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification 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 �> May 21, 2008 N Inspector's Signature Date r The system inspector shall submit a copy of this inspection report to the Ap oving P horit-�!Board of Health or DEP)within 30 days of completing this inspection. If the syste is a sh"d sys.)em or has a design flow of 10,000 gpd or greater, the inspector and the system o ,,,ner shazsubr the report to the appropriate regional office of the DEP. The original should be 'ent to ft sym 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. t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for y y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I 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 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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: 1 ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H y Y 21, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for y y 21, 2008 every page. Citylrown 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 asses if the well water analysis, performed at a DEP certified laboratory, for coliform Y P Y , P rY, bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 m provided that no other failure criteria are triggered. A co of the analysis must be pp , p 99 copy Y attached to this form. 3. Other: r D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z 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. t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H Y Y 21, 2008 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ 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. t5-2940.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M e 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for y y every page. Cityrrown State Zip Code Date of Inspection C. Checklist t 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? SAS inspected ❑ ® 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 with provided t 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)] t5-2940.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H y y 21, 2008 every 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): 330 gpd Number of current residents: 3 Does residence have a garbage grinder? Removal of grinder is recommended ® 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 d 378 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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): t5-2940.doc•08/06 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 °M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for Y y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 26+years. Design plan dated 1218181 (Board of Health files). Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M , 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H y y 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: Not determinedfeet 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: Not determined Sludge depth: Not determined Distance from top of sludge to bottom of outlet tee or baffle Not determined Scum thickness Not determined Distance from top of scum to top of outlet tee or baffle Not determined Distance from bottom of scum to bottom of outlet tee or baffle Not determined How were dimensions determined? Not determined t5-2940.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for y y every page. City/Town 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.): Tank was not evaluated as conclusive evidence of system failure had already been observed at the leach pit. Tank should be pumped dry at time of system repair and checked for structural integrity. 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.): 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): t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H Y Y 21, 2008 every page. CityfTown State Zip Code Date of Inspection 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: ❑ 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 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 not uncovered as conclusive evidence of hydraulic overload was observed in the soil absorption system. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2940.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for y y every 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): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appeared unsaturated. An observation hole was dug into the leaching pit stone. The top peastone was observed to be covered with a thick gray staining consistent with prolonged effluent contact. Standing effluent was observed three inches below top of the peastone. t5-2940.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H Y y 21, 2008 every page. Cityrrown State Zip Code Date 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.): t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May 21, 2008 required for y y every 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. LOCATIONS LEACH 3 A B D-BOX o 1 7.5 FL 24.5 Ft 2 2 13 Ft 29 Ft SEPTICa 3 17 Ft 33 Ft TANK o t 4 24.5 Ft 49 Ft A B EXISTING DWELLING # 69 WAYLAND RDAD NOT TO SCALE t5-2940.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 69 Wayland Road Property Address Celia Maria Freitas Owner Owner's Name information is Hyannis MA 02601 May required for H y y 21, 2008 every 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 ground water: 11+ 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: Not found 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: Approved design plan on file with the Board of Health shows bottom of system to be 4.2 feet above the bottom of a witnessed test pit in which no water was encountered. t5-2940.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable p�OF1HE Tp�� o� Regulatory Services l MSTABLE. ; Thomas F. Geiler, Director M�1 `fig 639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be ,listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. i Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC z, r Fee 5 0.0 0 l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Aiopoml Opotem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 69 Wayland Rd Hyannis Mr. Forti. Assessor's Map/Parcel / a a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Sery P.O. Box 1089 Centerville 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 gallons per day. Calculated daily flow gallons. 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) install d—box and TY 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 ssu�db �f]Hea�ith . Si ned Dat Application Approved b Date 3 Application Disapproved for the following reasons Permit No. 3 �'�— Date Issued G � 50.00 _r No. ��7 <+ .._ Fee{ Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS } Zipprication for Migpogal tip.5tem Conttruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components F Location Addressor Lot No. Owner's Name,Address and Tel.No. "69 Wayland Rd Hyannis Mr.' Forti Assessor's Map/Parcel I .� q Installer's Name,Address,and Tel.No. I Designer's Name,Address and Tel.No. W.Q. Robinson Septic Sery P.O. Box 1089 Centerville 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 gallons,per day. Calculated daily flow gallons. Plan Date Number'of sheets Revision Date Title Size of Septic Tank Type of S.A.S:'" ,.. Description of Soil: a Nature of Repairs or Alterations(Answer when applicable) install-d—box and TY ' 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 ssued b�ti f Health. �'"' Si tied Date Application Approved by ' Date 3 �:5 Application Disapproved for the following reasons Permit No. Lo Date Issued 01 Forti THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 0,,k y Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by { W.E. Robinson Septic Service at 69 Wa-yldnd Rd Hyannis has been constructed in accordance with the provisibns of Title 5 and the for Disposal System Construction Permit No. �� Z&Z dated co 13 C Installer Designer The issuance of this ermi shaJ not be construed as a guarantee that the systemZ li c ' a e Date (' G s Inspector J No. 4�)M —Z, Fee 50.00 Forti THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigotal *pg;tem ongtruction Permit 7Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 68 Wayland Rd Hyannis 4'.µ...aw. 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:Construction 7mst be completed within three years of the date o this e Date: �9 I I3 Approved by f ' TOWN OF ARTS ABLE � SEWAGE # MAP & LOCATION LOT?—"1"ZZ" ASS ESSOR'S VILLAGE d INSTAL.LER'S NAME &PHONE NO. �66 /r- SEPTIC TANK CAPACITY ' � —(size) LEACHING FACILITY:. (type) NO.OF BEDROOMS Ja DZ ✓ L BUILDER OR OWNER u DATE: PERMIT DATE: 3 .3 COMPLIANCE Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom o Leaching eu ezistlity Feet Private Water Supply Welland Leaching Facility (If Y on site or within 200 feet of hing facility)any we exist Feet Edge of We and Leaching Facility within 300 feet of leaching facility) Furnished by I s� I MAP Z7I COMMONWEALTH OF MASSACHUSETTS PARCEL - ZZ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE ' r J d i. F Af Q y lab op? V� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ) CERTIFICATION Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner's Name: FORTI A Owner's Address: 69 WAYLAND RD. HYANNIS,MA 02601 -�1 RECEIVED Date of Inspection: 6/2/03 Name of Inspector: (please print) JOHN GRACI,INC. JUL 0 12003 Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 TOWN OF BARNSTABLE HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 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 X Conditionall asses _ Needs Furt Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 6/2/03 The system inspector shall submi copy of this inspection report to the Approvinb Authority(Board of Health or DEP)within 30 days of completing this in spec ion. 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. Notes and Comments SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. SEPTIC TANK NEEDS NEW TEE. D-BOX IS STRUCTURALLY UNSOUND AND ALSO NEEDS TO BE REPLACED. ****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(lie same or different conditions of use. Title 5 IncnPrtinn Fnnn rill v,)nnn I f Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 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 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.SEPTIC TANK NEEDS NEW TEE.D-BOX IS STRUCTURALLY UNSOUND AND ALSO NEEDS TO BE REPLACED. B. System Conditionally Passes: X 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. n/a 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: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped PUMPED 1 1/2 YEARS AGO BY OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? _ X Were as built plans of the system obtained and examined?(If they were not available note X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ 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: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]L�. Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO �(�0 Water meter readings,if available(last 2 years usage(gpd)):-NIB Sump pump(yes or no):NO Last date of occupancy: n/a COMMERCIAVINDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: PUMPED 1 1/2 YEARS AGO BY OWNER Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 21 YEARS BY OWNER Were sewage odors detected when arriving at the site(yes or no):NO F Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_Polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000 GALLONS" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" 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.): SEPTIC TANK IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.TANK NEEDS NEW TEE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 IS STRUCTURALLY UNSOUND AND NEEDS TO BE REPLACED. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R r Page 9ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6'/OCTAGON leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.PIT HAD F OF LIQUID IN IT AT TIME OF INSPECTION. STAIN LINES INDICATE PIT HAS NEVER HAD MORE THAN I' OF LIQUID IN IT.BOTTOM IS AT 816". CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WAYLAND RD. HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. w I ��C Sheen De4 m � o 5qL AD �5a �n N9 in Page.11 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WAYLAND RD.HYANNIS,MA 02601 Owner: FORTI Date of Inspection: 6/2/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12 FT. i 11 `LOCH 10 SEWAGE PERMIT NO. to- l� � 's ',-V'ILLAGE 06 Co �r-e aTwes,& rj� � CJ- INSTA LLER'S NAME 6 ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 9s �^ // �� � Y.T o a � y� � � � �j, �`1 ''- t� .� �� ti: �y � �� - . .. ,i7 o .,+ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..........................OF......Barnstable-----..--..--...........----------................ Apptiration for Uiipvsai lVorks ,Tomitrurtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..- ..� .... rn �cw. -- -------------------------- ----Hannis�... .............................................................. Capricorn Rea�ety" '�rust6� Falmouth or Lot H anni .... .�.._._...........- --•----••-----•-••--•--•.A ' y ..................•. ^y��wner�A� Address r ...... ..............'' .................. Installer Address UType of Building Size Lot--- ..........Sq. feet ,., Dwelling—No. of Bedrooms.......... ..............................,..Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building Rarl.Qh............. No. of persons............................ Showers (2 ) — Cafeteria ( ) p" Other fixtures ----------------------------------------------------- W Design Flow............55..........................gallons per person per day. Total daily flow........... 30........................gallons. WSeptic Tank—Liquid capacity. QQOgallons Length._$.-...... Width..4210-. Diameter................ Depth..5-1.8•---- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1............ Diameter......6............ Depth below inlet........6.'....... Total leaching area-----266....sq. ft. Z Other Distribution box ( ) Dosin tank ( ) �ldred e En ineerin 11-2 -81 Percolation Test Res is Performed by---------------------g•---•--.....�-.-••-•---•--••-•-•..g.........--- Date-- .............. 2• 12 1... Depth to ground wateinpne encounter- ,=a Test Pit No. 1... .........aninutes per inch Depth of Test Pit................. p gr .-.--. (i Test Pit No. 2---U A----minutes per inch Depth of Test Pit------N-�A..... Depth to ground water-----N/A-.--.-.---- e d p -----------------------------------•--------------.........------------.............._.........-'-•-......................................................... Description of Soil........Q----2-----------�QaAI..-�---T.Q.P.S.Qll................................................................................................. U ---•------------------------------------2.'.-10........Kedi.um..Yella r...Saxad..................................................................................... --------------------------------1.Q 12- me.a..-..Whit.e._.$and/t.rg.oes----Q.f..GrayaI/no..Water at 12 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 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by the board of health. Signed. •.. • .......................... ................................ J� Date Application Approved By...... �...,�/" -- - - •----------------------------•-- ------ ............ Date Application Disapproved for the following reasons----------------•------------•-------•--...--------------------•-------------•-----------------------------'-.... ---------------------'-------•-------.....---------------•-•-•----------------•--•-•----•--------••------I--••-••-•.......-------••-------•-••--••-•--••------------•-•---•-••-••--•----••-•-•-•••...._.. Date PermitNo......................................................... Issue(L....................................................... Date 0' . , No................_. Fimz........... +"..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration for Disposal Works Tonstrurtion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Yste�},l�q at: .....�.T...i»» ...1.�_._......Y...-.`/.v.v. ..,�Srt ......... ....L7Z7n----- "",.''... - - --•---•----•----.......................................... Location-Address or Lot No. 17 4 fh h 1,+tn n,�.3 v �.'..n v+v.� ................. er � Address ^ W •----- _............!:r >........::.: n � ............................................... ...........•-_.._.......----•-••.._..........-•---._....•._......._..............._......._..... F Installer Address >r dType of Building Size Lot.l_S,-_l.�_1...._......Sq. feet Dwelling—No. of Bedrooms.........?................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building n� �_.............. No. of ersons_........................... Showers ( — Cafeteria GPI YP g .............. No. P (.. ) ( ) � Other fixtures .................... -------------------------------------------------------------------------------------------------------------------------------- Design Flow............. -.. gallons per person per day. Total daily flow___..._....._ gallons. W 5- -- - �jQ R: Septic Tank—Liqul capacity_j:()&()gallons Length... .'_&�!.. Width_..,�_�_©la Diameter................ Depth... ! !t_. x Disposal Trench—No. .................... Width............t._._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._------------------ Diameter......6_1......... Depth below inlet--------6,....... Total leaching area.......26.&...sq. ft. z Other Distribution box (. ) Dosing tank ( ) Percolation Test Results i'. Performed by.._F::1.d:rn n.21 ........ Date----j_j__2_5_&1-------------- aTest Pit No. 14 .Z inutes per inch Depth oF Test Pit.........12.1... Depth to ground waterg one.--e counter (i Test Pit No. 2.._m_,(A_..minutes per inch Depth of Test Pit.__...ji/A..... Depth to ground water.....ij/A.......... ed x --------•-------•--------•--•-...-• ....................................................•----•......................................................... O Description of Soil.--•---..0.!- �.'-........-1704m... Aepeell-------•----•--------•---------•---------------------------•-- U --------------------- W --•-•--•-•-------------------•------ 1 )i d— - r� •zsa...V&.t-er...at...1-2-- UNature 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 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ....... ........ ... ` -w�� ............... ------- --------•- ✓ %Y!�!N f Date Application Approved BY ....— ' -•-- ----------•-------•--- j ~10 Application Disapproved for the following reasons------------------------•------------------------•-----••--------------------------------------------......•---- -----------------------------•--------••--------.....•----•............••......_....-•--------------------•---•--------------•-------------•------••--------••----------------------------•------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I a'3 Y'l" l R 5 b! P 1 TrrtifirFatr of ToutpliFaaarr THI1 �;T.+ I Y, That the Indivi V f w e ii�sp sal System constructed ) or Repaired ( ) �'� .— bY--••••--••••------------------•---------••-------------•-•--------••••••------•-_.._ _... ` Installer . atla S an.n--17--- .. <'t5 --------------------------------•-•-......-•---•-------- ----- has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Ne _:12'. y:.­................... dated-.-...-......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................. .................... Inspector........&A.zT-............................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... o......................... F ,.S. ........ Disposal Works vpwaatll W rmit Permission ishereby granted --`-•-•..............:..... ...............................................--------------------------...........................--- to Construct (•' ) or Repair ( ) an Individual Sewage Disposal S stP:, atNo..Lc:�....., c.,/..t ._-- - ....\A q � ' ----•-------•--•--------•---•------•----- .. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... gi ----------------------------------------------- Health DATE...............................................................:................ FOR14 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTA�BBL�E LOCATION to I V1 ,K GISG' SEWAGE # �iII.LI+GE �t,40 ASSESSOR'S MAP & LOT INSTALLER'S N &PHONE NO. SEPTIC TANK CAPACITY b O LEACHING FACILITY: (type) V (size) nnolY r P 'i NO.OF BEDROOMS 1 3 BUILDER OR OWNER 4 N11 0 PERMITDATE: 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 leaching facility) ] Feet Furnished by ` in� -U3 =5 - N a O V Z=04a - N c u I O,C')00 l� E C Z 1N I Dl�l-i toC3 } J F s•g 20' Sa .p- s, f3 . �o - t V 1 k 1 A. * 1 r !.- P; O 24 l o' Jul 1 N ' 77. Wco � L 744 / ♦ �' kf 00 To Q ------ ! 19-1,3 l: 4 3M @STD � U l ' �ESSIONAG`� �. �GEND OF ESN CERTIFIED . ' PLOT PLAN EXISTING SPOT , ELEVATION 0x0, yG EXISTING CONTOUR --- 0 FINISHED SPOT ELEVATION. Lov l$ WAYL.AND POHD N1ANNIS FINISHED CONTOUR 0 --' IN APPROVED BOARD OF HEAL AilkISIAf d 3 r DATE AGENT ' SCALES 1 " 30' DATES Now !dig �� LOREDGE ENGINEERING Ca IN CLIEPIT fiaA^*�- "'"' 1} CERTIFY THAT THE PROPOSED EGISTERE REGISTERED ,�Q� Rp,"r r7—`8 BUILDING SHOWN ' ON THIS PLAN CIVIL LAND ' CONFORMiS TO THE ZONING LAWS ENGINEER SURV DR.oy!: *' - OF .®ARNSTA E� ASS. 712 MAIN ST. ` CN. RY 4 Z I Z 0$•4► . .- HYANNIS, MASS:: 9NEET`ygpF ,�„�„ - DATE. EG. LAND SURVEYOR j ,3 7" T W �a ul 14 � OC4: VW F. `�_ �� W v..� 2lz W hul p W e Z0 � � 0 °o"ww • a° 4�pol J � � oy JWQQ U � ` : e a . • o hh 2R � W14 �� 2 It � . l? 0 �. V W '� O o 0 Z lk 0 4 4t1l1 Q 'A14 14u4 � a2 Z � �� � �� o, w a ° w elW t Lo o , • . a .,a y ` o W w o f � w q14 14 lb z IS 2 AL 4, lk it v o � �L � � rlk 11 h � hy • _, y�� sv rA ON Q Y O y 2 O QjbV WQO 2 � h aW14 NJ ® i �C WOt� Qo ? � � G��SE.rs C •I �a Qh � hC � ►1 h h W � 14k s vc . ......... PROVIDE PRECAST CONCRETE T.O.F. EL.=-60.91 EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-Box= 59.5'+- 4'SCHEDULE 40 PVC MIN. SLOPE I % FINISHED GRADE OVER DIFFUSERS = 59.5 - 58.5' GENERALNOTES COVER TO WITHIN 6"OF F.G. OVER INLET AND OUTLET COVERS. REMOVABLE COVER OVER RISER TO INSPECTION PORT WITH ACCESS BOX TO SLOPE @ 2% MIN. 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE WITHIN 6"OF FINISHED GRADE WITHIN 6-OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 60.0'-+ FINISHED GRADE OVER TANK EL. 59.8'+ 5' DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. ....... -- ----- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 36"MAX. IN. EXISTING 4" PROPOSED 4" 9"MIN. 1 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 36"MAX. TOP OF SAS B.O. 57.08' SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3"DROP MAX 9. PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN OP MIN 3" 9" 2"DROP MIN.SLOPE 1% JOINTS (TYP.) ELEVATION =57.08' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 110" 4" PVC IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 0. 14" 5 7._3 SEPTIC TANK 4" PVC OUT TO 171=i F-" 1.33' 16"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. • LEACHING FACILITY 0.90, (TYP.) 10.1"TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. nj ITI ;=T CONTRACTOR CONTRACTOR SHALL 7 12" 1 E 1 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. k OUTLET TEE 57.00 MIN. 5 SHALL VERIFY SIZE 48' VERIFY CONDITION OF 6.83' 56.6 \-55.75- (LAID FLAT) -2.875'(34.5-) 5.75' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER o n 6"CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#Al 801-4x22 4 OVER MECHANICALLY 5.01TANK NECESSARY � �P3 COMPACTED BASE (TYP.) 5'MIN. 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 60.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A TREE STUMP AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 47.67' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC (#3616BD) BIODIFFUSERS TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING M"t REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM • 4 APPROPRIATE AUTHORITY. NOTE: ENTIRE PROPERTY IS LOCATED WITHIN A DEP .1 TEST PIT DATA a X APPROVED ZONE 2 AND THE ESTUARINE WATERSHED. /5 x", r PERC NO. 12479 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS MAP 271 • -41 KI LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE PARCEL 230 SWING-TIES 0 INSPECTOR: Marybeth McKenzie - THEY SHALL WITHSTAND H-20 LOADING. Benchmark • EVALUATOR: Michael Pimentel, E.I.T.- Nail in Tree Benchmark DESCRIPTION HCA HC-2 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. I v_ = 0 L0_00� • 16 DATE: February 20, 2009 Elev. =60.00' so A pprox M.S.L.M SL BIODIFFUSER CORNER(1) 33.0- 32.7' TEST PIT#: Approx. M.S.L. 0 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 41 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. BIODIFFUSER • CORNER(2) 62.6' 542 0 ELEV TOP 59.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, EXISTING 1000 GALLON SEPTIC TANK TO ELEV WATER= <47.67' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). BIODIFFUSER CORNER(3) 62.2' 49.2' • LO BE UTILIZED AS PART OF THIS DESIGN 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN CCO PERC RATE <2 min./inch C) m 12-VV BIODIFFUSER CORNER(4) 323 23.4' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 161. 28 CO 0 M 70, F •• • DEPTH OF PERC 26"-44" z I _k so a 16. PROPOSED PROJECT IS LOCATED WITHIN: CB/DH(FND) 0, , :�*_ a 0 1 10 /y, PROPOSED DISTRIBUTION BOX • TEXTURAL CLASS: 1 ASSESSOR'S MAP 271 PARCEL 229 OWNER OF RECORD: FEDERAL HOME LOAN MORTGAGE CORPORATION PROPOSED TOTAL 12ARC 36HC BIODIFFUSERS 31 0. . ADDRESS: 8250 JONES BRANCH DRIVE / 10, (6 BIODIFFUSERS EACH TRENCH) MAP 271 5900' y, MAILSTOP A62 Fill i PARCEL 218 • 4- Loamy Sand 58.67 MCLEAN,VA 22102 I OYr 3/1 8- 58.33' FEMA FLOOD ZONE C MAP 271 >,< 41 X HCA itable B Loamy Sand COMMUNITY PANEL# 250001 0005 C PARCEL 229 1 OYr 5/6 17. DEED REFERENCE: L.C.C. 187385 15,111 S.F.± • 56.83' 26" Perc c 18. PLAN REFERENCE: L.C. PLAN 36508-C 2) 44 55.33' 19. ALL DISTURBED AREAS ISHALL,6E RESTORED TO ORIGINAL CONDITION. BH 0 TP2 >'< 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 4.6' 4%1 >,< FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 59.0 • 642 * >'< • 049 Medium-Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. C TP1 0.0" 2.5Y 6/6 0 _0I (Loose) 0 iff >,< 59.01 0 CV (D #69 1!3 J< LOCUS PLAN- co >1< 0 11 EXISTING I HC-2 � SCALE: I"= 1000' 3-BEDROOM136" 47.67' _j T ION OF EXIS f IN APPROXIMATE LOCA DWELLING J< No Mottling, Standing or Weeping Observed TOF 60.9'± uj DISTRIBUTION BOX TO BEXMOVED . ..... < SCREENED 57x5 J< ------ --� o I I PORCH >1< DESIGN DATA TEST PIT DATA LEGEND < PERC NO. 12479 50X0 EXISTING SPOT GRADE LP NUMBER OF BEDROOMS (DESIGN) 3 INSPECTOR: Marybeth McKenzie 50 - - - EXISTING CONTOUR GAS GA S J< DESIGN FLOW 110 !3AUDAY/BEDROOM EVALUATOR:-Michael Pimentel, E.I.T. PROPOSED CONTOUR APPROXIMATE LOCATION OF EXISTING J< TOTAL DESIGN FLOW 330 _GAUDAY DATE- February 20, 2009 LEACHING PIT TO BE PUMPED AND FILEDX1 DESIGN FLOW X 200 % = 660 GAUDAY TEST PIT#: 2 EXISTING OVERHEAD WIRES PATIO WITH CLEAN, COARSE SAND USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 59.00' GAS GAS EXISTING GAS LINE SHED eCV'2,�, ELEV WATER <47.67' EXISTING WATER LINE TEST PIT LOCATION PERC RATE X ecv INSTALL 12 -ARC 36HC (#361613D) BIODIFFUSERS>1< DEPTH OF PERC = LP EXISTING LEACHING PIT LU x SYSTEM CAPACITY TEXTURAL CLASS: 1 EXISTING 1,000 GALLON SEPTIC TANK DRIVEWAY 0 0� < a \ -- / / (TOTAL L.F. OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 0 x (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING DAY 0. 59.00'0 Uj MAP 271 Fill [3 PROPOSED DISTRIBUTION BOX ULjL 4' 58.67' (3 PARCEL 219 Loamy Sand io 1 OYr 311 LU TOTALS: PROPOSED ARC 36HC(#3616BD)BIODIFFUSER 8- 58.33' 58 >1< B Loamy Sand -X-X-X-X-X-X-X-X-X-x-x-X-X-x- TOTAL NUMBER OF BIODIFFUSERS: 12 1 OYr 5/6 X-X-X-X-X-X TOTAL NUMBER OF COUPLINGS: 0 26" 56.83' -X-X-X-X-X-x-x-x_x_x TOTAL LEACHING AREA: 468.0 SQ.FT. _X_Xj DATE BY APP-D TOTAL LEACHING CAPACITY: 346.3 GAL./DAYREV. DAY . DESCRIPTION ---------- S75. 112,11 PROPOSED SEPTIC SYSTEM UPGRADE 143.39, PREPARED FOR: NOTE: Medium-Coarse Sand CAPEWIDE ENTERPRISES EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE C 2.5Y 6/6 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER (Loose) LOCATED AT "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO MAP 271 ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST 69 WAYLAND ROAD PARCEL 228 MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. HYANN IS, MA 1 1 SCALE: 1 INCH 10 FT. DATE: FEBRUARY 20, 2009 136" 47.67' 0 5 10 20 40 FEET No Mottling, Standing or Weeping Observed OF NOTE: CHU HILL JOH L. PREPARED BY: 0 RESERVED FOR BOARD OF HEALTH USE R.MAP 271 JC ENGINEERING, INC. VIL 1.) MAGNETIC MARKING TAPE SHALL BE PLACED 41 2854 CRANBERRY HIGHWAY ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM PARCEL 220 EAST WAREHAM, MA 02538 COMPONENT. SITE PLAN 508.273.0377 Desi MCP I Checked B SCALE: 1"= 10' Drawn By: g By: y:BSM ned JLC JOB No.1566