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0118 WAYLAND ROAD - Health
118 Wayland Road Hyannis A- 271 - 202 r - TOWN OF BARNSTABLE LOCATION SEWAGE#.6�'�G��� VILLAGE f-/w ,C.,,.i .S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&'PHONE NO. a 6 IA- 56 SEPTIC TANK CAPACITY :;:BLEACHING FACILITY: (type)\�2- L.,G (size) 'NO. OF BEDROOMS 3 OWNER 41-0^. PERMIT DATE: 2- — C —C> COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and eaching Facility(If any wells exist on site or within 200 feet -leaching facility) Feet Edge of Wetland and Leac ng Facility(If any wetlands exist within 300 feet of lea c ing facility) Feet FURNISHED BY t � c � , f W G" J No. _o 0 7— O 1 4 y Fe$1 0 0 - 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rtlphration for Digpogal �*, pgtem cow9tructi0n vermtt Application for a Permit to Construct( ) Repair({) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 2 71 /2 0 2 Owner's Name,Address,and Tel.No. 7 71 —7 5 9 2 118 Wayland Rd, Hyannis Carol Reed Assessor's Map/Parcel 118 Wayland Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech 43 Triangle Cir, Sandwich Type of Building: Dwelling -No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder (no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to the plans of Eco—Tech, #ETE-2537 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 Env'ron ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed DateA/,ii CI Application Approved-by Date —0 7 Application Disapproved by; Date for the following reasons Permit No. Oo-?" Date Issued ""ro 5 -..._o'w'.. • ..,�. ,. _ .-:°"tr ^4'. ,.I'-. -L..• .�......-. .T,r .�."`. ^�'t'i. -t^.=Y'."«Y.h-a�.. - � ;��;'�; Feel nn nn THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes, ZIppYication for Migonl qPpgtem Congtruction Permit Application for a Permit to Construct( ) Repair_(;) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.2 71 /2 O 2 Owner's Name,Address,and Tel.No. 7 71 —7 5 9 2 118 Wayland Rd, Hyannis Carol Reed Assessor'sMap/Parcel 118 Wayland Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4-O 8 9 4 Wm E Robinson Sr . Septic Eco—Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder PO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of.Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system-to the plans of Eco—Tech, #ETE-2537 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He lth. (' Signed + Dat®l?�,G J Application Approved by Date Application Disapproved by: U Date for the following reasons Y Permit No. 0 U V Date Issued a O THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Reed t to�Cer tftca of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) r Abandoned( )by Wm E Robinson Sr Septic 118 Wayland Road, Hyannis �'� at ' has been constructed in accordance � / 6 r 4t with the prcvisic nos o`Title Sand u".e fur Disposal System Construction Permit No 9-G U�— O dated z 0167 ._ Installer Designer �')' 1J "�� #bedrooms 3 Approved design flow ?( 26 gpd The issuance of this permit shall not b4c nstrued as a guarantee that the system will func'G io as designed. Date /�/ Inspector ————=——————————==————————————————————— — ———— �067 (91 No. Fed 0 0.0 0 Reed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 118 Wayland Road, Hyannis and as described in the above Application for Disposal System Construction Permit.The applicant rew izes 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 thi�erm-i�t., Date E E 6 Approved by i Town of Barnstable Regulatory Services • Thomas F. Geiler,Director MRNWABLK , t639.'SS Public Health Division '°�Enrr►o�° Thomas McKean,Director 200 Main Street,Hyannis,AIA 02601 office. 508-8624644. Fax: 508-790-6304 Installer&Designer Certification Form Date: -- J,? ,G G Sewage Permit# `11 i l Assessor's Map\Pareel 2 71 /2 0 2 Designer: Eco—Tech Installer: Wm E Robinson Sr Septic AAddress: 43. .Triangle Circle Add- . PO Box 1.089 Sandwich ..Centerville On Wm E Robinson Sr Sept issued a permit to install a ate (install&) septic system at 1 1 8 Wayland Rd, Hyannis based on a design drawn.by (address) F.co=T -ch. dated 02-01_-07 (designer) I%ZI certify that the septic system referenced above was installed substantially according to the design, which may niclude 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.relocation of the SAS or any vertical relocation of any component gu Of the septic system) bizt in accorda-nrce with State &Local Regulations.- Plan revision-or certified as-built by designer to follow. H OF Af,4 t, �o DAVIDD. c'sa COUGHANOWR N (Instal er's_Signature) _ No. 1093 ISTV !TAM, (Designer's Signature) (Affix Designer's Stamp Here) PLEASE' RETti12N T® : BARi[STABLE PUBLIC HEALTH.. DIVISION. C'ER77F'ICATE OF COMPLIANCE .WILL:NOT..BE ISSUED LNTIL BOTH THIS FORM AND AS-BITIi.T CARD ARE RECEIVED BY THE BARNSTABLE T-BLIC HEALTH DIVistri I. THAAJYT yOgt. Q:Health/Septic/Designer Certification Form 3-26-04.doc 1 gay 777 I� ' o C T 10 SEWAGE PERMIT N®. VI AGE i h Al i ISS. INST LLER'S NAME i ADDRESS_ GUILDER OR OWNER r✓'194co Gi ea UV DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 0� * � �n M � O �' Z �-E. ti N N 0 M � � N � v � °� N e Town of Barnstable OF IHE 1p do Regulatory Services Thomas F. Geiler,Director BARMTABLE,p 9 MASS::. 0 1639. Public Health Division ArED Mp'�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 16 2007 Ms Carolyn Pihl Todd 118 Wayland Road Hyannis, MA 02601 ORDER TO COMPLY.WITH STATE ENVIRONMENTAL CODE, Title. 5 The septic system owned by you located 118 Wayland Road,Hyannis,MA was last inspected December 13th 2006 by Brian K.Tilton, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"fails"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in hydraulic failure You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH EPARTMENT Thomas cKean, R.S., C.H.O. Agent of the Board of Health Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments —�' Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information CW/ � Important: When filling out 1. Property Information: �� forms on the lza computer,use 118 Wayland Rd. Hyannis, MA. only the tab key Property Address to move your Carolyn Pihl Todd cursor-do not. use the return Owner's Name key. 118 Wayland Rd. Owner's Address Q tennis MA. 02601 City/Town State Zip Code Date of Inspection: 12/13/2006 erom Date 2. Inspector: Brian K. Tilton Name of Inspector The Building Inspector of Cape Cod Company Name P.O. Box 307 Company Address Eastham_ MA 02642 City/Town State Zip Code;;, 508-255-9343 Telephone Number B. Certification Cr p i cn certify that I have personally inspected the sewage disposal system at this add�e.s and tb-"at theta information reported below is true, accurate and complete as of the time of the ins p ection.The Inspection was performed based on my training and experience in the proper function and m�intenance of o�,site sewage disposal systems. I am a DEP approved system inspector pursuant to ectior5.34,0,of Title 5 (310 CMR 15.000). The system: i ❑ Passes ❑ Conditionally Passes ® Fails ❑ ds Further Eva tion by the Local Approving Authority �LG 12/13/2006 I pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow.of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the.future under the same or different conditions of use. 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection 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:_ 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Not for Voluntary Assessments I Subsurface Sewage Disposal System Form B. Certification (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form B. Certification (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd 12/13/2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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: 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cost.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State ZipCode Carolyn PIN Todd _ Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is.less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 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. 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments J�¢ Subsurface Sewage Disposal System Form B. Certification (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection 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. 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 118 Wayland Rd, Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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 CMP, 15.302(5)] 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts — F Title 5 Official Inspection Form tA Not for Voluntary Assessments i^M Subsurface Sewage Disposal System Form D. System Information 118 Wayland Rd, Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection. 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: 3 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment. Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/perso.ns/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): 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form - Not for Voluntary Assessments Subsurface Sewage Disposal System Form �SY D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection 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 r ❑ 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: 1/8/1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Ins ection Form P Not for Voluntary Assessments M : Subsurface Sewage Disposal System Form D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection Building Sewer (locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 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 ❑ Yes ❑ No .certificate) ----------------------------------------------.----------------------------------------- ----------------------- ---------- Dimensions: 5'8"x9'6"x4'10" Sludge depth: <1 Distance from top of sludge to bottom of outlet tee or baffle 30 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 18 How were dimensions determined? LlWayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title, 5 Official Inspection Form _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM D. System Information (cont.) - 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn PIN Todd Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle c-ondition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): system was pumped approx. 3 weeks prior to inspection. evidence of system back up over outlet baffle. 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: r ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection 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 Liquid leaking out D-Box cover. 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.): Failed SAS causing liquid to leak out of D-box, heavy green lawn over D-Box area, no ponding or visible flow to surface. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms.in working order: ❑ Yes ❑ No 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: SUbSLrface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments C4 o Subsurface Sewage Disposal System Form D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code . Carolyn Pihl Todd Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type; ® leaching pits number: 1 ❑ 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.): lawn over top liquid level over inlet with anerobic bacteria stains around cover. hydraulic failure. 118 Wayland Rd.t5insp.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts t Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts =�t Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal.System Form D. System Information (cont.) 118 Wayland Rd. _ Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection . Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I W (A%aY A . O � O Z ' A I 28� A 140-F TD SCALE t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 118 Wayland Rd. Property Address Hyannis MA 02601 City/Town State Zip Code Carolyn Pihl Todd Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: 11/25/1981 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: f 12' as per design plans, correction Not calculated due to failure of leaching system 118 Wayland Rd.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 LEACNI'iYG P/T A.lE /yORP THAN l" to :M GRAO��A, ET.ER CaNG'R.�T.E COv,:� ts- SJhIALI B.F BROCIGHT TD GRAOrE.C, N EXTRA'• eONCR!'l4� ' g 1aYC OIPE t1E.4VY. CA ST IRON COVleR SIA/4 L[". !3E 4ISELo'.. Al/M. PITON GOYER3 "QFRFy- /FIN ORIVEyVAY .b' Cd/dCRL�'T.E 2 Y. ',•.12'-A An C O YER GR• CLEAN SANG BAC.�F/G.L _. 2.LAYER PAM Ml1V. DIST. o • • • • •• b v4o wAS.h+FO STONE Pelt rr SEPT/� T�iNwK Day � b �i y i i :i •' ;'p b.�. r s 1�p a �.� ���FZ'T/VLF � e ♦ ,, •3 ¢ "' f Pr r ;ir:5;'s - ��°'• v` � 1 • 1 ♦ ► • i ► o p a P CAS. G s e. • • • • i • • e a P/7 OR jMV/V rNYeRT CL,Ei/ATl�Ns i�8, :,� :�, 4�t .P. A a s �. ../NYERT AT QlIILO/N6 .. FT.. e..:_... !NG ET : bi C{ E TABLLATI DN,� P1rc.�kPptGii�.. sit--a 6 p. D.. "OIJ7LET SlPT/C Tic > e' w...:w ALB.'. GROUND Mri1TE TALE ' /NLET D1S7R/'a'rr'oN ®OX db•1�. f,:^ SECTION OF `'OtJTLt`TD/STRI�..7/ON dOX�F?:: • SP1�VA�'E' O/�POrSA t SY,ST�M.. IIVLOT LEACHING 40=117* $. d FT. Tj,SULAITIAN LE,4Cf1ING P/T aIMEnls/oN A 3 In'T. DES/6N CR/T,ERlA SCALE is-, G FT. NUMBER OF BEDROOMS DW4NS/ON C --FT. At l Q C,4jgdA4GEL'/5P05AL I/IV/T SD/L T,EST TqT.�� Es7I/r1 'v FL4HI 3 G.4L.�DAY `SO![. TEST. I.; SD/L TEST#2 XUM$FR QF t1rACN1NG �►!iS l; -...:.., : ,, ',;" :.f^ZtiwY. '$�'r.�.:.,,` A-LaPY, ,GATE OF SO/L TEST (I �S•4t, S/D,E,LGA so Or;, LOAM ULTS AvIrNESSlED aaTToM LFAcXiNG vER PIT.�� S4 A?- 0-1 f►�PSoi�- RERCOLATION AAr&,"/ M1t.0mcH TO7A4 dEAoH/NG �4REA. ` 2•G(' SQ.. FT. ` ;�' F hCOGA�''/oN RATS `�k2' —2-�-- M1w.�lNCf+ RaS.E'RIes Z.EAC'wmer AREA F,T.. of Gg, L .\ �N O ttg i tNQF 4�L �,s 2-12 sRuP L�vT 4-7 - wA,fLAr riD or y� o o , ;. y O MO S� y •r, No.-iassi�o � ,� L DRE©GE ENGINEPR/XG ca"M 712 MA1/Y ST. 4�0 Stitt`1 `osSi0NA� a� EL= S,S: HYAN/v/3 MASS. [�. NO GROUNIT.YI�i4TC°R"1rNCOlJNTEREo A A. G�GUNO Y✓13TER'.47` ELE(/.' J06 NO, g�1o•S_ SHEET ZOF Z V � cA . . '`•• Wlu IAM TOW T/92m, __ 1654; 4500: WAYIANb RD 118 ....... ..._._--- __ wuiXA11'4DD 1WI31MOC 1731: 7700: WAYLANO RD 118 ...--...... . WAYLAND RD 118 :wtLiAM TODD 1111/�0D5: ... 1755: 2400' .WAYL.AND RD 118• 11Y{LLIAM 100D u12r2005... .... i784: ..__._. .-•-.•a -- WAYLAND RD.118 ;WiltfAMTOOD 7(1212Q05, IM: --4' W. VYlLLIAM TODD iQ112/200 _,___._1883. _-____. BaoO• .wAvlAND RG•118 . __.. .--- _ - ._._.__... ",WAYLAND RD 118 :VM.0 M TODD; vt ....____..... 191� ..._.._... . ..... - /��ffa aid q/�T four ro/.,�od aD�f b�ov TOTAL P.01 F � • k Ln`n D ll:�tir fJ n . I r- .. • ru r-q . Er 0 Postage $ H)'� 0 O Certified Fee O "ark O ReturnReceipt Fee I ik (Endorsement Required) —0 Restricted Delivery Fee r=1 (Endorsement Required) ___, a Total Postage&Fees ul Q Se Tt Q�'U /� �r .�. - d ------- -------------- - - - S`deet,Apt No.%I V d or PO Box No. b /`�U a ------------- -- ---- --- � O -- Cfty State,,ZIP+4lyrz a)i r)r s `L1 �. d Certified(Nail Provides: (es�anay)ZOOZ aunt ooee W,o�Sido A mailing receipt e A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or'Priority Maile. e Certified Mail is not available for any class of international mail: o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. 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Internet access to delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable P# Department of Regulatory Services ' Public �Health Division Date �Ep a�� 200 Main street,Hyannis MA 02601 Date Scheduled_ �� Time---� Fee Pd. SOU Suitability Assessment for S age Dis t Performed Bw �tTW V D. C00G?H/41J oW R L$ Witnessed By: ELOCATION& GENERAL INFORMATION Map/Parcel: � (N(�-YWt N (� /� y [ Owner's NamerVot/ q `�c ,�o`'t't"!�L 7Address 0 �'V l�yL A-iV IY/'T�-71/ �(�66Engineer's Name REPABt Land Use 'e51 Aevi-FI 611 Slopes Surface Stones h Distances from: Open Water Body 10 0 't ft possible Wet Area 1601 _ --__ft Drinking Water Well ob t g Drainage Way '5 O c Property Line ft Other ft - SKETCH:(Street name,dimensions of lot,exact locations of test holes 8c perc tests,locate wetlands 3`n proximity y to holes) � o(i� GROUNDW ` ATER ADJUSTMENT EXISTING GROUNDWATER LEVEL r G SS DEPARTMENT RTME T RECCORDS.ON TOWN OF rABLE ti INDICATED GW 28.00 INDEX WELL AIW-230 ZONE D READING DATE DEC. 2007 READING 23.6 ADJUSTMENT 4.1 ADJUSTED GW 32.1 i Parent material(geologic)�� cictl 0VfWg54 'n Depth to Bedrock h — t _Depth to Groundwater. Standing Water in Hole: Weeping from PitFnce InDY� Estimated Seasonal High Groundwater qbo W� DETERMINATION FOR SEASONAL HIGH WA, TABLE Method Used: -s'G'C G(,boVot._ TEK T��� i; f� Depth Observed standing in obs.hole: ))) Depth to weeping from side of obs.hole: in, Depth to soil mottles: in Index Well# Reading Date: Index Well level �" in, Groundwater Adjustment ft. . ..o Adj,factnr Adj.Groundwater 1 evel PERCOLATION TEST Date �I�...' xlute.?�M FMinJlnch Time at 9" n l q e t VN /� 1 Time at 6" 6 k Time @ �i D4 V Time(9"-6") V b e1 ---- __ t ch h q Site Suitability Assessment: Site Passed�_ Site-Failed: Additional Testing Needed(Y/N) Original:.Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within.100'of wetland, must first notify the, Barnstable Conservation Division at least one(1)'week prior to beginning. Q:ISEPPICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% rave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) . ' Mottling (Structure,Stones,Boulders. Consistency,%Gravel t T J DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten T t Flood Insurance Rate Man: Above 500 year flood boundary No— Yes _.____ Within 500 year boundary No Yes Within 100 year flood boundary No✓r Yes Depth of Naturally occurring Pervious Material Does at least four feet curring pervious material exist in all areas observed throughout the area proposed for t a stem? If not,what is th ott&wall ing pervious material? o D. Certification U COUGHANOWR I certify that on o «1 (d a have passed the soil evaluator examination approved by the Department of En ad ° and that the above analysis was performed by me consistent with . the required training, Rso- erience described in 310 CMR 15.017. Signature Date 1,2007 `�� �' � , Q:6SEPTICVERCFORM.DOC SOIL TEST LOG DATE OF TEST: FEBRUARY 1, 2007 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. TEST PIT I GROUNDWATERNO P D AARENTMAATER MATERIAL: OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 47.75 - 0-3 Ap LOAMY SAND 10 YR 3/6 NONE FRIABLE 3-26 B LOAMY SAND 7.5 YR 4/6 NONE FRIABLE 45.42 26-120 C MEDIUM SAND 10 YR 5/6 NONE LOOSE 3'�.'�5 ll TEST PIT 2 NO GR OUNDWATER EL: PROGLACIRAL OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 46.60 0-5 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE 5-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 43.33 36-130 C MEDIUM SAND 10 YR 5/6 NONE LOOSE 35.77 FEB ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � z�iz Town. oF.......Barnstable.................•----..................---------- �'� App iratinn for,Bi-spnaal Workii Tnnitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System.at: l_l. �/�I.��.�ealtv _ ...:�...-• ------ '-.!"-`��-- --•. ......................... ..... .............................................................. -Address or Lot No. .............Cpricorn Trust 7._65_ Falmouth Road, Hyannis_____.. ............................................... -•-- ....--- Owner Address W Steve Lebel Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.._..._..._ .Ex Expansion Attic�__...-__--•------------------ p ( ) Garbage Grinder ( ) aOther—Type of Building _Ra.nCh____........... No. of persons............................ Showers ( 2_) — Cafeteria ( ) d Other fixtures -----------------------------------------------------•------------------------ --------------•-•-•------ W Design Flow.............55-____.-.-----________--_gallons per person per day. Total daily flow_.__-__33�_............................gallons. WSeptic Tank—Liquid capacitylD.0.0-•gallons Length.82.6".__._ Width----- ' O'biameter________________ Depth.5__'_8 -_ Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area _-.........sq. ft. Seepage Pit No.____1............. Diameter.......6.......... Depth below inlet......6....._._.._ Total leaching area.2bb..__....sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Res Its Performed b Eldredge Engineering Date_11--2 81 a a Test Pit No. 1__ _2_..0-_-_minutes per inch Depth of Test Pit_1 z�_____ Depth to ground waternone encounter- 4 Test Pit No. 2..... ...minutes per inch Depth of Test Pit.N..A.......... Depth to ground water...N_A_........... e 9 -------------=--- --------------•------------------------------......----------•-••••-•--------......................................................... 0 Description of Soil.......0-'--2..._...-----•.LQaIl1---&__Topsoil............................................................................................... v 2•,-1C-r Medium_•Yellow Sand ..............................------ _0_'_-12- ---------N�ed_�._..WYI�_ e---Sand%trace.s...of_-Gravel, no_-water... at_.12.' 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'T':'j• 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 h h. Signe � D e ApplicationAppro4By --•-- --•--••------------------------•--------••-----------------.....---_. _...t Z. !._. �---....... Date Application Disappe following reasons------------------------------------------------------------------------------------------------•-----•••------- ...._...----•--•••--------•••-•-------•-----.--•-••-••--•------------•-•------••--r-------------•--------•------••---...Da......---•------ te Permit No......................................................... Issued------••------ Date �r No.� :: .... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .--- n1>r...."...................O F........: ApplirFatiuu for Diupuiial Works Tonjarurfivat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...:��,:---� ................. .........?=•n i.x.;... ,.. ----•-•----.......-•---•---•---• ..... ...... Location-Address or Lot No. ......................r,ienrn :nal-fir ,,rust 7 a5 r'a.7-Mnjjth .Rnarl _ vannii� --•--....... .................••---------•--••--------•----..........-••••.........._.... .-••-.................... .. .- -- ••. ........ _ Owner Address W .s•4w�? L �il�l Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _ ............ No. of persons............................ Showers ( 2) — Cafeteria ( ) 04 Other fixtures --------------- ----••------••. . Design Flow.............5.5.........................gallons per person per day. Total daily flow.......3.3.0.............................gallons. Septic Tank—Liquid capacitA-0.00..gallons Lengtha.'..6....... Width__- "Diameter................ Depth-5......... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.... .............. Diameter.._.._6_`_.....--- Depth below inlet.................. Total leaching area2.6C1.........sq. ft. Z Other Distribution box ( ) Dosing-tank ( ) '-' Percolation Test Results Performed by...... .1drac, .0 �i21.3.4C1s-i1T'_ Date_1.1- 2.5-81--------------- a Test Pit No. 1`�.2...0.....minutes per inch Depth of Test Pit 12 ' . Depth to ground watemnne...emcounter- GL, Test Pit No. 2...VA----minutes per inch Depth of Test PitUA.......... Depth to ground water..n/A............. ed --••------------------------------------------------- ..._................................................------•--•--............._..._.._...-•--.-•--- O Description of Soil......02 =2.............I '?1..& T42tp o zl v . 1-0 ------...Med um..Yellom.-Sand----------------------------•--•----------•---------••----------•--- ...-- -----•-- W -----------------------------------1.0.'-12.1 •-••-----=A. 11,1te....Sand/traraes-_ of rra���-,���?...w t_er._at..1-22 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 ITT..:., p 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---.. r+ ..... ! L.eC'�- ` ...- - -��--'cf/e- 1 Date T---- ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:............................................................................................................... -•...................•-----------•----------•-------------------•---•-----•---•-•••----•------------•--•---------...-••-...•--••-••----•-----•-------------•-•-----•---••-----•---------•-----•--•...... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................O F..................................................................................... Tn tifiratr of Toutplitattrr THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by............ .a:4/G_ C-_.[3C1 ............... ---------- `f--•••-•----- .-----•-----•---•.....-••------••-....---•-••--.............---•••......--------•------ Y,f Installer has been installed in accordance I with the provisions of TI 15 f T e State Sanitary Codi aside , ibef3 in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4 DATE ............ __ _...... Inspector.........,,. ------t=./ �--------------------------------•--•----........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....... f 7 7 FEE...... %posFal Vorkg Tuuu#rurtiuu rrutit Permission is hereby granted --------•-----.7.......------------------------------------------------------------------------------------------------------- to Construct ( ) or Repair ( )'an Individual.%Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No.....................-Dated.......................................... ! Q.. Boaffof Health DATE..--•--•. ........ ..................................... ri'r FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS < t i v i tA b / Av pc jr if, LOT l+8 � �j a' .r . ,� i k mgNLIEL 14 i ! t NIONrE1RO Lor '417 /k SF L Lor ALBmo Own�ERS cb .o ,pNo.10951ex �0(Q.� OF hf1 LEGEND �� �" ;"s CERTIFIED` PLOT PLAN EXISTING SPOT ELEVATION Ono o JOHN EXISTING CONTOUR --- 0 a r FINISHED SPOT ELEVATION . h LOT- 47 WAYLAi11) ROA11i 4YANn415 FINISHED CONTOUR 0-........_ o,ST i N r APPROVED $, BOARD OF "EA. H rho sum SCALE., / - 30 DATE:No- DATE AGENT • L.DREDGE ENGINEERING CQ INC) GLINT ''�'"�`' I CERTIFY THAT THE PROPOSED EGISTERE REGISTE-RED JOG alp, �' BUILDING SHOWN ON THIS PLAN CIVIL CONFORMS TO THE ZONING LAWS ENGINEER U V QRox'n 'OF ,BARN�iTAB E, ASS. ?I2 MAIN�ST. CN.'RY� HYANNIS, MASS. $HT ,; pF.'Z, DATE . LAND SURVEYOR /F, 'E/TNeR 7'NES'EPTIC TANk OR a LE/fC•�l/rYG >/T ARE MORE THAN /2"J'FLD i r GRADE,f� 24'O/AME7 GaNCRET� COi�E,. (. /D MIN S1,lALt eE BEOUG/HT To GgAGE.�.4N EXTRA 4 PVC PlPz -- CONCRCTE . + �EAYy C/�ST IA-ON COVER .Sfd.4LL !3E USED M/N. P/TGN /F/N DRI✓EyVA Y` Flo o CO-VERB /B'PF,P FT _ 21 MiM. COIVCRE TE co I�ER CLEA/V .SA/V!O BA Ch'F/Z L � - - - 1/�,t!®D LEVEL - - �M�- t=_ .• �1�TT—� ' 2LAYER 1 j/BM 4 - 4 4F /B / DN Pisan'.. u®0O `Gott:_ ° o �/TC DlST. • • • • a ° • •• • > 04 ryAS/fE0 S73JNE %4'PER r'T SLEPT/C . TANfC • ,• • BOX a • • ei • • • � .•° • Q o r R • °. a y y: .• o • • •EFFECT/VC • • r • • DL•PTN • • ' ° 0 wA.SHED .STONE i I O • I • • a ••• ( I p a sp n_-- 6 • ' PRE A5:T SEEPAGE" r • Oi • / • • • • • • 1 b °�p e. _ - s o r • • • s • • • • " e o .0/7 OR EQUt V. i lAlV 4wM7 G►LEVAT/OWS D. EL .:1. a -i g, •P. D. 6/T D/AM.. ./NVERT AT QU/LD/NG• �� FT SEE 7)WVLAT/O/V • /WAFT '.SEPT/C'_a. �< ! .` 7'' (� —LQ F . OIA.M. C F�tT'Gf��PkG tTl� S49`6•P. D. Ot!?LET`SEPT/C GROUND W,47EA TAQLE /WAFT D/ST/R!c"?''ON BOX-- F7. ..SECT/ON O F" ` OtlTLETD/STR/z!< ^/ON BOX 86 `L FT. SEWAGE O/SP4SA L SY.STEA? INLET LEACNlNG PIT $�,d F7::' , "r/I evtAT/ON LEACH/!VG =/T DIMENSION A 3 FT.. SCALE DES/Gl+l' CRITERIA N/JMBER OF BEDROOMS 3 D/MEWS/ON C_ _FT. M I f J CaARQAGED/SPOSIIL UNIT O SOIL LOG SO/L TEST I TQTAL'ESTtMATEG FLOW 330 GAL./DAY SOIL_TEST #/ - SO/L TEST#2 XUM8ER QF L.-Acm e. P/TS l LEY, QATE OF SOlL TEST ( I lLS I S/OE LCAGH/NG PER P/T i g� Sqj 'PT. LAM RESULTS PV1 r VESSED 9oTTOhI L61CItl1VCr PER P/T 2 SQ. PT. 0-11 &TOPSO+!- PERCOLAT/ON /IRTE, TOTAL LEACHING AREA Ulo(o SQ. FT. _ F 11'COLAT/ON RATE 2 O� !"11N.�lNGH I RESERI/E GEACNJN6 ARfA ��� SQ.. FT. -EacEs or G0/wF-L MED OF �NOFl1 � i s �Y. - ti-11` SA' J� LC)T 4-i - wA-�La�.rt� o MORN yGN A�!w 1 S 1 BMW t ' T2aces of 40AjCL- t�i, U MO SE' . - - No:.iassi�o = ✓ ELO RED GE ENGINEERING Co,JNC- t•'@/ ���i�Q 712 MAIN ST. 4�0 HY SUR� NO GROUN(7 yy�4TER ENCOUNTERED ,gNN/3, MASS. . CT GMOUNO yvATER AT ELF(/ Foa NO. Bl'(p5 SHEET�-OF '1- P IKE'O+�ti Town of Barnstable public He?ith Division 20.0 NI—A-il Street 5§ Hyannis, NM 02601 � Amw Z' l s PITNEv BOYVES 7005 1160 0000 0191 2755 _ 02 1A $ 04.640 0004606238 JAN16 2007 1u. ) ;: �y MAILED FROM ZIP CODE 02601 t t ° ii Ms Carolyn Pihl Todd IS ! i� O MOVED;LEFT NO ADDRESS f � PITNEY BOW/�ES f UONABLE TO FORWARD BLE AS ADDRESSED 02 1 A $ 00.000 ATTEMPTED-NOT KNOWN 0004606238 JAN 1 7 2007 UNCLAIMED ❑REFUSED MAILED FROM ZIPCODE 02601 NO SUCH STREET eeMOVAUE ❑NO SUCH NUMBER . ❑'INSUFFICIENT ADDRESS SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature ❑Agent item 4 if Restricted Delivery is desired. X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ! N Attach this card to the back of the mailpiece; ! or on the front if space permits. D. Is delivery address different from item 1? ❑Yes ! ! 1. Article Addressed to: If YES,enter delivery address below: ❑ No i i Ms Carolyn Pihl Todd ! I 118 Wayland Road Hyannis, MA 02601 3. Service Type i ❑Certified Mail ❑ Express Mail ! ❑ Registered ❑ Return Receipt for Merchandise i ! ❑ Insured Mail ❑ C.O.D. J-a) t= ►# 4. Restricted Delivery?(Extra Fee) ❑Yes t j 2. Article Number 7005 1160 0000 0191 2755 f (Transfer from service label) '•. ;i i { PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 Town of Barnstable do Regulatory Services snxxsrnBLe; Thomas F. Geiler,Director 6 •� Public Health Division RFD MA'S A Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 16 2007 Ms Carolyn Pihl Todd 118 Wayland Road Hyannis,MA 02601 ORDER TO.COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 118 Wayland Road,Hyannis,MA was last inspected December 131h 2006 by Brian K.Tilton, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"fails"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in hydraulic failure You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH EPARTMENT Thomas cKean, R.S., C.H.O. Agent of the Board of Health i$.; ;. F: 1 "ap HYANNIS. MA ZO RSON CONTOURS " " TE JE3ROAD CONVE ROU ~ DISTANCES CHARTI EXISTING - - - - - - - 50 d INCHES 7;0 MINIMAL GRADING PROPOSED w�O DECIMAL FEET —// / 0 TO LEACHING GALLERY 1n f (/ o m w ALL DISTANCES ARE IN DECIMAL J m FEET NOT IN FEET AND INCHES. 0 �� �� Noo� � 2 .1 /. /\77 < "' 1 P3.0 59.5 38. 4 .33 C 5 41 2 54.1 41.E 43.6 � LOCUS .50 w 3 63.3 52.1 54.9 6 .53 o-J� 8 .67 LOCI I 4P u�- w<3 1 9 .75 ♦ U S M / \ maw m cooz la .9� A� NOT TO SCALE z 11 m z .. �cn0 GAS ���� _ m w ow° B 12 1.11 /� �� GATE �'S z w~ �cnc� 2 0 / P ono CD w A J�C'� �\ WATER LEGEND uj d o F-� _J z 3 w 3 �� / �� GA TE \ EXISTING Ul �--� � 11 w J 5 / JI❑ / W= �Uzm <W w z � A // �� \� 1000 GALLON W <�<_ W 3 U _j > `` 1 j� � /5 �'�� SEPTIC TANK DLO ffff < J � N P� p x / D-BOX ❑ Q m� ❑ W w w ~ GARBAGE GRINDER 46 / �,� j TEST PIT W o _j 0 v w IS NOT ALLOWED a �� WITH THIS DESIGN. / EXISTING e w m P`� �� v�P/ LEACH PIT • z UX m / �P� �� / UTILITY ROLE m N 46 \/Q_� o o v �,N �� 0 > ��� / TREE pj _ _ / {�� Q \` -NUMBER REFERS TO N w L p-0 / \ (� < O / DIAMETER IN INCHES. \/ LETTER DENOTES TYPE. 18-P zp U __W O\ / 30 \ �� Q`/ / O-OAK M-MAPLE P-PINE WZ Z �i / 12-0 �\ /� O A" ll e p X O J Z W / TP-2 // J~ Z U O m 48�11/ 12-0 /� \ �XO� / OF w� ' \ 0) CN MqS ZN of z 4- �'' ass W Paz c,, � 24ftx125ftx2ft o a w w a Ef�CHING GALLERY o i oho= DADVID tiGNN U�o� DADVID yG� J o f + rmi c I COUGHANOWR COUGHANOWR �' W rco r Ln Z 1 / No. 1093 / o w *12-0 I U o m L "' SB TP-1 FG� r sO���CENS �.SL' \ A AL i � SyFO � �� i IF e rvo y 2-0 0 7 �--� z z J � p �__ \ / �0 e TEO SEWAGE DISPOSAL SYSTEM PLAN L z J LOT 4 j TO SERVE EXISTING DWELLING 0 Q u_ '—' -� ~ ��- �/ o ° "m j < U 50 _y-�_ �`�ARE� = 1811� sf +- EST. CAROL_YN P. TODD O � II, � X � � 48 ______ � 48 OWNER OF RECORD i LtJ ED W 14 0� __ / �� 1995 118 WAYLAND ROAD _ HYANNIS. MA CI) FLAN ��___ ��Q� PROPERTY ADDRESS ASSESSORS MAP 271 PARCEL 202 0 of �� 43 TRIANGLE CIRCLE SANDWICH MA 02563 LAND COURT PLAN 3 6 5 B B-D SCALE: 1 �„ = 20 FL BENCH MARK 506 364-0694 N Q ? W DATE. FEBRUARY 1. 2007 J o W W W W 20 a 20 40 TOf? OF BULKHEAD CORNER X _)OE? #ETE-2537 PAGE 1 OF 2 VERSION: A L� ELE=VATION = 48.90 THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED 0 18 20 BAfRNSTABLE GIS DATUM SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG Ja (491� _ DESIGN CALCULATIONS DATE OF TEST: FEBRUARY L 2007 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) PAARENOTUMAATER AL EPROGLACA LD OUTWASH DISTRIBUTION BOX: USE 3 OUTLET D-BOX. TEST PIT I 2 MIN/INCH IN C SOILS SOIL ABSORBTION SYSTEM: A 24 Ft. x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH A6ot = ( 24 x 12.5 ) = 300 sf ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf Atot = 446 sf 47.75 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Vt. 0.74 x 446 = 330.04 GPD USE A 24 ft, x 12.5 ft x 2 ft. GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 0-6 Ap LOAMY SAND 10 YR 3/6 NONE FRIABLE 6-26 B LOAMY SAND 7.5 YR 4/6 NONE FRIABLE 45.42 LEACHING GALLERY NO T TO SCALE 28-120 C MEDIUM SAND 10 YR 5/6 NONE LOOSE 37.75 1 1 1 1 1 1 USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-10 LOADING) CONSTRUCTION DETAIL 500 GALLON DRYWELL TEST PIT 2 POARENOTUMAATERIAGRNDWATE EPROGLACNCOUNTEALD OUTWASH DIMENSIONS AND DETAIL 2 MIN/INCH IN C SOILS DRYWELL UNIT STON USE H-10 UNIT INSTALL ONE INSPECTION RISER TO WITHIN SIX 24..0 Ft 7 INCHES OF FINAL GRADE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER AND INDICATE LOCATION (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING m� ON As-eulLr PLAN 46.60 -0 m w � 0-5 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE N m p 33 v N 5-38 B LOAMY SAND 10 YR 4/6 NONE FRIABLE m 0000000000o OOOp� 1n 43.33 s.5 ft 8.5 F'_ 8.5 FL .5 ft �0000000000 000 38-130 C MEDIUM SAND 10 YR 5/6 NONE LOOSE a0000 0 i� i 1 � 35.77 24.0 f t Gj8 02 1 n CROSS SECTION VIEW 2 g314 PEASTONE 2 in PEASTONE 28 24 1n I O T C 1n TO EFFECTIVE 2 i to TO n I yIJ 1n GRAVEL DEPTH 1-1/2 to GRAVEL 1n INSTALLER MAY ELECT 1) GARBAGE GRINDER NOT ALLOWED WITH_ THIS DESIGN. TO SUBSTITUTE AN 46 in 58 in 46 In APPROVED GEOTEXTILE 2) SEPTIC TANK TO- BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FABRIC IN PLACE OF FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. LAYER1SPECIFIED.NE 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 150 to OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. ANDFILLED OR REMOVED. GROUNDWATER ADJUSTMENT a 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON, FINES AND DUST IN PLACE. EXISTING GROUNDWATER LEVEL Z) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN. BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. SEWAGE DISPOSAL SYSTEM PLAN 6) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES INDICATED GW 2e.00 -TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. INDEX WELL A1W-230 91 SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT ZONE D CAROL_YN P. TODD PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. READING DATE DEC, 2007 11B WAYLAND ROAD HYANNIS, MA READING 23.6 10l,INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. ADJUSTMENT 4.1 EEO-TECH ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ADJUSTED GW 32.1 STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-25371 FEBRUARY 1, 2007 1 2/2