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HomeMy WebLinkAbout0855 WEST MAIN STREET UNIT CAPT SCUDDER UNIT 1 - HYANNIS CONDOS �. • 855-WEST MAIN STREET-Fisherman's. Hyannis Village I - Commonwealth of Massachusetts ?'T/,os/' 006 ,p Title 5 Official Inspection Form tiI; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f � 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner, Owner's Name/ information is required for every H annis ✓ MA 02601 7/1/2020' y page. City/Town State Zip Code Date of Inspection k Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road VQ Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails /2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ': Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 20 bedroom condo has an H-20 3500 gallon septic tank with an H-20 D-Box feeding a 38 x 79.5 leaching field. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional.Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. I *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N FIND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in imanner which will protect public health, safety and the environment: t5insp'doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 7 Commonwealth of Massachusetts Title 5 Official Inspection Form +_ �I Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments >r; � 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is Hyannis MA 02601 7/1/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] � ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. r 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: Yes No ® ❑ 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)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 pages• City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 20 Number of bedrooms (actual): 20 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 2235.5 GPD Description: Number of current residents: Apx. 32 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): town water Detail: In 2019-55,600 cubic feet were used and in 2018-61,500 cubic feet were used Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is recjuired for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) r Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No - If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is H required for every y annis MA 02601 7/1/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2002 New D-Box and leaching Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 4'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flowing at the time of the inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owners Name information is required for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-20 3500 gallon Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 42" ' Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. l t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments « � 855 West Main Street System 1 (Units 1-12) V� Property Address Fishermans Village Owner Owner's Name information is requited for every Hyannis MA 02601 7/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): '. Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 ,i Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page.: City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insd.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is requirtsd for every Hyannis MA 02601 7/1/2020 - page.- Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: One-38X79.5 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp:doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp•doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,V 855 West Main Street System 1 (Units 1-12) Property Address F_ishermans Village Owner' Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 14: Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ° $ c n 2- r 5 G .0 / lU s r. r _ r • t5insp.d6c-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feetfeet 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: I augered a hole to 12'to show four plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5inSp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 e Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 855 West Main Street System 1 (Units 1-12) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 7/1/2020 page.. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included f5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts 0?#/_ 0 31 006 — �� ,p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 855 West Main Street System 2 (Units 13-22) Property Address t Fishermans Village Owner Owner's Na mq information is Hyannis V MA 02601 07/01/2020 ! required for 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. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co � Company Address Teaticket Ma. 02536 City/Town State Zip Code � 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails � 20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) V� Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 12 bedroom condo has an H-20 2000 gallon septic tank with a D-Box feeding 3 leaching pits. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c� 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: .4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) u� Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ u 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 12 Number of bedrooms (actual): 12 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1320 plus GPD Description: Number of current residents: Apx 19 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d town water 9 ( Y 9 (gp ))� Detail: In 2019-55,600 cubic feet were used and in 2018-61,500 cubic feet were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 855 West Main Street S u Ystem 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth f Ma ssachusetts assachusetts �v Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 24" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flowing at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Ste, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u� 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-20 2000 gallon Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 42" Scum thickness 5" 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 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form r 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank tank must be pumped at time of inspection)9 g ( p p spect on) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lIII Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v� 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is Hyannis MA 02601 07/01/2020 requirey d for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �1�_ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form tiI; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner information is Owner's Name required for every Hyannis MA 02601 07/01/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately c M 1 I c E � At,6_= jq sa t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts �n Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 13 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole to 13 feet and found no ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 F€ Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 855 West Main Street System 2 (Units 13-22) Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 07/01/2020 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rM w 855 West Main St. Hyannis, MA "Fishermans Village' System 1 Property Address Fishermans Village nnr`t7 r,; Owner Owner's Name 4" information is required for every Hyannis MA 02601 8-24-16 - page. Cityfrown State Zip Code Date of Inspection 4,11,. Inspection results must be submitted on this form. Inspection forms may not be'altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: . key to move your cursor-do not Darrell Stone use the return key. Name of Inspector Cape Cod Septic Inspection ma Company Name P.O. Box 1466 Company Address Harwich MA 02645 Cityrrown State Zip Code 508-240-2500 S14995 Telephone Number License Number 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 16.000).'The system: ® Passe ❑ Conditionally Passes ❑ Fails ❑ Nee rt er Evaluation the Local A g Authority , 8-27-16 Inspector's Signature Date - The system inspector shall submit a copy of-this inspection report to the Approving'Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 I at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 _ , - t „ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 _ IIC Commonwealth of Massachusetts z :. Title 5 Official Inspection Form,,. Y Y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ""855 West Main St.Hyannis, MA "Fishermans Village" System 1 f Property Address __. Fishermans Village Owner ,,"..Owners s Name information is yH Hyannis MA 02601 8-24-16' ' required for every ,; y page. ,�,.{.Cityrrown State Zip Code Date of Inspection -41 11�,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: •' 4 B) System Conditionally Passes: ❑ •One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. • , ' '" - Check the box for"yes", "no"or"not determined" (Y,N, ND)for the following statements.if"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. F�,,Y 0 N : -ND(Explain below):, - t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 855 West Main St. Hyannis MA "Fishermans Village" ; System 1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis - MA 02601 8-24-16 page. Cityrrown State Zip Code Date of Inspection, B. Certification (cont.) ❑ Pump Chamber,pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑' broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation.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. •- 11. System will pass unless Board of Health determines in accordance with 310 CMR I6.303(1)(b)that the system is not functioning in'a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ ' Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 y ` Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 855 West Main.St.:Hyannis, MA "Fishermans Village" System 1 Property Address P Y Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 8-24-16 page. Cityrrown: - State Zip Code Date of Inspection B. Certification (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. ❑ Tlie system has'a septic,tank and SAS''and the SAS is within a Zone A of a public water supply. ❑,The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. - ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well . Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or'No"to each of the following for all inspections: Yes ,No Backup 1 f sewaga into facility or system component due to overloaded or ®: clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box,above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool isrless than 6" below invert or available volume is less ❑ ® ' than V2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection ForM Subsurface Sewage,Disposal System Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA • "Fishermans Village" System 1 Property Address t Fishermans Village Owner Owner's Name information is required for every Hyannis - MA 02601 8-24-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,jcesspool 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 cesspoo.jr 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. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should.contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 'r ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection: Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 _ , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Systern Forr6'Not for Voluntary Assessments 855 West Main St Hyannis, MA Tishermans Village" System 1 Property Address Fishermans Village + " Owner Owner's Name information is required for every Hyannis '" MA 02601 8-24-16 page. Cityfrown 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' I $ ® ❑ = 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 compdnents, 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. '® 0 Determined in the field (if any of the failure criteria'related-to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: '= '2p 20 Number.'of bedrooms (design): _ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2200 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r c Commonwealth of Massachusetts AWNTitle 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA "Fishermans Village" System 1 Property Address Fishermans Village Owner Owner's Name information is Hyannis MA 02601 8-24-16 required for every H y - page. Cityrrown State Zip Code Date of Inspection D. System Information Description_ Residential condos _. Number of current residents:Does residence residence have a garbage grinder? ,. ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ,❑ Yes ® No information in this report.) Laundry system inspected? - ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)):. ., t. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: ti r Design flow(based on 310 CMR 15.203): �, Gallons per day(gpd) Basis of design flow-(seats/persons/sq.ft.,etc.): .' Grease trap present?, 1 ❑ Yes ❑ No- Industrial waste holding tank present?, �. ,, ❑ Yes ❑ No, ' Non-sanitary waste discharged to the Title 5 system? ...: f . ❑ Yes ❑ No ' Water meter readings, if available: t5ins;3/13 ',* _ Title 5 official Intpection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 855 West Main St Hyannis, MA "Fishermans Village" System 1 ' Property Address Fishermans Village +` Owner Owner's Name information is Hyannis MA 02601 8-24-16 required for every . y page., - City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date . Other(describe below): Generallnformation r Pumping Records: , Source of information: 2012 and 2013 Discount Septic Pumping (508)240-2500 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ` ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach•previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract-. ❑ Tight tank.Attach a copy of the DEP'approval: ... ❑ y Other(describe): t5ins-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page t3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St Hyannis MA "Fishermans Village" System 1 Property Address Fishermans Village Owner Owner's Name information is Hyannis MA 02601 8-24-16 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source,of information: 1973 Both tanks 2007 D-box and SAS per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Tank#1 41" Tank#2 43" Depth below grade: feet + Material of construction: ® cast iron ®40 PVC f ❑ other(explain): ' Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t Both tanks have two inlets each having one cast iron and one SCH 40 All inlets in good condition Septic Tank(locate on site plan): 31" 33" 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 2-3,000 gallon tanks Dimensions: 5 17" 13" ' Sludge depth: Page 9 of 17 t5ins•3113 t Title 5 Official inspection Form:Subsurface Sewage Disposal System• Commonwealth of Massachusetts ' Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St Hyannis, MA i' w "'Fishermans Village" - .System 1 Property Address Fishermans Village Owner Owner's Name information is H annls �'` MA 02601 8-24-16 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(Cont.) " - • - ..-. Distance from top of sludge to bottom of outlet tee or baffle 45„ 49" 4" 4" 'Scum thickness S. 5" Distance from top of scum to top of outlet tee or baffle 1611 16" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Sludge Judge 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#1 Both covers to grade under walkway Normal liquid level No sign of leakage SCH 40 outlet tee Recommended next maintenance pumping.within 1 year Recommended maintenance pumping every 2-3 years Tank#2 Grade to inlet cover 6" Outlet to grade Normal liquid level No sign of leakage_ SCH 40 outlet tee Recommended next maintenance pumping within 1 year Recommended maintenance pumping every 2-3 years Grease Trap(locate on site plan): Depth below grade: feet Material of construction: " ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance-from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 t • Commonwealth of Massachusetts Title 5 Official Ins t ri Form p ec io o m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments H 855 West Main St. Hyannis, MA "Fishermans-Village" System 1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 8-24-16 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass T❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow:, gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Officialinspection 'Form .e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments sye;. 855 West Main St. Hyannis, MA "Fishermans Village" System 1 Property Address Fishermans Village Owner Owner's Name information for every is required for Hyannis - MA 02601 8-24-16 page., Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if pre'sent must be opened)(locate on site plan): Depth of liquid level above outlet invert Oil Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-20 D-135 Grade to box 54" Cover to grade Good condition 4 Outlets with speed levelers Normal liquid level No sign of leakage Scum removed No sign of failure 0. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 855 West Main St. Hyannis, MA • ti "Fishermans Village" System.1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 8-24-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 44 ❑ 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.): 44 Infiltrators, in 4 rows of 11 Inspection port to grade in driveway Dry No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 117 Commonwealth of Massachusetts Title 5 Official Inspection VForm • _ Subsurface Sewage Disposal Su ag sposa System Form-Not for Voluntary Assessments 'r 855 West Main St. Hyannis, MA ""Fishermans Village" System 1 ' Property Address Fishermans Village Owner Owner's Name information is Hyannis MA 02601 .8-24-16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site,plan): , Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 4 ` t5ins•3113 Title 5 Wdal Inspection Form.Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-,Not;for Voluntary Assessments w 855 West Main St. Hyannis, MA "Fishermans Village" System 1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 8-24-16 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within"100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately f_ A B C D t t1-0 8- Z ZO_a 7- -( 3 - - a -o 52-0 if• QG 6. r tj _Y x/ i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Forni Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 0 855 West Main St.Hyannis, MA "F&ermans Village" System'1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA, 02601 8-24-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: w _ ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells > 5 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2007 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Plan on file ❑ Checked with local excavators, installers-(attach.documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Elevations from design plan Bottom of SAS ELV. 49.0 Bottom of Test hole ELV. 44.0 NWE Separation >5 Before filing this Inspection Report,please.see Report Completeness Checklist on next page. 15ins 3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of W '�. Commonwealth of Massachusetts Title 5 Official Inspection Form '= Subsurface Sewage Disposal System Form-N 9 P Y of for Voluntary Assessments 855 West Main St. Hyannis, MA "Fishermans Village" System 1 Property Address Fishermans Village Owner Owner's Name information is required for every Hyannis MA 02601 8-24-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file • f t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION C FAILED INSPECTIC? �.k I�rE® t is C`, f,L W� V 2 12004 y . �.,-ED INSPECT J i r":VN,-?F BARNSTABLE HEAt_TH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION R M NV41 S J °L LA4E Property Address: 4C3K 0, Ma,A 1;I•- .�(�9 Owner's Name: oc ra,--tF SOGt�+vr r�pRCE4 3�fig' Owner's Address: f 6146 .� Q ox `� � , 0 `llfm0A, tYla oOL13 1 OT / Date of Inspection: k. =' Name of Inspector: (please print) C1 e Sy aQ *-- Company Name: 1140e n+Pc-Oti$eS LI.G •e Mailing Address: p 6v :1 _ : Cn Telephone Number; �Z — yleir a.y, Alf co CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1$.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes eeds Further Evaluation by the Local Approving.Authority Fails Inspector's Signature: Date:_ Date: ,ou 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. Notes and Comments ****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. l ;;�,_. T;rte 5 Tnsnertion Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION(continued) Property Address: 6� in1- Owner: 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 described in the"Conditi al Pass"section need to be replaced or repaired.The system,upon completion of t e replacement or repair as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in a for th following statements. If"not determined"please explain. The septic tank is metal and over 20 years old or a septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank proved by the Board of Health. *A metal septic tank will pass inspection if it is struc Il 'sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is a ailable. ND explain: Observation of sewage backup or br out or high static w ter level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settle or uneven distribution I x. System will pass inspection if(with, approval of Board of Health): br en pipe(s)areseplaoed. . struction is removed distributioII 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 Q obstruction is removed ND explain: i Page 3 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS i( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(czwtinued) Property Address: Owner• Date of Inspection:+ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine 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 10 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 wed d or a salt marsh 2. System will fail unless the Board of ealth (and Public Wa er Supplier,if any)determines that the system is functioning in a manner that pr ects the public he th,safety and environment: _ The system has a septic tank and soil a orption cyst (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface ter suppl . The system has a septic tank and SAS and the is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the AS . within 50 feet of a private water supply well. _ The system has a septic tank and SAS and t e SAS is less thap 100 feet but 50 feet or more from a private water supply well".Method used to de ermine distance "This system passes if the well water analy s,performed at a DEP certified laboratory, for coliform bacteria and volatile.organic compounds in tcates that the well is free from pollution from that facility and the presence of ammonia nitrogen and ni to 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: Page 4 of l l OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM PART-A. . CERTIFICATION(continued) Property Address: T Owner: Date of Inspection: O� a D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: iYes 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''/z day flow _ equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ ny 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. _ y 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 cvliform bacteria and volatile organic.componnds 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 S.ppm, provided that no other:.failure criteria are triggered.A copy of the analysis must be attached to this form.] . (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. r ..t 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 _ � system is within 400 feet of a surface drinkingwater supply PP Y Ythe ystem is within 200 feet of a tributary to a surface drinking water supply ystem 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. ' Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ` SQL nx)' g— CL Owner- Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Ye No umping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? as 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 o the affles 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: Ye no Existing information.For-example,a-plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] M 1 . Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMEN TS , SUBSURFACE SEWAGEbISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: A 1DO FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 11'�& Number of current residents:. Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):_no[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):-YID Last date of occupancy: �L),Cr rt• COMMERCIAL/INDUSTRIAL Type of establishment: . Design flow(based on 310 C 15.203): ___gpd Basis of design flow(seats/per ns/sgft,etc.): Grease trap present es or n Industrial waste holdpresent(yes or no):_ Non-sanitary waste di to the Title 5 system(yes or no):_ Water meter readings,if vailab Last date of occupanc use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: VP OF SYSTEM tic 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: 1 q ? 3 O r i G;'ne-4 1 n 1�t`�2r� 1© �• Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: La. in WX Owner: "2�!ft Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron A 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: 'ryGfCC4-4& Material of construction: oncrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: a!�00 �E`p RS Sludge depth: _ Distance from top of sludge to bottom of outlet tee or baffle: h C4— Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: )cz Distance from bottom of scum to bottom of outlet tee or baffle:j" How were dimensions determined: 1'n(2 Comments(on pumping recommenda ions,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage, etc.): I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S Owner:fa.JtRsc , Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_ 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.): n PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): ' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner• Date of Inspection: q IC41C) + SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,nunler 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.): l0 0 ' 160 11. — &xL } 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 or 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.): Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: rfot Owner: Date of Inspection: !R I c'111 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. ov�ot Un�� v :Vc:x �M 1 i. Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner:60JAtL4 ' Date of Inspection: JaJW SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�']_feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Ahecked with local excavators,installers-(attach documentation) ccessed USGS database-explain: You must describe how you established the high ground water elevation: U Se CA. MC.D5 L tuch i(14 n L CA e,(% 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form-Not for Voluntary Assessments M �' 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name ' I ? information is H annis V 0 I� �J ' ?j �j MA 02601 required for every Y 8-6-14 ' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Darrell Stone u I use the return key. Name of Inspector Cape Cod Septic Inspection as Company Name P.O. Box 1466 Company Address Harwich MA 02645 Cityrrown 508-240-2500 S ate te Sta Zip Code 4995 Telephone Number License Number 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: � Y 4 ® P sse Q, Conditionally Passes is s urther Evaluation b Loc Approv' uthority 8-7-14 ec Signatur Date The system inspecto 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. l5ins'•3/13 - Title 5 Official Inspection FW..rf.. wage Disposal System•Page 1 of 17 t _ .. r r t Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 855 West Main St. Hyannis, MA System#2 a x Property Address Fishermans Village Condo Association'. Owner Owner's Name information is Hyannis , required for every H Y MA 02601 8-6-14 page. Cltyrrown State Zip Code Date of Inspection B. Certification,(cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D Aj System Passes: W R ® 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20'years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑. Y ❑ N ❑ ND(Explain below): c t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 • Commonwealth of Massachusetts 991A_E�T Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA System#2 Property Address Owner Fishermans Village Condo Association information is Owner's Name required for every Hyannis MA 02601 page. CltylTown 8$-14 State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed. ❑ Y ❑ N ❑ ND(Explain below): J. 1 1. C) Further Evaluation is Required by the Board of Health: " El 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. I. 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 t ins•3/13 F Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 8-6-14 page. City/Town State Zip Code Date of Inspection B. Certification (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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Ll- 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 ❑ s ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 + t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•''¢ 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association + Owner information is Owner's Name required for every Hyannis MA 02601 8-6-14 page. Cltylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. • ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 16,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply. ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection +Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Me 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . M 855 West Main S . Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 8-6-14 page. Cltylrown 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_ " ® E1 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? ® E, . Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage.disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Na Number of bedrooms(actual): 16 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1760 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 A , 1 Commonwealth of Massachusetts IFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St. H annis MA System#2 Property Address _ Fishermans Villa a Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 8-6-14 State Zip Code Date of Inspection D. System Information Description: Residential condo buildin with 16 bedrooms Number of current residents: 5+ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? s ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 1241.88 Detail This water usage is for the whole complex 2013-412,896 gallons 2012-493,680 gallons 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): v Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ` ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I " Commonwealth of Massachusetts Title -5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St. Hyannis;MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 8-6-14 State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Da te Other(describe below): General Information ' Pumping Records: . ' Source of information: 11/2009 Discount Septic Pumping Was system pumped as part of the inspection? El Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ®_ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool . Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 —r Commonwealth of Massachusetts .UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association _ Owner Owner's Name information is required for every Hyannis MA 02601 page. CltylTown 8$-14 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Pre 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site.plan): Depth below grade: ,. , . - 4311 feet Material of construction: 3 ® 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.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: 37 feet Material of construction: " ®concrete ❑ metal ❑fiberglass ❑ polyethylene ' El 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: 3000 gallon Sludge depth: 22" t5ins•3/13 Tige 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form' -Not for Voluntary Assessments 855 West Main i,r -St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is - required for every Hyannis MA 02601 8-6-14 page. CttylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) • ' Distance from top of sludge to bottom of outlet tee or baffle 38 Scum thickness 1/2" . . 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 2411 How were dimensions determined? Sludge Jud e' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grade to inlet cover 7" Outlet 8" Normal liquid level No sign of leakage SCH 40 outlet tee Recommended next maintenance pumping within 1 year Recommended maintenance pumping every 2-3 years Grease Trap(locate on site plan).- Depth below grade: feet Material of construction.- ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness . Distance from top of scum'to to of outlet tee or ba ffle affle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 855 West Main S . Hyannis, MA System#2 Property Address F_ishermans Villa a Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 page. Cltylrown 8$-14 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.): f 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 El other(explain): Dimensions: Capacity: gallons Design Flow: , gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 4 Title 5 official Inspection Form m Subsurface Sewage Disposal System Form-Not for Voluntary Assessments III 855 West Main St. Hyannis, MA System#2 ' Property Address Fishermans Village Condo Association f Owner Owner's Name information is required for every Hyannis MA 02601 8-6-14 page. Cltyrrown State Zip Code Date of Inspection D. system Information y Cont. 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.): Grade to box 50" Cover 14" OK condition 3 Outlets with speed levelers Normal liquid level No sign of leakage No scum No sign of failure Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): I *If pumps or alarms are not in working order, system is a conditional pass. Soil.Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Disposal Sewage Dis 9 p System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 i page. City/Town 8$-14 State Zip Code Date of Inspection D. System Information (cont.) Type. ® leaching pits number: 3 ❑ 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.): 3 (6x6') pits with stone Grade to pit#1 49" Cover 2" Bottom 123" Ponding 5" Grade to pit#2 61" Cover to grade Bottom 137" Ponding 22" Grade to pit#3 61" Cover 2" Bottom 137" Ponding 24" No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal posal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System`Form-Not for Voluntary Assessments 855 West Main St. Hyannis, MA System#2 Property Address u Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 8-6-14 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure level of on i do condition p g, d tlon of vegetation, etc.): 9 , 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.): - :t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Tide 5 OffidalInspection .or J. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 855 West Main St. Hyannis, MA System#2 Property Address Owner Fishermans Village Condo Association information is Owners Name required for Hyannis MA 02601 every page. CttylTown 8-6-14 State Zip Code Date of Inspection -De system Inforr afA®n (cont.) _ _ Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separatel �1-J = t A B 6 2 3 3 3 - 30- o 5 - ® 7 (- o 6 z9-6 t5ins•3/13 _ Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts • Title 5 Official In spection Form Subsurface Sewage Disposal System Form-Not for Y Voluntary Assessments M 855 West Main St. Hyannis, MA S stem#2 Pr y Y operty Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis - MA 02601 8-6-14 page. City/Town State Zip Code Date of inspection D. System Information (Cont.) Site Exam: ❑ Check Slope _ a ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >4 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Previous inspection of file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Elevations from USGS database Approx. Property ELV. 60.0-56.0 Approx. Bottom of SAS#1 ELV.49.75-45.75 Approx. Bottom of SAS#2 ELV. 48.59-44.59 Approx. Bottom of SAS#3 ELV. 48.59-44.59 Approx. GW ELV. 36.0 Adjustment 4.1' MIW-29 Zone D 8.2' November 2010 Separation >4 } Before filing this Inspection Report, please see Report Completeness Checklist on next page. !Sins-3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 .� Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 855 West Main St. Hyannis, MA System#2 Property Address Fishermans Village Condo Association Owner Owner's Name information is required for every Hyannis MA 02601 8-6-14 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file + ,t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Cape Cod Septic Inspection Discount Septic Pumping t PO Bog 1466,Harwich,MA 02645 508-240-2500 To Whom It May Concern: On behalf of the property owner, and all parties involved, we are requesting the Health Department to review and process out of regular order the Title V Septic Inspection Report for: U G 7-S /3 ova Due to the upcoming real estate closing scheduled for: Your cooperation is greatly appreciated. Dank yo Sn >.._ COMMONWEALTH OF MASSACHUSETTS i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION - r b i LOB TITLE 5 i r r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:%9!5' 1J.f11rj,nS*r. QiOt0140. �vr11:p i S � ty1 Owner's Name: (fir &_ ftt Ae,soG,'QAt?.S Owner's Address: iA , Naacmen� Date of Inspection: C 10,14 b1A Name of Inspector: (please print) _c hcz n v_L)Lr`tcLj Company Name: R� tJ�L�� F ntGf`UrtS� Mailing Address: Telephone Number; 96,4K— 'A14 — 40-W 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/Passes Section 1$:340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Signature. Date: 0. Inspector's Si afore: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 4 , Title 5 Inspection Form 6/15/2000 page l Page 2 of 11 311 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMEi�1$I"S SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM � PART,A CERTIFICATION(continued) Property Address: 5 Q.Maun 51' 000r5 L3-2-9-, }1yo n n to �s�c Owner: 6�t��1 ci�- cS .►:•.4,� 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: Observation of sewage backup or break out-or liigh 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)areaxeplared, obstruction its rzcmoved 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: e Page 3 of 11 OFFICIAL INSPECTION FORM o NOT FORYOLUNTARY ASSESSMENTS �( SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: t„1,M-.;n 51 13kIg itk U of�5. 13"��-► Owner: r i-I�i-t Se-- c' 1�,jj e5 Date of Inspection: q 114l og 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 "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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DFSPOSAIYSY.STEKINSPECTION FORM PART.A . CERTIFICATION(continued) Property Address:_ riEoS } a. J n i t3 va � i'_ IfYIG� Owner: G p L Date of Inspection: 01 n u 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 __�k 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%day flow _-L Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 7l 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. I Any portion of a cesspool or privy is within a Zone 1 of a;public well. A Any portion of a cesspool or privy is within 50 feet of a private water supply well. A 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.-jThis system'passes if the well water..analysis, performed at a DEP certified laboratory;for co form 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.equalto,or less than 5ippm,provided that no other.failure criteria are triggered.A copy of the analysis must-be attached to this form.]. (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• r -t. 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 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 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ,fil�,�n 51- alo�a a- n►TS 13—°d 9, Owner: Date of Inspection:®tgaA 10Q 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) X _ 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: Yes no a Existing information.For example,a-plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)] r -Page 6 of 11 OFFICIAL.INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS i SUBSURFACE SEWAG&DISPOSAL SYSTEM INSPE CTION FORM PART C SYSTEM INFORMATION Property Address: g� W t' C j*n Rf1Lel- rn a Owner: ,.,^ ,;i mac, Date of Inspection:_ / �"N'�"©` -- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):J12, Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):�® Is laundry on a separate sewage system(yes or no): j [if yes separate inspection required) Laundry system inspected(yes or no):-00 Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)):11 Sump pump(yes or no):ao Last date of occupancy:-- — COMMERCIAL/INDITSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgtetc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 'Was system pumped as part of the inspection(yes or 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/Altemative 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: Were sewage odors detected when arriving at the site(yes or no):nD Page 7 of 11 _j OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM[ INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:.9(6,5 W,MCICA st (3lclg 0 n i rS 13 941- Owner: ter} f t I t fta,6 I t-e r. Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: " Materials of construction:_cast iron __A.40 PVC_other(explain): Distance from private water supply well or suction line: lh� Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 3(p"\ Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: A 9GtIto0S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3 2 Scum thickness:9_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: . fi u, How were dimensions determined: fll ectS JC`�1 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:®(locate on site plan) Depth below grade:s 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): x Page 8 of I I OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ?A TMa MCI Owner: Date of Inspection: Q 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 oth er(exp lain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOZO: (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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: T;_r,'_j, Lj, T)„b -';)r wo 4-.a. U r%i Vs ►3-'�.� tiyQ n ��—�q ci Owner: Date of Inspection: gjaI{ &py SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type (oA(,o leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): cuc, v 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:s Materials of construction: Indication of groundwater inflow(yes or 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.): n " Page 10 of 11 OFFICIAL INSPECTION FORM m NOT FOR VOLUNTARY ASSESSMENTSSUBSURFACE SEWAGE DISP®SAL SYSTEM INSPECTION FORM � PART C SYSTEM INFORMATION(continued) Property Address: Y'SK g.(Yln►`n St, .A)cl5 oofprS 13PA;k, 13 Owner: oGgc,��c 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. 33N 3 / �-Ilv i 3W� 5r G n�fi5 ncA au%'Wi,na14'a 2 4ry* . i i Page 11 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property-Address: es 5- L.2-may n 6i-�q w-a, 0 n i is )3 at el MCA Owner: G14} Date of Inspection: __ G {!u I O L) SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: ]1 i:SENDER:'CO M! PLETE THIS SECTION COMPI UTF ThJS SECTION ON DELIVERY, ■ Complete items 1,2,and 3.Also complete FSig a u � � item 4 if Restricted Delivery is desired. B'Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Re c ived by( tinted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from-it6—m i 1-11 Yes r�J 1. Article Addressed to: If YES,enter delivery addres e ,No i Fisherman's Condominium Board-of Trustee's C/o Paul Baron}-_ PO Box 1682 �} 3. S rvice Type t �r CjN / East Dennis,MA 02641 - ertified Mail [3 Express kIN ❑ Registered Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number 7 0 0 6 ,�$;10° 0.0 0°0 3 5 2 SR 6,";5 9 7 (fran-sfer from service�ls' 1 :i{, x v ,. s _ PS Form 381 1, February 2004 Domestic Return Receipt 102595-02-tin-1540 UNITED STATES POSTAL SERVICE • irt (�ss Mai(.,. iDlaR 4,T. P+z;�� �i.:;,a, ' s sggg�i Paid ' "'W+aansKn. ! i • Sender: Please print your name, address, Adz�'4in this • I I i 4 Town of Barnstable ' Health Division 200 Main Street Hyannis, MA 02601 ` (508)771-8222 DIANE L. KELLY 1J Court Reporter P.O.Box 147 '^�. Centerville,MA 02632 P Certified Mail#7006 0810 0000 3525 6597 aF rati Town of Barnstable .� Regulatory Services anxxsrABM "'^ELCL Thomas F. Geiler, Director i6gq. �0 Public Health Division Thomas McKean, Director e 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 rLrt Fax: 508-790-6304 I March 23, 2012 Fisherman's Condominium �� -- Board of Trustee's C/o Paul Baron PO Box 1682 East Dennis, MA 02641 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 855 West Main Street, Hyannis, MA was inspected on March 23, 2012 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received at The Town of Barnstable Health Division. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Exterior wall along the bottom (where it interfaces with the ground) located on the back side and the front side of dwelling Unit#15 has water staining, mildew and signs of flooding due to poor drainage. The grades of both areas pitch towards said unit and create a source of chronic dampness. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Rug within common area needs to be installed. You are directed to correct violations listed above within thirty (30) days of your receipt of this notice by implementing a system to divert the water runoff so that it does not flow towards said unit; by installing flooring within common hallway. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will i result in a fine of$100.00 per violation. Each day's failure to comply with_an order shall constitute a separate violation. Should you have any questions regarding the above QAOrder letters\Housing violations\Rental ordinancel338 Megan Hyannis 5-18-1 Ldoc violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. 7PE ER OV HE BOARD OF HEALTH homas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Diane Kelly; Occupant QAOrder letters\Housing violations\Rental ordinance\338 Megan Hyannis 5-18-1 Ldoc 1 t 'FORM30 HAW Homs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H-FmnALTH CITY/TOWN W o `� ►/� � DEPARTMENT ' ADDRESS �M S�y`0 o TELEPHONE f Address s V" _ — Occupant_ t Floor Apartment No. No. of Occupants No.of Habitable Rooms No.tleiiping Rooms No.dwelling or rooming u o.S ries „ Name and addre of ow _ f D 31YV - 1 `' g marks Reg. 1 Vio. i�� YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: �._., Walls: — Foundation: Chimney: o BASEMENT Gen. Sanitation: Dampness: C'�� Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceilin : op Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect..- Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove — Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: -- - -Infestation . - - Rats, Mice,Roachesor_O.ther:_ lip 5 C� Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED A E IS A CONDITION WHIC MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTIO EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF P RJ Y.- INSPECTOR TITLE 2 �— P.M. DATE J �^ TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,'when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water' t (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements'of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. L Failure to install electrical plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, , P 9. 9 9 9 P P 9 9 gas-fitting and electrical wiring standards or failure to maintain such facilties as are required b 105 CMR 410.351 and 410.352, 9a 9 9 q Y accident or other danger or impairment to health or safety. so as to expose the occupant or anyone else to fire, burns, shock, acc d g p y (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and_well-_bein+g of an occupant upon the failure of,the owner, - to remedy" 5id condition"within the time-so ordered by the Board'of Health.' ....-``""^•Yrr r.-���... s«v r r,. •' x.r a�' • � •+""'n""_"`i°'.r...•F•r-i.x r.,...y.•'c„uyrr.;....-.•»s�4^.+.."y„'•�y.�„F'•^;-�.�*f�•+... r�..r..�".-�-.,r FORM30 &w HOBBSEWARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN W — .�( DEPARTMENT ADDRESS f �Y TELEPHONE .� t.K��c Address _ Occupant b � Floor Apartment No. No.of Occupants f No.of Habitable Rooms No. °leeping Rooms No.dwelling or rooming units_ o.Stories r, Name and addre of oWge.r f d F Q � 3 ""Reg.( p r' RrO emarks 60. YARD Out Bld s.: Fences: / Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: 7' Roof . -0 R Gutters, Drains: Walls: r Foundation: N '� CJ Chimne BASEMENT Gen.Sanitation: f fs � Dampness: CA) Lighting: %. STRUCTURE INT. Hall,Stairway: /f`lam (�.�' / i IA <�J Obst'n.: '"_��JJ Hall, Floor,Wall,Ceiling: F , e� Hall Lighting: Hall Windows: [ c HEATING Chimneys: _•Central.s❑_Y ❑ N- Equip,: Repair ._- ._ _ ,> _ a_ • �:�.�.�_ TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line.- H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 L7 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box.- Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen , Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove �--- Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin Shower or Tub: �� -� - Infestation ='� Rats�Mlce;- oac —hes.or,Other: ,,' - / �_� ,y °`"� `- Egress Du'ai`and"OfisYn: General Building Posted t y v '` y Locks on Doors: ONE OR MORE OF.THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH f MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF P =RJ RY." INSPECTOR TITLE A.M DATE l r J TIME / P.M. THE NEXT SCHEDULED REINSPECTION A.M.P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and we of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. Failure to install electrical plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, L 9 9 9 P OP 9. gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. Page 1 of 1 O'Connell, Timothy From: Halfmann, Paul (DPH) [paul.halfmann@state.ma.us] Sent: Thursday, March 29, 2012 7:12 AM To: O'Connell, Timothy Subject: RE: Hi Tim, the land is the responsibility of the association. It's hard to see degree of pitch in the pictures but if the grade causes flooding into a unit,you would be able to cite. ] would include 410.500 because the structure is not sealed to prevent the flooding, which is the condition you need to have corrected. Changing the pitch of the land may be the.resolution to the problem Paul Haitmann, MPH Assistant Director Community Sanitation Program (508) 792-7880, ext. 2338 Website:,www.mass.gov/dph/dcs From: O'Connell, Timothy [mailto:Timothy.00onnelI@town.barnstable.ma.us] Sent: Thursday, March 22, 2012 2:42 PM To: Halfmann, Paul (DPH) Subject: Paul have a condo unit owner who has complained about water runoff due to grade of land pitching towards unit. See pictures. Although pictures do not depict grade pitching towards unit, it does. Is the land, out side a condo unit, the responsibility of condo owner or condo trust??? I would think it would be the trust. If so could I site trust on 410.602 (A) (Land.) Where it states"The owner of such parcel of land shall correct any condition caused by........which effects the health or safety and well being of occupants..." There has been past flooding which was not observed due to spectacular weather. Although, Like I said you can tell land is pitching towards unit(on slab no foundation) and staining and small amount of rot can be observed. <<Mar22 0001.jpg>> <<Mar22 0002.jpg>> <<Mar22 0003.jpg>> <<Mar22_0004.jpg>> <<Mar22_0005Jpg>> <<Mar22_0007Jpg>> <<Mar22_0008.jpg>> q�imotlll4 TA WLonnell, �PFlltl( 'Jn8}1Prtor Town of TjarustahlP 200 Main -�§trPPt aijttnnis" +,MA 02501, 1 +Email: timothy oronnPll@fown.harnstnble.ma.us i 4/2/2012 Citizen Web Request Page 1 of 1 t k Citizen Request Management - Internal Use `- Request ID: 36785 Created: 3/22/2012 10:32:11 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Category: Chapter II : Housing Substandard E.C. Date: 4/5/2012 Created By: Wadlington, Ellen Citations: Health Office Time Worked: 0 Response Time: 0 Requestor Details: / Email: Request Location: ondos 855 WEST MAIN STREET Hyannis, Ma 02601 96'rcel Number: Map: 249 Block: 031 Lot: OOP Request: problems caused from improper drainage. Drainage running back onto building has caused lots of problems; mold, had environmental work done, pulled up carpet in hall, down to concete hall wall; rodents in wall,thinks one might have died and made and smell in her be room; advised to set traps in ceiling, no exterminator called. ' http://issgl2/InternalWRS/WRequestPrint.aspx?ID=36785 3/22/2012 THE FOLLOWING IS/ARE THE BEST IMAGES, FROM POOR QUALITY ORIGINAL (S) IM / L DATA AA 10 001 BARo1V' FRopE1tTY MANA PO Box 1682,East Dennis,MA 02( Te] Fax 508-385-9499 Email: l / 1-G� /n5 j i Ai ril 5,2012 � k Town of Barnstable Board of Health Division 200 Main Street Hyannis, MA 02601 Attn:Thomas McKean,Director Dear Mr. McKean, RE,:Fisherman's Village Condo Assoc. Violation Notice 105 CMR 410.000 Please be advised that on behalf of the Fisherman's Village Condo Association's Board of Trustees,we would like to request a hearing regarding the violations of the State Sanitary Codes indicated in your letter dated March 23, 201.2. Please note that we have already corrected the common area rug violation,which was already being addressed before the inspection was done by Inspector Tim O'Connell. We will,however,need to discuss with the Board of Health the drainage and grading issue. Please submit our name for the next available hewing, Thkyouor your attention in this matter. Si PaPrnager- FVC TOWN OF BARN STAB L E Health Division— 200 Main Street - Hyannis, MA 02601 1 tHE T � of °kti FAXDate: 10/20/10 / snxxsrnstie, 9� Mns i639. Number of pages including cover sheet: 4 To SUSAN ANGUS From: SHARON CROCKER Town of Barnstable Health Division Mail to: 200 Main Street Phone: 508-360-2462 Hyannis,MA 02601 Fax phone: 508-362-8220 Phone: CC: Fax phone: 508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment FISHERMAN'S VILLAGE, 855 WEST MAIN ST, HYANNIS Attached are the excerpts from the Board of Health Minutes in 2007. See August 21, 2007. At of today, the Septic Escrow has not been established yet. The owner should anticipate this will be coming up some time soon. The idea of the.escrow is to have a chance to built up the funds to pay for the sewer connection ahead of time so it is not one big hit. As far as I know, the system is not yet connected to sewer. You can confirm this with Water Pollution Control at 508-790-6335. t t' oFIKJE la Barnstable jol � Town of Barnstable krftvl AtAmedeaChy BARMWABLE, MASS. $ Board of Health abgq. ♦� ArEa MAC°i 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Excerpt from BOH Meeting Minutes - January 17, 2007 B. William Weller, Weller& Associates, Fisherman's Village Condominium, 855 West Main Street, Hyannis — Requested a discussion regarding a failed septic system. William Weller presented the failed situation. . One owner had spoken with Mr. McKean and explained the large cost of$100,000 for one building's repair using a FAST system and pressure dosage. They are in a zone two. William Weller asked if they could just repair a part of the system. They have corrected leaks to ensure the decrease in taxing the system. The flow is 2,200 and there are 10-12 property owners sharing the cost. Dr. Miller said the Board needs to know the priority of the Town as far as who gets on the sewer system. They need to know from the town just how close the complex is to getting that particular location on sewer. If the time frame is 10 years or less, a compromise may be possible provided there is a stipulation that an escrow be established for the cost of a sewer hookup. The Board will continue until February 14, 2007. EXCERPT BOH Meeting Minutes - Wednesday, February 14, 2007 XII. Discussion: William Weller, Weller& Associates, fisherman's Village Condominium, 855 West Main Street, Hyannis — Requested a discussion regarding a failed septic system. Mn Weller represented Fisherman's Village Condominium. He reported that Bob Bergman, Town Engineer, will have an answer by mid-year 2007 of whether the complex can be hooked up to the town sewer. If so, this may take place within 5 to 10 years. Dr. Miller acknowledged the complex is in an area which the town will have to respond to its groundwater sensitivity. l 3 The complex, which contains 10-12 dwelling units, has two septic systems. One system had passed inspection but needed repairs which have been completed. The second system failed inspection due to evidence the D-box had not been filling. They were only able to locate the D-box and one of the three pits. The other two pits may be located somewhere under the pavement. Initially, the system was pumped two times a month, then pumped routinely for a number of months. It now appears to be working properly. Estimated cost for a new system is $200,000. The Board recommends (1) having the second system re-inspected to see if it now passes, and (2) submitting to Mr. McKean the pumping records. Considering the size of the complex, the re-inspection, and its pumping records (if the pumping only needs to be done 3-4 times a year), it will probably be all right to continue using the current systems for a period of time anticipating the arrival of the sewer system - provided an escrow account is established with the town which would be applied towards either the cost of hooking up to sewer (if it arrives in time), or towards the cost of repairing the current septic system. The town is establishing a program to manage escrows for this purpose. The town is in the process of funding the budget item for personnel of DPW and Health to run the program. The Board asked to submit the above paperwork to Mr. McKean and to come back to the Board on June 12, 2007 for a review. EXCERPT BOH MEETING MINUTES -JUN 12. 2007: B. William Well, Weller & Associates, Fisherman's Village Condominium; 855 West Main Street, Hyannis — discussion regarding a failed septic system (continued from BOH February 2007 Meeting). Mr. Wells said they re-inspected the system as requested at the last meeting. Mr. Wells said they also found the other pit which they had not been able to locate earlier. That pit was full. He will meet with Mark Ells to see if he can connect or at the least, he can do a easement to connect. Then they will have a joint meeting. EXCERPT BOH MEETING MINUTES - AUGUST 21, 2007: B. William Weller, Weller & Associates, representing Fisherman's Village Condominium - 855 West Main Street, Hyannis, review plan to repair failed septic. William Weller gave a summary of the prior discussions at the Board of Health meetings for the septic systems reviewed to date. r Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the plan dated August 3, 2007, with the following conditions: 1) Fisherman's Village Condominium owners will tie into the sewer once the sewer line is available to West Main Street , and 2) once the Septic Escrow program is established, the owners will have escrows set up. (Unanimously voted in favor.) 4 <S- THE COMMONWEALTH OF MASSACHUSETTS i i TOWN OF BARNSTABLE Fee: r( Board of Health $75.00 t, Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health( 105 CMR 435.00)permit is hereby issued to FISHERMAN'S VILLAGE CONDOMINIUMS corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 855 WEST MAIN STREET, HYANNIS, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. QUALFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. Wayne Miller, M.D., Chairman Board This permit is valid until December 31, 2008 D.M.D. of Paul J. Canniff, Junichi Sawayanagi Health POST CONSPICUOUSLY By Thomas A. McKean,RS, CHO, Health Agent f EN i�l#CER CHLABORATORIES,INC. T.NO.:M MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name PoolTection Location Fisherman-Village? Address David Stevenson Hyannis,MA E Dennis MA 02641 Sample Date 05/27/08 Collected By Pooltection Sample Time NA Sample Type Swimming water Date Received o5/27/08 Lab Order Number PS-80359 t,,r yA..::: ,. w wg�5/2712008a fit_ NArA° ': t ? Y k,0utdoor_Pool ;. Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform /100 ml 2 0 9222 B 5/27/2008 RS Standard Plate Count /1 ml 200 6 9215 B 5/27/2008 RS - --- .. ------- ------- --------— -- - --...___..--- - - ------- Pseudomonas Aeruginosa /100 ml 1 0 9213E 5/27/2008 RS Comments: Y�e�Water`is suitable-for ing-for_ arameters tested. - - --- - — --._._-_... -- ..__.__._.-._.....Date f�1L�0 ---------------- ona d J.Saa Laboratory rector Cn y j l ,I BRL=Below Reportable Limits Page 1 of 1 *See Attached *-OMMONWEALTH OF MASSACHUSETTO TOWN OF BARNSTABLE S�Q�1MG' SWIA IINGPOOLINSPECTIONREPORT TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE ❑ POOL VOLUME GAL. MAX. BATHER LOAD NAME OF POOL ADDRESS OWNER ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. ✓03.Bathhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 0.Sewage disposal 0 Location,structural stability, finish 06 Water circulation&filtration systems.Filter effluent flow meter reading DJ gpm.#of turnovers v66 Suitable automatic equipment for disinfection of pool water. �06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. k/68 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max, water level. Properly shielded&located. "'�08 Main drain suction outlets covered w/suitabl rotective covers/ rate.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc...At least one anti-vortex drain provide " 08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. L,"'O 8 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose or can be removed w/o tools until repairs are made. Wfr08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. _V'09 Cross-connections.Potable water supplied through air gap. 1z,0 Skimming Facilities. of rec tion drawn from surface of pool. -e ��2 Line with floats separates non-swimmer area from deeper water. (,V q {����y r Ael W� w �f G''I Ire f—(J I�12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marked with contrasting color. �3 Walkways&Decks 4 ft.wide. Safe condition. ZV���� 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. ��J✓l 15 Diving equipment in safe condition. Lf Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. '-�21 Permit issued.Adequate maintenance and testing records. Records initialed by person making tests. ALL Health Regs. Signs posted Warning signs for special purpose pools. V 23 Lifeguard ❑Qual.Swimmer Af lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhorn provided.Qual.Swimmer:CPR trained, BOH approved.Limit bather lofid to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire 4 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. -/25 First aid equipment provided. First aid kit complete. 1/25 Emergency Communication system at the pool and in working order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. ✓l6 Waste&backwash water disposal properly discharged.No direct connection to sewer system.Sep ation nk provided for diatomaceous earth filter backwash water. r ,/29 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity 60-150 Free chlorine 1.(TT 0 Cyanuric Acid 30-50,max 100 Comb.chlorine 0.0-0.2 Water temp. 78-84,spa<104 pH 7.2-7.8 11/30 Water testing equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips &32 Water Clarity: Can see 6"black disk at bottom of pool.Water clarity maintained. Filtration operating continuously. AA)2 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPP.Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing. COMMENTS: SIGNED: SIGNED: DATE: L Wif OPERATOR BoUr of Health/Health Dept. Representative THE COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE Fee: >� Board of Health $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health(105 CMR 435.00)permit is hereby issued to FISHERMAN'S VILLAGE CONDOMINIUMS corporation or individual for the operation of OUTDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at 855 WEST MAIN STREET, HYANNIS, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 19 bathers. t QUALFIED SWIMMER MUST BE AT POOL SITE ALL TIMES POOL IS OPEN. 4-. � Wayne Miller, M.D., Chairman Board This permit is valid until December 31, 2007 of Paul J. Canniff, D.M.D. Junichi Sawayanagi Health i POST CONSPICUOUSLY By can Thomas A. McKean, RS, CHO,.Health Agent "_ 6ONWEALTH OF MASSACHUSET'I" TOWN OF BARNSTABLE SWIMIvIINGPOOLINSPECTIONREPORT 3 �� TYPE OF POOL: PUBLIC ❑ SEMI-PUBLIC SPECIAL PURPOSE ❑ POOL VOLUME: GAL. MAX. BATHER LOAD I� NAME OF POOL ° p ADDRESS OWNER I ADDRESS Regulation 105 CMR 435.000 effective date:2/20/98 The items marked below with an"X"indicate the violated provisions.Items marked with a check are satisfactory. 03.Bathhouse and sanitary facilities adequate lighting,ventilation:sanitary condition.Adequate enclosure around pool.Gate self-latching 4 ft.above ground. 04.Sewage disposal *-0 i�/05 Location,structural stability,finish fJ 06 Water circulation&filtration systems.Filter effluent flow meter reading GV gpm.#of turnovers t_ 06 Suitable automatic equipment for disinfection of pool water. 06 CO2 equipment for pH control CO2 cylinders anchored Inaccessible to public Adequate ventilation. /08 Inlets&Outlets-Inlets located to produce uniform circulation.Over rim fill spout 6"above max. water level. Properly shielded&located. to 08 Main drain suction outlets covered w/suitable pro ective covers/grates.Cannot be removed w/o use of tools.Open area does not provide entrapment of fingers,toes, etc..At least one anti-vortex drain provided v MW"ti ✓08 Each system outlet protected against user entrapment by anti-vortex cover or by other means.Minimum of 2 suction outlets provided for each pump,properly located and plumbed. 08 Suction outlet covers in place,unbroken and secure and cannot be removed except w/use of tools.Close pool immediately if outlet covers missing,broken,loose N� or can be removed w/o tools until repairs are made. /08 Special purpose pool&wading pools equipped with emergency shut-off pump switch.Accessible and prominently marked. >✓ 09 Cross-connections.Potable water supplied through air gap. L 0 Skimming Facilities-4,0%of recirculation drawn from surface of pool. t/ I2 Line with floats separates non-swimmer area from deeper water. f� ,/ 12 Water depth markings on deck and walls.Properly spaced.Boundary line on pool floor and walls. Step edges marked with contrasting color. j_,/I 3 Walkways&Decks 4 ft.wide.Safe condition. 14 Ladders,steps-one per 75 feet.Not less than 2 ladders. 15 Diving equipment in safe condition. n j pvs / �° jb.! V17 Pool supervision provided.CPO w/proper training.On staff or on contract,Documentation provided. 17 11 21 Permit issued.Adequate maintenance and testing records. Records initialed by person making tests. �X2 Health Regs. Signs posted Warning signs for special purpose pools. !/23 Lifeguard ❑Qua]. Swimmer XIf lifeguard:proper credentials,proper suits and garments worn.Whistle&bullhom provided.Qual. Swimmer:CPR trained, BOH approved.Limit bather to d to 19 ❑Red or orange bathing suit with proper lettering for lifeguard ❑Yellow Qualified Swimmer attire "/24 Safety Equipment.Ring buoys and rescue hook provided.Rescue tube and backboard w/straps at pools attended by lifeguard. /25 First aid equipment provided. First aid kit complete. �. i/ 25 Emergency Communication system at the pool and in orking order.Emergency communication device in unlocked area and available at all times to staff and the public.Operating instructions and emergency numbers posted. V 26 Waste&backwash water disposal properly discharged.No direct connection to sewer system.S aration tank provided for diatomaceous earth filter backwash water. �9 Chemical Standards. Frequency of Testing: POOL SIDE READINGS IN PARTS PER MILLION-ppm Bromine 2.0-6.0 Total chlorine Alkalinity ,bd 150 Free chlorine 1.0-3.0 Cyanuric Acid 30-50,max 100 Comb. chlorine 0.0-0.2 Water temp. 11W, spa<104 pH 7.2- 7.8 61/30 Water test'.mg equipment DPD kit provided for chlorine&bromine.Unbreakable thermometer for special purpose pools.No test strips V 31 &32 Water Clarity: Can see 6"black disk at bottom of pool.Water clarity maintained. Filtration operating continuously. A0 32 Special purpose pool drained&cleaned every 14 days minimum 33 Thermostatic control provided for each SPR Thermostatic control only accessible to the pool operator. 34 POOL MUST BE CLOSED UNTIL IT MEETS 105 CMR 435.29 THROUGH 435.31. If the pool is closed by a Health Inspector or other agent of the B.O.H., the pool shall remain closed until the Health Inspector re-opens pool in writing, COMMENTS: .. tt),Dj N� Imo- m� R SIGNED: GNED: DATE: OPERATOR rd of Health/Health Dept. Repre enfative h i ENVIR H LABORATORIES, INC • ' MA ' T. NO.:M-MA 063 l 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 i (508)888-6460 1-800-339-6460 FAX(508)888-6446 i Client Name Oceanside Pools Location Fisherman's Village-Pool Address 161 Queen Anne Rd. Barnstable,MA Harwich MA 02662 Sample Date 08/10/06 Collected By Oceanside Pools Sample Time o:oo Sample Type Swimming Water Date Received 08/10/06 Lab Order Number DW-2006-3561 Well Specs NA fF �' Location`Source' ' � Date Collected w TimeaCallected �' � �r`� ' ' ` 4 Comments � r r z` Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform(pool) /100 ml 2 0 9222 B 8/10/2006 Mc Comments: ' Yes-Water isI suitable for swimming for parameters tested. i Date I R n d J.Saari La oratory Director �-etle— i Z 01 i- C::1 t�l BRL=Below Reportable Limits Page 1 of 1 *See Attached t To Barnstable y Town of Barnstable AN-AM BARNSTASM eftac ft ,�� Board of Health A 200 Main Street, Hyannis MA 02601 lit 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Mr. William Weller September 4, 2007 Weller and Associates Bayberry Square, Suite 4C 1645 Falmouth Road Centerville, MA 02632-0417 RE: Fisherman's;Vlllage Condominium, $55 U1/esf:Mal( ,"Street Dear Mr. Weller, You are granted permission to construct an onsite sewage disposal system, without any innovative/alternative nitrogen reduction components, at 855 West Main Street Hyannis. This permission is granted with two conditions: 1) The new septic system shall conform with all of the regulations contained within the State Environmental Code, Title 5. 2) When sewer lines are extended to this area sometime in the future, the condominium buildings shall be connected to public sewer at that time. One of the two existing septic systems is currently in failure and is in need of repair as soon as possible. The applicant informed the Board that sewer is anticipated sometime in the future and to require a shared innovative/alternative system at this site at this time, would cause great financial hardship to the condominium owners. Sin r ly, ay a Miller, M.D., Chairman BO RD OF HEALTH Q:\WPFILES\WellerFishen-nansVillageSepticApprovaIO7.doc t Weller & Associates ada� Bayberry Square --- Suite 4C C 1645 Falmouth Rd. — P.O.Box 417 Centerville,MA 02632-0417 August 3, 2007 Town of Barnstable Board of Health 200 Main St. Hyannis, MA 02601 %Re: 855 West Main St., Hyannis, MA, "Fisherman's Village Condominium" Dear Board Members: Would you please place us on the agenda for your August 2Is'2007, meeting, for the review and approval of the accompanying Site/Sewage Plan for the repair of a failed septic system at the above referenced location. Thank you for your cooperation in this matter. Very y y urs, I William G. Weller F i Fax: (508)775-0754 Phone(508)775-0735 ts .�' 01-7- S 6 la Al-AL -:2--L -bQ � t � r R r } 4(4- Town of Barnstable ' �/4--e 1e1h S/?t qA � ` Regulatory Services Department Public Health Division 'ki 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Thomas F.Geiter,Director FAX: 508-790-6304 Thomas A.McKean,CHO lbf 31'p, October 31, 2005 Mr. Mark Ells, Superintendent Department of Public Works Town of Barnstable School Administration Building 4t'Floor 230 South Street Hyannis MA 02601 RE1FiAsl�erman's Vi�liage�C�on�do�m�iuurr�s; 8S5��es�,l �ain�treet;Hyanxus Dear Mr. Ells: The Town of Barnstable Public Health Division requests the Town of Barnstable Department of Public Works to extend the sewer line down West Main Street, to Fisherman's Village Condominiums, 855 West Main Street, Hyannis. These condominiums are located within a designated area of concern and within a nitrogen sensitive area. In addition, one of the two existing septic systems is currently in hydraulic failure, which is a potential environmental and public health hazard. The engineer representing the condominiums is currently researching the cost of a shared innovative/alternative nitrogen reduction system to install there in the near future. However, he has already informed me that a shared UA system would be an economic burden to the residents there. The Public Health Division is committed to providing any assistance you may need to accomplish this objective. You may telephone me at 862-4644. Sincerely yours, c olaos . McKean,RS., CHO Director of Public Health rA. r �.._ ...,. ... , .. 4++' • .. .. -./�.f�-'+.• ,.ti-+-../1�+�..'.p .�..y ♦ 'Y��A•. '. it 61�—re •'r... ^v....f.. r .. 0 00yu60 S lux No. Fee THE COMMONWEALTH OF MASS ETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Mi,5poa.Y bpoem Cow5truction Permit Application for a Permit to Construct( ) Repair(v� Upgrade( ) Abandon Complete System ❑Individual C6mponents Location Address or Lot No. 55 ct �sT/- Owner's Name,Address,and Tel.No. '�.StP.a3 °l4es� pe,. ©x sit ' Assessor'sMap/Parcel �p �� �3l i.. 00 I�taller's Name,Address,and Tel.No. 6Q�r Designer's Name,Address and Tel.No. S �> z Type of Building: Dwelling No.of Bedrooms i( Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs (Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date O� �c Application Approved by Date -(3'C Application Disapproved by: Date for the following reasons Permit No. 0�04 ' 1� Date Issued /.,,h ..FY ...,,• ^^.v-' w.iq•r�j, v.:f•iti •.e.• •;�•w ���-sr•.ro.:,-:,.;a `s ,.'"° �3..#�'-r+w"`i..,.°�'•''f. `",.aLi ,P 5... ;,,.�r:. .bh _ ,•i' ., .r• „= , + _ 3 I w 1 eO>. i�`�©ts,. �t�/l '!�' ��.f - rg �_1 ' .1 ,. M l�:.. n' • ! ,' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,MASSACHUSETTS Yes - 01pplication for Mgogal *pgtem Cottgtruction Permit Application for a Permit to Construct O Repair(f Upgrade O Abandon ❑Complete System ❑Individual Ct7mponents Location Address or Lot No.�Ss C4,>-3_ �. - Owner's Name,Address,and Tel.No. ''77r-cl Assessor's Map/Parcel J?( +„ ©® � ®x ; � r a tnstaller's Name,Address,and Tel.No. Cc� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) IV gpd Design flow provided A74-- gpd Plan Date Number of sheets Revision Date Title A Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs �a14ons(Answer when applicable) � �c �J�, ?� �fp , t y�,., �Ytc 4A(� 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 y' Compliance has been issueyd by this Board of Health. _t Signed c:/`�'�-�'� Date `✓ a� Application Approved by Date S':(3.0 Application Disapproved by: Date for the following reasons Permit No. 9009—,' t3 Date Issued d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Cerf:ifcte-of- ontYior�ce Loa THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed`( ) Repaired Upgraded ( ) Abandoned( )by at J S c�7�s�T� 1-�/t c� v` �' ; has been constructed in accordance ru with the provisions of Title 5 and the for Disposal System Construction Permit No. a Oog^ � (.3 dated Installer �+®��1 ��C50 _T , �;,�C Designer v #bedrooms _ - 1/. Approved design flow ` gpd The issuance of this_permit s all no,be onst_rued as a guarantee that the sysrorwil fu, ti as c�esigned.r Date �, ! ""y j.' - Inspec - - - - No. —— — —— —=————————— ———————————— Fee �oa9 _r O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigont *pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair (/7 Upgrade ( ) Abandon System located at ��� �i✓ �.n � '�a i r�,c �.��,�-, s�k� 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 must a completed within three years of the date of this permit. Date ��(3 — b a Approved by TOWN OF BARNSTABLE LOCATIGI4T 5,f SEWAGE# Zoo-7-3-7S I VILLAGE il S ASSESSOR'S MAP&PARCEL Z - INSTALLERS NAME&PHONE No. (fopewii CQ �',�f o?rS S'Ua. SEPTIC TANK CAPACITY :,3600 c LL LEACHING FACILITY:(type) c.'(IBC /Up (size) NO. OF BEDROOMS o2y OWNER_Es PERMIT DATE: /2-$I2,00-7 COMPLIANCE DATE: � i Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 11L Feet Priva:e Water Supply Well and Leaching Facility(If any wells exist on site or A7thin 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) FURNISHED BY _._ Feet 1t 1 9ran� dd.er i �a 3a •0 3 G 53 i Q �b i . No. n OU 1,� � 1VVt 6Q4. &I L( IO-7 ` Fee CE CO MASS a HUSETTS Entered in computer: PUBLIC HEALli DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r Z[pphcation for ;3iopont 6pztem Conotruction Permit Application for a Permit to Construct O Repair O Upgrade(VI"Abandon O ❑Complete System Individual Components Location Address or Lot No. gs s wt Si 6w.,61 gr Owner's Name,Address,and Tel.No. 511� �-►`) �`���� N,%AV%Ai_5 Lo-r Jy Gonc!® ArSa(,jW*its,, Assessor's Map/Parcel aLig • pr Installer's Name,Address,and Tel.No. 6A/��-� � l s� Designer's Name,Address and Tel.No. me K*Ua44 P 0.iSawc 7103 p't 3 j f �t4 R o Type of Building: 4- Dwelling No.of Bedrooms 2L 0 Lot Size �Xj '71 1 sq.ft. Garbage Grinder ( ) Other Type of Building &,n4 0 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 'ZZI S. 5— gpd Plan Date r� Cj Number of sheets Revision Date Title 1—t c�y�a 0YN tYh V i Ar'.f I,,I Size of Septic Tank 3So® Type of S.A.S. `3Y X 74-.5 L e464 4 1 d ul ke— 10.'5 �^^ Description of Soil Nature of Repairs or Alterations(Answer when applicable) bi 41,�j j.49 -1b WAJ D —11 y Gul tec /o a s /4-2 6 w/ S i�►� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. c Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons i Permit No.�d—) ? Date Issued «t1 ———————————————————————�———————————————————-- d.T.IE.°f _.~ I�(�////j `1 � �,�Y -./1'j:�� _F IY �}rH'T�.'ri' ..�pw-�l'•�w.lQ1s^�.rL+ .j1..��rN'y (AidMSPid''`Y..e.T✓x T.�rr'+If..rY"YY..G e. •\ J�... + -1 Fee V �HE CO 4WEAL-T �OF MA ,TTS Entered in computer: PUBLIC HEALPIVISION - TOWN OF.BARNSTABLE,�MASSACHUSETTS Yes T,#:- Z` rication_fort-TD B o.5af �`item Conotructiott Permit It, Al. Application for a Permit to Construct O Repair O Upgrade(V)*'00'Abandon(� ) .Complete System U Individual Components ' Location Address or,Lot No. S ss. O e yT' ".,A 5r Owner's Name,Address,and Tel.No. F'51J f wt 0"`) o f 14,A ,anni S t.tpr ty GOndo A?Sof b4 Assessor's Map/Parcel jInstaller's Name,Address,and Tel.No. g f J Designer's Name,Address and Tel.No. W�(�t'�4 k'SJ oG i�f�;�' Oa a�K -�b3 r L424 k(dzc Cc.,Ki.,;114F 177 A ' ' < Type of Building: - Dwelling No.of Bedrooms q 0 Lot Size 7A 7P I ' sq.ft. Garbage Grinder ( ) Other Type of Building &,n4 U No.of Persons Showers( ) Cafeteria( ) { Other Fixtures Design Flow(min.required) Z.ZO Q, gpd Design flow provided ZZ.1 . '� gpd Plan Date ' —cj—ZO01 Number of sheets Revision Date Title an' U�t(/ Size of Septic Tank 7366 c Type of S.A.S. 3 4 A -75-5" 4ew4 4-G Col k'cIQp,� Description of Soil <Qn- D 144n t rr �� yD ii Nature of Repairs or Alterations(Answer when applicable) N C,,j f ee /v o's 1 --z t& I✓/ S X,—t_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Z Application Approved by 2 Date 'Application Disapproved by.cl Date I4, Tor the following reasons Permit No. Un"' -3 7 5 Date Issued' —o'U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS P.. (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by CAl1�t y166 en4,9/-e S [�L c— at�5� IJOS�l M`�`IA� h 5-Tact r`�'`�4-M 010 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D007 . 3 - dated Installer (,„i4/ue,t) G�a ®l ard'5 C3 CIL C Designer ��f�►o( � �{ja G.��tS #bedrooms �/0 Approved design flow f/O gpd The issuance of this permit shall not be construed as a guarantee that the system will�u)cti0h as designed. Date u'��c -7 Inspector j11tv, r"f Fee 'i"vim j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwi5poOal �&p5tem Construction ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at W gn-r M A,�, !;-r and as described in the above Application for Disposal System Construction Permit.The applic*ant ecognizes his/her duty to comply with Title 5 and the following local provisions or special conditio s. `Provided: Cons ctto must be completed within three years of the date of this permit. Date Approved by f FROM :CRPEW I DE n F PY NO. :5084283928 Oct- ag 207 10:26PM. Pi f , Town of Barnstable i Regulatory Services Thomas F.Geeleir,®irecte►r �" •"`� �� Public Health Division. MAM Thomas MclCexn,Pirector 200 Niziu Street,Hyannis,MA 0260:1 i Faux: t(�3-7yt;_t,,ti)9 Of nx: 508-862-4644 %stall•er& l)esi ner('ertificaation F'orin Z Date: OGirober ti' �� I Se.wige pe;"naitl� �c�0-1- 3�7 Assessor's �€.ap\Parcel '�143. Designer: `8cl L6 ouATc'S installer: t•a `66 Cil ! Address: i��t .o�,�-i�;�r_ l?�Ad Address*. was issued a permit to install a On (date'.) ) septic system W�� .at, Z 55 r t-tea,'„ 4Tt .t t 1 w-4w3 based on a design draK n by (address) r vvas��;w�tr dated. Wcsiinerl' 1 certify that the se tic system referenced above W3S installed substa,;tially acc.oaitir..b to the deign, which n.}ay include 111inor approved changes such as lateral relocation of t.ile distribution box and�!or Septic.t:Ank. I ^ i ccrtiR, that the septic system r6crenced above was irist�.iled with Major changes (i.e. tiretiter. ihatt 1()' lateral relocation of the SAS or any vertical,relocation of any component or the septic systemj) but in accordance with State & Local Replations. Plan mvision or certiticd as-buiIt bvjdesigner to follow. +, ZF10F MgSs9C� i DANIEL E. yGs BRAMAN "a (installer's iature)— CIVIL C No. 32686C l ST. Fs3�0 ECG\ (De,signer's SignatttrL] _ (r1 "ix D.signe fexc) l'd.E.lS1r RE'IUP-N TO AARNSTASL PUBLIC HE TH tsiV SION CERTIElCATF OF C ?�111.3ANC. WILL NO'li �THIS FO&M Alm_D AS�Bii1LT :4RU ARQ It1+: OLE P'LlBLIC 9ia ALTFfi 1QIVlSI®1+1,-'1'H[ANK 1`01j. i Ce;Heeltli'S.Tticlik,p�at Corti ficdtionFarm 3.26-04-doe i . r l S'S TOWN OF BARNSTABLE L(?CA1'IUN3 l,o). Mar) , ( SEWAGE # VILLAGE �� ,�n.in n t S ASSESSOR'S MAP & LOT21!! 031 INSTALLER'S NAME&PHONE NO. � Cat,: i SEPTIC TANK CAPACITY 0, 5-oo i' w t LEACHING FACILITY: (type) 3 (size) 1 1 .NO. OF BEDROOMS BUILDER OR OWNER �,SkQA rylan. } to PERMITDATE: 0 AA 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 3 1 /'i� 34 •o - 3 y1 . 0 61 �)7 6 3 i3 3 y a- �ti 13 V 135 sy,o No. . Fee 60 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS U � 01ppYicatiou for Wgpogal *pgtem Cougtructton Vermtt Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System Yindividual Components Location Address or Lot No. .SS.- m,4cin S -r Owner's Name,Address,and Tel.No. 4 N Assessor's Map/Parcel � a"ss c.J eyr rn a: �. . © rtJ,r�a�cw Installer's Name,Address,and Tel.No. !1 Designer's Name,Address and Tel.No. (.l Type of Building: Dwelling No.of Bedrooms L Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building (20ti't j.0 No.of Persons Showers( ) Cafeteria( ) Other Fixtures ( V ►,,,+S_ I3. -i� ®oyirts Design Flow(min.required) gpd Design flow provided 1`?-C)0 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank `�_�C3O® Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (Lp 14�c&_ Y. 1 N esSq Date last inspected: Cj - Z`(— Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 60 - Zd oil:, Application Approved by 3V b1N. S Date /0 -6 — few Application Disapproved by: Date for the following reasons Permit No. /t)h(n Date Issued o 6"-11 l� G No. . I ? _. z _ 1a Fee - THE COMMONWEALTH OF'MASSACHUSETTS ` Entered in computer: � �.. .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes applicatton for Mid ogo.Y * $tem Con!Aruction; ermtt Application for a Permit to Construct O Repair(/Upgrade,( Abandon O ❑ Complete System Individual Components �- Location Address or Lot No. '" Owner's Name,-Address,and Tel.No. - ASS �eSi vtii�4;v� 'T'. t1r}�` s ma o2jvoN 1 (Sticr✓�,a�;5 U�ll Assessor'sMap/Parcel 2'11- Q ! 1t1��r✓�UtV�n YUr�d+dnu &„ �" rya+1`Sot�. i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. &v.6 ek 1-ee Qv i ae�p C�.-�,3 f,:C t`�'•� J-�� a2to3�.- i�t C'� l�1 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage\Grinder ( ) Other Type of Building c�o No.of Persons Showers( ) Cafeteria( ) Other Fixtures C�J r1 tkS l� -�! roo /YLS Design Flow(min.required) gpd Design flow provided 1-4.-QC gpd ti Plan Date Number of sheets Revision Date Title ` - Size of Septic Tank 71-C)100 Type of S.A.S. el,4-� y5 ' r Description of'Soil Nature of Repairs or Alterations(Answer when applicable) •l'3,.CJ A !q�!� eec es5 f 3.f • Date last inspected: Ct Z-k( - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the:provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , { Signed Date `O ' �ca 'Application Approved by IM°, r Date lO " k> Application Disapproved by: Date for the following reasons Permit No. /n (n ' Date Issued �V `6_ V - --, - . THE COMMONWEALTH OF MASSACHUSETTS I j�cp V-bUx ' BARNSTABLE, MASSACHUSETTS Certif irate of Corry hance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X) Upgraded ( ) Abandoned( )by cr.. w,d-e- . at & r IAJ(7iT �M n / [., Aoeq J has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ���(�` 7 S dated I0 Installer Designer #bedrooms �// -" Approved design flow /�1��/ gpd r The issuance of this permit shall not be>rccons6ued as a guarantee that the system will function=as designed. Date Inspector_ No. 7G)(r - / Fee l.UV..�.-- f fiE CONLYl0i�i`w>�Ai;I H OF MASSACHUSE°TTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mtgo al *p5tem Congtruction Vermtt Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at S S r-A �^� s�- �r�'t 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: Cons ction must be completed within three years of the date of this permit. Date DS/y c". Approved by ( � I f For office use onl 1 ��--/-3� J ly� i OWN OF BARNSTABLE OFTNET� I' � R OFFICE OF ocoo a Bsaa9TABL 3 BOARD OF HEALTH 039'k\em 367 MAIN STREET Q-3 °' •�oMa� HYANNIS, MASS.02601 o VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. �ISFl��2�!/�s �it,q�� TEL. NAME OF APPLICANT � # 7' eo p oryr ADDRESS OF APPLICANT 0&--fF- /j'l.Aijt/6T. h//,�/.v�iS9 /W.4ss7• NAME OF OWNER OF PROPERTY ee�n/R�is9�/✓�tlia? ou/i✓�2 SUBDIVISION NAME Ft S tt L.eZ MA U 5 y 111 a6d DATE APPROVED ASSESSORS MAP & PARCEL NUMBER c�V9 LOT SIZE LOCATION OF REQUEST 8�SS7 /rld�iNS7.'—J�y//�/scri�, ✓i'1�53`. �-��®/ VARIANCE FROM REGULATION (List Regulation) 5wI KVASR rf "01 PC-: K W TS gTT Ac 6kt---p L4L")�ZaTo t REASON FOR VARIANCE (May attach letter if more space is needed) PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING , VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL {�2 n Ann Jane Eshbaugh, Chairman AUG 2 6 19q, Susan G. Rask TOWN-OF BARNSTABLE Joseph C. Snow, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE • i - -- _ i � � !, � . - .� � � � r, � � • �.r 1? .- a I Sf I ,� ` ,P. _ � ,_ _ _ � , � - i �"'�' _� , � � � _ . � �� �� � _� �. ._. �, �l ACOptea I , June 4,=�1984 September 26, 1989 , € TLI CRITERIA FOR GRANTING MODIFICATION FROM THE RECOMMENDATION OF THE POOLS AND. LIFEGUARD CODE, RE(�,ARDING. SWIMMING STATE- ENVIRONMENTAL REQUIREMENTS QUALIFIED SWIMMER - In,constant attendance when pool is open. Only swimmers passing a swimming.:test;shall be used at_pool.. TESTS CONSISTS OF: y Swimming lengths of.pool: - Treading water 5"minutes. f$. Retrieving object from bottom of pool, r �Ll Q'11 tJ(�`TlD?i The swimmer(s) .shall be 18~years of age or older holding a current _ -Tt+kS American Heart ' Association or American Red Cross CPR ®� certificate with training In child, adult, and,pediatric CPR. SEGTI�GJ Also, this swimmer must demonstrate familiarity with .life saving `equipment, including rescue procedures and administering first aid. The maximum capacity at the swimming pool site:is restricted mot to exceed 19 persons. y , The insurance policy of the pool must name the Town as coinsured in the amount of { $1,000,000. Ann Jane Eshbaugh: ' Acting Chairperson . � /J es H.!Crocker. OARD OF HEALTH TOWN OF BARNSTABLE z.• i _ . r 7 855 West Main Street Hyannis, Mass. , 02601 August 16, 1991 ' Barnstable Board of Health Town Hall ' Hyannis, Mass 02601 Gentlemen: i We , the undersigned Trustees of Fisherman' s Village Condominium development on West Main Street in Hyannis, wish to petition the Barnstable Board of . K Health for a variance of the .Code regarding swimming pools. We feel that we are being discrimminated against by being required to have, not only a qualified 'swim- , mer certificate , but also an American ,Heart Association CPR certificate (which includes several life saving techniques not related to water safety. ) We have operated the pool on our property since 19?4-, without incident. Most of the' residents are, � owners of their condo unit and fall 11to the category of senior citizens, who have always acted in a respon- sible manner. The pool, of course, is enclosed in a locked, fenced area. Access can only be gained by an owner's key. Rules for pool safety and use are .con- spicuously displayed and stringently enforced by mem- bers of the community. 4 ' " Over the years, the residents have looked forward. to using the pool since few of us have the inclination to wade into summer traffic at the local beaches. Petition - Fisherman's Village op. 2 Because of our small size ( 22 units) , employing a life guard would be prohibitive. Many of us are on fixed incomes and we feel that we could not support such an expe tse. In a telephone survey of several of the towns on Cape Cod, we find that while condominium develop- ments of our small size with pools are rare , there has never been a drowning `iric' dent reported. Since the Qualified Swimmers certificate has a CPR requirement as part of the test, we feel that this is adequate for our situation. A "walk-around" telephone with emergency' numbers attached would be available in the pool area at all times the pool is in use. It is our hope that the Barnstable Board of Health will grant us a variance for the, balance of this year and will consider a renewal- of the variance for the sum- mer of 1992• Sincerely, 71 ' rley Price, President Jame Brown, Secretary-Treasurer Ha riet F eedmann John. Mulrey • Jame Spellis BARNSTABLE SURVEY CONSULTANTS, INC. MEMBERSHIP IN: MASS..SOCIETY OF PROFESSIONAL ENGfNEERS SURVEYORS AND ENGINEERS a LAND suRvsYolis POST OFFICE gOX 734 4 1 1 M A I N SIT R E E T CAPE COD SOCIETY. WEST YARMOUTH. MASS, 02673 PROFESSIONAL ENdINEERS TELEPHONE: 775.7719 & LAND SURVEYORS Town of Barnstable Board of Health November 13 , 1974 Town Hall Main Street Hyannis Ma. 02601 Re : 72-767 Investments of Cape Cod Gentlemen: I. EverettH. Hinckley, Mass. Registered Professional Engineer #13230 hereby certify that I have inspected the construction of the subject disposal facilities and that they have been constructed according to the approved plans and Article XI of the State Sanitary Code. It should be noted that this certification applies only to systems #2 and #3 as shown on the above referenced plan . as the other two ave been installed previously and I assume inspected by others. I spoke with Mr. Robert P. Fagan of the Department Of Public" Health and they will accept our certification in lieu of theirs as specified in their letter of approval dated AugustU16, 1973 . Very truly yours, Everett H. Hinckley P. E. LAND COURT PROPERTY • RIGHT OF WAY SOUNDINGS • FILL PERMITS PIER PERMITS • TOPOGRAPHY • SUBDIVISION CONSTRUCTIONS • SANITARY LANDFILL Flea....No. r �U--- -- ---.... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ,/.ep.c �_..... . ..0F............... .........---- Applira#ion fox Ditipasal Works Cnowitraarttoaa Vrrmft Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: 4 Location- dress or Lo 3r•.... .....�' We Own A re --------- e - Installer Address Q Type of Building Size Lot............................Sq. feet U Dwe?ling—No. of Bedro _--_____-.__ __.Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Buildin '/ _• No. of persons 0.� YP -- --�-- •- p ;,.____- Showers ( ) — Cafeteria ( ) AQ' Other fixtures __-__LfC�. c__:________�_../„�'Jy. �d°�' �F------•----•--• W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacit2.00"Vgailons Length_------------- Width........-------. Diameter_--.-...__..-._ Depth...____-_.-_-- x Disposal Trench—No--------------------- Width-_-,____---.._-__-_ Total Length-------------------- Total leaching area-------.------------Sq. ft. Seepage Pit No.._.__�^____--__ Diameter-___-4... .._... Depth below inlet.................... Total leaching area...._.___._______sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by._5-,W- --. ..���_...- 04 Test Pit No. I................minutes per inch Depth of Test Pit____________________ Depth to ground water__.__-_-.-._-._. f14 Test Pit No. 2................minutes per inch Depth of 'Pest Pit.------------------- Depth to ground water--._...--__-___.__-____. 9 --•--------------------------------------------------•-------------•-•-•----------•----------.---•------...---•-----•-----------•--•-•----------------------- O Description of Soil------------------ - ------------------- x -------------------------- W 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 Article NI 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. Signe --- _ lam-_ - --------•----•--- -----•---y 5� `` Application Approved By.....t._er _..-. f' ova'--_- ----- Date Date Application Disapproved for the following reasons----------------------------------------------------------------------- ------------------------------------- ----------------•-----------....-----------•-•-•-•------------•-----...... ----------------•-•--------------•--------------•----------•--- Date PermitNo. 6.....-• -•••-- Issued........................................................ Date NO.. --- FEE...../B THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ......OF............... a . ......: Appliratinn -for :41-4poml Workii C owitrurtion Vrrmit . Apph.. 'tion,is hereby made for a Permit to Construct ( W<Or Repair ( } an Individual Sewage Disposal Q:Ra- S��yyyst��e►►m��^^aI: yyffff _ -------•--- ,_�/ - ~----.. Ki ._ � ��.e Loc tion dress wno -------------•-•-----•-----•-----------•---•"`y/�+'�'�fr� h •-•-J --, ..'�•-.'-/�C�r"-�`_`sir' Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bed g— _________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Build in , 5�.�►No. of persons.--_" � Shoy�ers ( ) — Cafeteria ( ) Other fixtures . '."._L +__�___-____ -------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid capaci2PAPgallons Length................. Width................ Diameter---------------- Depth-----..-___----- W x ; Disposal Trench— Width__y./� _-_-__- Total Length-----------­----­ Total leaching area--------------------sq. ft. Seepage Pit No----------........... Diameter.....�___P!----- Depth below inlet___________________ Total leaching,area------------------Sq. ft. Z Other Distribution box ( ) Dosin tank ) '— Percolation Test Results Performed b n + ____/ 'F' Y - _ .._ - it Date"_ ___ '-16,--73----- Test Pit No. 1................minutes per inch Depth of Pest Pit.................... Depth to ground water-..-:.--_-__-..-_.--_--- ;14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._.-_--.---•.-_-_--._. W ---------------------------------- ---•- •. ----------------------------------------------------------•------------------------------------ D Description of Soil --- -------------------------- x W 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 Article XI of the.State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the boardoof h lth. SigneR'____- •--•--•-• - -------------- -------- ------•--- -` 3 7 --/ S late w `'�e± j` Date Application Approved By_____ '�o G'�-_ _ Date Application Disapproved for the following reasons:-------•----------------•--•-------------------•----------------•---•---••-------------_...___------------------ --------------•-•-•--------------------•/6 0•. ----------------••---------•-- •----•-•----------------------------------•--.._..------------- Date PermitNo----- -------------------------------------- Issued........................................................ Date £ TH -C,QMMONWEALTkI OF MASSACHUSETTS BOARD OF HEALTH .............OF.....r3V-*1k.jS-4Vk- ................ W.rrtif iratr of TIMplianrr THIS IS CFRT FY, That the Individual Sewage Disposal System constructed (600<or Repaired ( ) by-A�-�- 1pf�� ............................................................ ..... -----------------------------------•-----••------•------ �'',', .. .�0✓� Installer.--------------?'�'.!�s'-fn'i�'xv�+•�=M--------has been installed in accordance with the provisions of Article XI ofThe Stary"Cod as d cribed in the application for Disposal Works Construction Permit No-----1 6_d____________________ dated_.' :.:+ :. .._.____.._.___._ - _ - THE ISSUANCE OF THIS (CERTIFICATE SHALL NOT BE CONSTRUED AS A ARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector- -=--------�=---------------------------------------------------••--•--_---•- THE COMMONWEALTH OF MASSACHUSETTS 4iM1 ..+.,L•++" BOARD . F HEALTH No... �D / �/� .t6/_........ ..... r'K ....... ......OF.... .::...:.. ................Bt-svofi 1 Marko.To i rartion �rrudt Y g =------ Permission is. reb ranted_ + .K-------- to Cons ct (lor Re air ( ) an Individua Se age Disposal S s atNo. - r "•------------------- --------- ---------•--- Street as shown on the application for Disposal Works Construction Permit No..40!_6.... Dated_' .. ............... _____________________________________________ _____J_--. -. ___-_ ............................. Old of Health !�VDATE. -••-- 1 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r/ Y 600'Washington St. ' Boston, Mass: 02111 � 0��Py 1 ,.K 4 7y { ^ty 5. o ��qn- -'S 5 • ��' 47.s:: A� .y.��r `d � ,q I F� � �,+qjg f `7 .7 v r�2 �•A r�1� �� f�1�i•,J'rfR��L�G1lWa �,•if1iR���n:'�j7,7 )!Ft+� ..,k j�, 40 006 06*4100tol Otto,' to,* uuh is . � ;. „ yam. ,,f�►lpy _ ? $ yerfdR:rs� :Rfi 3.�r'1✓Fils?1dMR�4 _ Pl iv by . �vs � it Yl 'may { • vt iix VNI ?lR. '^"a" r ► ` .*•' < � 4.Aia174 � ob .. s AA � 'fit ' Sy s' _ . +� � b to At to" 40 i to oold, AVA at obutaod, *ha t-M Of "# Math loot . . W"I v at . tit gyp, o lls t ti 41 ��] • l __ �4iTh47r.Ji. a 5 �` *� t Sl'� As .. 'yf fr Fr+•'iie ftII 01486946, to MiA VX k t .y is •k .l. f t y`-:8yg1 ;:�. tt !' .•e' "- n 3�' K`yt k r girt a. . R ���}:yj �,`Y)YW,.ir�i ���G{• 1 �', '$(' +1 k � .eX{, 1 �.�' l ,S � _ r } a �'iiFi '�.�` �,� ���4 �� �t-2 •` 4 y i « { #;.^f r .�, T ! R . ,t 't. + •3' -r:rar- i iR Usk y 'F 1. !x.• � i L j ,. ' R' y <.}r'rY + aw r } ��, � y -t .r` _ Y r t - �II oil r lux ZVI a t C � � ] . t f-r ♦,. �j t . � � �^ f � v i yr t : t 9 '•� xf q - vt • + ~F t R& •7 - t 9 . �'S �P'@ u"YA 4:.. * 'i. 12G �n Yt . "All, m a ` 'Fax Ty `�'3 ': ar.♦�ri A � 4„ 't`.. ,.F, �- }. s c`.«r� 'l+R+3' 4 �t' •._ .,L r J t:'' WON: µpi ... •. .' _ - • .. - ,"� _r xs r�,r , No. ' THE pp�4n OFFICE OF THE BOARD OF HEALTH OF THE 13A]MSTAU TOWN OF BARNSTABLE, MAS rasa op 1639. Q MAY At. 19 SF SAGE DISPOSAL PP1IT .� Permission. is granted to _ { "_ y-�T=>— < to construct "`__ __= t Upon the Premises of s " r'f ' °�f = s t `L ' Sketch In the village of 100 or more feet from any source of water supply 1 20 feet from building 10 feet from property line x Health . ficer. _ ------ No. 4HE OFFICE OF THE BOARD OF HEALTH OF THE 139MNSTAM TOWN OF BARNSTABLE, MASS. y MAO& 1639. pp oMAYA'� — 19 SEWAGE DISPOSAL, PERMIT Permission is granted to �' to construct a r .Upon the Premises of Sketch 4 rd 1 In the village of t v r f - - 100ror more feet from any source of water supply 20 feet from building. ' 10 feet from property line —7o y _ Iµ 4tOfficer. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH, 3s- yc h � I _ 1'►-. OF........ . ..... .................. Appliration -fur Disprr.sal Works Towi#ruriion Prrmi$ Application is hereby made for a Permit to Construct ("-<Or Repair } an (Individual Sewage Disposal system ar. -..................... -- .44 'on•Ow Add s t .. -- ---.-�- -• ..... .. - -------- ....... - - --- --------------•� rser Add W Installer Address UType of Building /n _ Size Lot----------------------------Sq. feet Dwell i , No. of Bedroo llff ----------------Expansion Attic ( ) Garbage Grinder ( ) -------- -- - a4 Other Type of Building . .............. o. of persons.-_-_____._____e___ ___ Showers ( ) Cafeteria ( ,) p S — Q' Other fixtures ---- - -- �--- ------- Design �.• �`h W Flow_____________ .(�...........�° allons per person per day. Total daily flow.... l _,..____________...._...gallons. WSeptic Tank—Liquid capacitu� -�'g'allons Length---------------- Width........... Diameter-----.---------- Depth-__.-------.._. xDisposal Trench—No- -------------------- Width-------------------- Total Length-------------------. Total leaching area--------------------sq, ft. Seepage Pit No....._%!r------ Diameter-------------------- Depth below inlet---------------------- Total leaching area_)_V!Li._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------- --------------- --------------------------- Date-------------------------------------- . Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.._-____-_-_._-...___- i 4_1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ CY .................... D Description of Soil--------------------------------- �. J V --•-----••---- --- -.--- ��- ----- - - W ----•--------------- --- 14 -.d�--`�_ - --•------------ -------•--•------ . --• - U Nature of Repairs or Alterations—Answer when applicab e._--------------_----- --_-__.-._..._.._._...._.__... �2 77---------•--•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Cod The undersign further agree to place the system in operation until a Certificate of Compliance ha e ' sued by the heal �. 4. Sig •-- ---- --- ----- ••. . ---------- -------------------------------- ate Application Approved By..... . --- -•---• •---- ------------- ------------ `' Application Disapproved for the following reasons:.............................................................................................................. .^ ' ^ rr = ......-•---•............ ..........•------------- ¢+ ...._.. Date --.---•-•--- fit lam` P e, - �a � h.� PermitNo......................................-•---------------- Issued....................... -------------------•-----------• Date ..- ...............................:............... ............................................ ........................ THE COMMONWEALTH OF MASSACHUSETTS,4.: ,.,, - -! BOARD HEALTH .............O F....... .......... :..... .. .. ............. (frrtif iratr of f=Impliatta THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by = = ....L1, 5•�/tp-�..---- Installer at U/---- — Sh�/t !'I/�/uf �d/LL �� has been installed in Ycordance with the provisions of Articlp XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- -- - ------------------- dated......../o....f�...73..,............. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ------�--1- ----------------------------•--- Inspector._ 41 --------`---- dw — � .tii ^► No_,�d7Y_ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .- ------ OF...... ................... Appliration -fear Uii oiial Marks Cnvmlrurt- n V r i� ,tee Application is hereby made for a Permit to Construct ( or Repair � an Individual Sewage 'Disposal S stem . Y -. '... - .................. .�J- on-Ad ... er r ur t s W Ow + Address Installer vio, Address Type of Building Size Lot____ ____________________Sq. feet Dwell i , No. of Bedroo -I--- Expansion Attic ( ) Garbage Grinder ( ) aOther 8�"Type of Building - ___ o of Pei yens. Showers ( ) Cafeteria ( ) ,,// Other fixtures f'%� G ^F .',off ` + ' '� "'""�---------f;, 4 W Design Flow____ _____:�" `_ ___ gallons per person per day. Total daily flow_____' _ _--..-. gallons. 9 Septic Tank�--'iL squid caplc�lt `__ gallons Length---------------- Width .__--..-. ._.. Diameter_-.--. .---._-_ Depth -.. Disposal Trencli S Io r_ y�-Atlt "_.___.____._ Total Length--_--------------- Total leaching area------------- Seepage sq. ft. Seepage Pit No______ ___ -------- Diameter--------------- Depth below inlet_______________ Total leaching area-PP f z Other,Distribution box ( ) Dosing tank ( ) t, a Percolation Test Results Performed'by--------------------------------------------------------------------------- Date-------------------------------------- Test Pit No. 1----------------minutes per inch. Depth' of Test Pit_..__________:____.- Depth to ground water-..---------------------- fi Test Pit No. 2.......----------minutes per inch Depth of Test Pit.................... Depth to ground water-------------------- ----------------------------------- - -•-- ---------------------•-- ----•- D De§eri tion of Soil-_- ------- ------ •••... : ------ v �► x P e?.at ------------- ----.. W ---- - ---- ------- -- ,�•�• � U Nature of Repairs or Alterations—Answer when applicab es +. -----•-•------------------- -- - -- - -- --------------------- _-•.--•'•------------.-- - -- ------- ------- : Agreement The undersigned'agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A rticle XI of the State Sanitary Cod The undersign further agree to place the system in operation until a Certificate of Compliance ha e sued by,the; heal t «a= Sig ---- -• ___.••._ : ---------- _---- Application Approved B '`. '1P __ D ------------ Date Application Disapproved for the following reasons-------------------------- __-- -------•-------------- ----•----------------- --.................. .............................. ••••••-------•------------------•-•------•......-••---••••• . # Date PermitNo......................................................... Issued........................ ..............---------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ff HEALTH ..... :... . OF... (11rrfifiratr of Tompliaurr 1 THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) byf�� G/ •----------- --- .................. Installer at iEh. `to J tl✓L G f ........................................................... ...... has been installed in �i'ccordance with the provisions of ArticI XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._._._ � :`a�_ _____: dated.._._._,�� ......� :_ ...... r„ _ THE ISSUANCE OF THIS CERTIFICATE SHALL' NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector THE COMMONWEALTH OF MASSACHUSETTS y deoe Mt; BOARD -07 ALTH_— 3.. '. /'fia• k.. No..... tea; FEE ` -••••-......----- Bispotittl Workii QIonf;tntrtion Vami# Permission is hereby.granted-------- -• _.. - to Constru t ( or Repair ( ) an Individual Sewage Di Po, System sp at No.......6Z.a •...... -------- ..............U/C 1 '_ F st1 t as shown on the applicarior f lr Disposal Works,Cons>ruetton Permit No.. _ __ �____ Dated..... q'_ 3_.___7_l.......... --- ---'- - ---• ------ u 3- 7 6 Board of Hea --• - FORM 1255 HOBBS &.WARREN. INC., PUa.LIS�FIJR$� af';,,� ,� .• _. SEPTIC SYSTEM MUST BE INSTALLED JN COMPLI WITH"ARTICLE II STATE' ° 1J .... Ficic............................ No.....�.._�.... RSAF(N��IT�AeRY CODE AND TOWN THE COMMONWEALTH OF"�RW ATJQNET- S- EOARD OF HEALTH........ _OF .. .....------------------------------------ Appliratintt -fear ]i,ivoiittl Works Tonfitrurtion Vrrmit Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal Sys �' ---------- --------- am --------'�-- ----- --------- . ocation A o" Own J Address a -----•-•---------------------- --------------- nstaller Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling o. of Bedroom --------- ----- -------__-- --.-_--._Expansion Attic ( ) Garbage Grinder ( ) Other -Type of Buildin o. oPei-soiis_._-_-._ ------ Showers ( — Cafeteria d Other fixtures -- -- ...�-----•- .... - - -- - ---------------- Design Flow_ ________________________________ ______ lions per person per day. Total daily flow..__�� «� gallons. W 3 W ;Septic Tank 1 Liquid capacity_.___ lions Length................ Width........... Diameter__._-_---...___- Depth___.__--_.._.. x Disposal Trench—No-____________________ Width-_-_-_-----_--______ Total Length-------------------- Total leaching area--- ____.____...sq. ft. Seepage Pit No.._,.._______. Diameter......`.:............ Depth below inle _.__ ............. Total le. ping area ._.__��._'�_sq. it. z Other Distribution box (A-) Dosing tank ( ) (' A t-tQ ~' Percolation Test Results Performed b ------------------______ ---------- .__-------------- Date__ _-__ � - - t 7 Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground wate .----------/-------- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..----___---..-.__-____ a ----•----------- x .�-�------------------------------------------ ----:----•------------------------------------------ 0 Description of Soil-------- ----------------------- - ----------------------------------------------------------------------------------------------------------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------_----------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst n accordance with the provisions of Article XI of the State Sanitary C —The unde sigi d further agrees t t place the system in operation until a Certificate of Complian e has e ssued by th a f heal Siged-.. - ----- ........ -- ---- ---• . • ------------------- --- ---- ----------- -------------------- 1 D Application Approved BY -----------•- /y Der Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ----------------•--------•-•-...--••-•-•---•••--......--------•----••••••••---------•--------------------•-----•-•------------------•-••-----•----••----•---------------------------- -------- ---- Date PermitNo.----- .................................................. Issued........................................................ Date -��-��������������•s�s�.a��.��a���.�.�������••�r��..�e.�••���.���e�•e��ea�����������o��•.e��• �.��.n�a��s..������.n�•�n�������e�re THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... .......OF....... � Trrfifirate of T"Tontpliattre THIS IS TO CERTIFY, That the In i ua age i posal System constructed ( 4)/Or Repaired ( ) by :: = ...... ---------------------------------------------------_--•------------- Installer at.............. L ......-- / 1�L` _...�! I-------------�/LL2eState �- �1�'-� lias been installed in accordance with the provisions of Artic e XI of Sanitary Code as described in the application for Disposal Works Construction Permit No------40.4 ....................... dated......la.."y.'..J. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........��'. _3..: ,.��-`-------------------------------------- Inspector------------------------------------------------------•----------------------------- 6.+.-------- ----= ----- ,..-_,d------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................... .............:.................................. Appliration -for Di,i oiial 10orkii Towitrurtion Vamit Application is hereby made for a Permit to Construct (1 or Repair ( ) an Individual Sewage Disposal System at: + Y 444 tl - - - - --- -- ocation A re .--"--- - �+►or L ..... _-------- ...... . 4 Own Address W ~ fJ � nstaller Address s Q Type of Building Size Lot____________________________Sq. feet U Dwelling, No. of Bedrooms___ ______-Expansion Attic ( ) Garbage Grinder ( ) U - aOther Type of Building _. ----------- o of persons Showers ( -Cafeteria ( ) W ,- - . Other fixtures W 117 Design Flow. .......................... Mons per person per day. Total daily flow----4 -:.__. _-___ __.gallons. R4 Septic Tank Liquid capacity dons 'Length_______________ Width--____.--. _... Diameter__-__ --- ----- Depth---___.------ Disposal Tlench—No. .................... Width---------_.___-___-. Total Length___.__. Total leaching area-. ._ ___sq. ft. Seepage Pit No _ _________ Diameter...:________________ De th below inle _-__:_p Total le ping area aq. it. z Other Distribution box (fr) Dosing;tank ( ) 1�L. .Percolation Test Results Performed.by Date_ v. Test Pit No: 1----------------mmutes per inch Depth of Test Pit- _____-______--___ Depth to ground water_-._ __._ - f= Test Pit No. 2----------------minutes per inch Depth of Test Pit------ Depth to_ground water-_.______________-._. t� O Description of Soil-------- ----•--- ------ ;-- ----- ---- ----- ....... ............. 0 W ---- --------- -- -------- --------- -----------=----------------- - -•--= - UNature of Repairs or Alterations—Answer when applicable.____-_. ------- --------------................ ------- _ ___ .------------ -------------------------------------- -- - --- -------- .............................. •-------- --- -- -•-- ---- ----------------------------------------- Agreement: The undersigned agrees to install the' aforedesc_ribed Individual Sewage Disposal Syst, n accordance with the provisions of Article XI,of the State Sanitary Co e— The unde sigi d further agrees t t© place the system in operation until a Certificate of Complia e.ha e ssued by,th a f lwal Sig ed -•-•- ••. . •---- -- -'� D ,e Application A roved B - Dae PP PP Y = ? , ' Application Disapproved for the following reasons:----•------------------ - ------------------------------------------- -------- ----------- -------- -----•--•---•--------------------•----------••-------==----------------------------------------------•---------------------•••--------------------------------------------------------.-----------.-•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH x ........... c`'°...........OF.._. �dt�t'�s�f1' Tntifiratr of T..Ampliattrr THIS IS TO CERTIFY, That the In vi ua11S,�wage _ posal System constructed ( or Repaired ( ) by ' nstaller at.......... ... ' _ .�.,o- --- /r---'--- ------ ------ ----- -------`--- --- ---- --- - has been installed in accordance with the provisions of Article.XI of T e State Sanitary Code as described in the j application for Disposal Wor"kss Q` 4ruction PermittI 'o i _ ____________________ dated'.---- ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ------------- Inspector ------------------- s ACV 00 HE COMMONWEALTH OF MASSA',tHUSETTS BOARD FO AL-TH ` g Ujd+6v ,/r a..., ............ . .. ....OF... .,�.�5?!� , T19e ... ...-.. No. 1 FEE /" DinVoiittl Norkii ClIon itrurtio r i# { Permission is hereby granted.........f'6 _... �cr ��.. .................... to Construcat No t ) or Repair ( ) an Individual Sewage Disposa System 40 , ------------------------------- ---------------------------------- Stree / as shogun on the application for Disposal Works.Coristruction Pfe mit No �O,Q• _____ Dated----d-_Q_, '__ _ ___________ 01 Board of Health DATE. ---- `�' s--------------------------------------- FORM 1255 HOass & WARREN-'INC.. PUBLISHERS � >„ <r• '- - - - VIV F >� No. .IY.. __ � ...Z................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... /�L!/`1L ----.OF.............. L: '" Appliratiun -for Dia aiittl Workii Cnomuurtiou Vautit Application is hereby made for a Permit to Construct or Repair ( ) an individual Sewage Disposal �r Lot No. Sys t . � 4 ocation• d � Ow er Address" taller Address Q Type of Buil i Size Lot___________________________•Sq. feet U Dwellin o:'of Bedroo s-.-___ __________________-Expansion Attic ( ) Garbage Grinder ( ) pa, Other . Type of Building _ o. of p son __ Sl owers ( ) — Cafeteria ( ) --- �`� Other fixt resTZ 1� L�sr�..�ifvd W Design Flow." ------------_ _ ________ __________gallons per person per day. Total daily flow.............. . __-__ _ . gallons. USeptic Tatik[Liquid capacity"" allons Length................ Width................ Diameter __.._--____ Depth.__.--___.-._. x Disposal Trench—No- ------------- Width-------------------- Total Length-------------------- Total leaching area..__. •._.___._. _sq. ft. Seepage Pit No-------�_---_- Diameter____________________ Depth below inlet.................... Total leaching area! 'y__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ------------------------------------------•-----•---------------- Date--------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water___._____-._..-.__.-__-- fq Test Pit No. 2----------------minutes per inch Depth of Test Pit.---_----.._______-- Depth to ground water------------------------ --------------------------------------------------------------------------------------------------- ............... Descriptionof Soil `' - - s---------------------------------------------------------------------------- x -------------------------------------------- U W U Nature of Repairs or Alterations—Answer when applicable.m-------------------------------------------------------------------------- ----------------- ----------------------------------------------------------------------------------------------- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste ' accordance with the provisions of Article XI of the State Sa Co The undersi ned urther ag ees n to ace the system in operation until a Certificate of Compliance as be sued by the b e t�1th. Sign e . . • - ----- - ---------- . . ......---•---------•---------- --- ------------------------------- Da Application Approved By------- ------ -- ---- - - � ate Application Disapproved for the following reasons: ---------------•---------------------------------------------------------------- -------------------------------------------------------------------------------•-•--•----------------------------------------------------------------------------------------------------------------- Date PermitNo........................................................ Issued----------------------- ................................ Date a THE COMMONWEALTH OF MASSACHUSETTS e BOARD OF HEALTHY ..............P.W.j..........0 F...... 0�1ertif iratae of Tomplianr.e THIS IS TO CERTIFY, Tha the Individualrg s os stem cons cted O or Repaired ( ) - _ by... ------------------------ - _— -- - &-• r� s Installer at �.G� s- -----._.... -------------------- �` s ------ !_l .0....----'---......."-------------•------------------------------ has been installetYin accordance with the provisions of Article XI of Tlfe State Sanitary Code as described in the application for Disposal Works Construction Permit No-------!a__�.6..................... dated__._-Tk-_j•� _ _3.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... .3_'_-7 y-=-----------•--------------•----•--- Inspector.................................................................................... No...... Fics... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. -�f" .....oF.............. .... „ App iralWu -for Uiiipasal lUorkg Towitrurtion Vanfil Application is-hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal -..rimer Sys at • :- ---'..... oration- d [j/J�� *or Lot No. MiYbl.v Ow er Address W ` • iistaller Address Q Type of Buil Size Lot....___---------------------Sq. feet V Dwelli o. of Bedroo s------- -----------er____.. .._.___Expansion Attic ( ) Garbage Grinder ( ) Other Type of Build in __ - SbowersCafeteria ( )g o o�f �on a Other fiai�res —rJ"------- -ems Q ------------------ ----- ------------------- flow Design Flow- ______________________ ailons per person per day. .Total daily _.__._.__.__. /t .....gallons. f � Septic TUiik Liquid capacity f ailons " Length___ ___________ Widtli__......_.___. Diameter.-.------------- Depth_._.._..__..... xDisposal Trench Now►___________________ Width-------------------- Total Length.......------------. Total leaching area--.__ __._. .___ - q. ft. Illh, Z Other Distribution,;box,( ) Dosing tank.(. a Percolation Test Results:` Performed by------ -------------=--- ----------------------- ------ Date----------=-. ----_------------------ y.. Test Pit No. --___-___--_--minutes per inch Depth of Test Pit_____________________Depth-to ground water._---__.-----_---.-.._. (� Test Pit No. 2................minutes per -inch Depth of Test Pit......................Depth to ground water------------------------ ---------------------•_.. '------ D Description of Soil+ :,_ ------------ = . ...:......... x ----- ---•• -•----•----------------- W ----- --------------- - V Nature of Repairs or Alterltions—Answer when applicable+--------------------------......:..................:......:.... . ....... .... ...... ----••-•--------------•-------------------------------------------------------------------------------------••-----...-----------•-----•.------.. ..................... -----------------------­-- 4 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste • accordance with the provisions of Article NI of the State Sa '- Co The undersi ned urther ag ees n to ace the system in operation until a Certificate of Compliant as be sued by the b filth. Signe ....-- - --•-- ---------------- --- ------------------- ---•- Date i �r Application Approved By----- ------ - � 'i ----- { . .._. Application Disapproved for the following reason's:............................. ............--------------------------------------------------------._.............................----------•-- - ------ ---------------•----•------•-----------------------___-----•-------------- Date Permit ........................................................ Date ; THE COMMONWEALTH OF MASSACHUSETTS `BOARD OF- HEALTH , ............., .cc,' `'.........OF...... Awsrs� ....'..................................... b' ` Qrrtifiratle of Tumpliattrr T. hat the Individual g spos stem cons ucted (7� ) or Repaired ( ) THIS IS TO ERTII Y by............ ------. . -• ------------------------- - "Oa its. Installer /Jdi F.f �? .* w has been ins all in accordance with the rov-isi.pn i`fe s-of Article XI of T State Sanitary Code as described in the I � p ti _ _ application for Disposal Work` ns,truction PermltArNota_ t _"+ ¢. ............... ..... dated_._.__�L_'.�l'. _j_________._____.__._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT,THE SYSTEM WILL FUNCTION SATISFACTORY. 3 7 el DATE , ............................................... Inspector--------------------------------`................................................... i .�s�Mr7D•��h. #i�t� ���'try,i�,�t a s THE COMMONWEALTH OF MASSACHUSETTS f4 .s !f #"�rA,�,» �y BOARD OF�NAALTH 1 t _ �. D lti� O F. �4 I` S>`!y/1, .. .. . .... ......................................... . 1FEE -------------- F , Permission is hereby granted--------� "-_... 1w: Tk¢sy---------------------------------------------...-------- to' Construct (, ) or -Repair' ( ) an Individual Sewage:=Disposa} System at No.•---4.•Ld. J----'----- �__l�.�Z�� ����5 ......:-...(lILG64- -4n----------------------------------------------------------- -�. }street / sho%�n on the application for Disposal Works Construction .Perr"nit No. ____-�_6__-_ Dated--.-. ._�'50 --------------------- as .................................... ' _ .. . ---- --------- •---------------------- � "` y ..> Board of Heal DATE...... FORM 1255 HOSE & WARREN. INC.. +P11L1:HERct1 c 46/A �T / ss..o 4_�-,� No HErO�' OFFICE OF THE BOAR _OF'--HEALTH2 ; OF THE. a" TOWN OF BARNSTABL_ E, MA19'$ . T SGE DISPOSAL PENT 7/4 _. 'Permission' is granted'.to ,t 'Is S l � a � I'�.�= •toconstruct __� ." �=y ""' - � .: Upon th'e.Premises of r r ' � Ail�4i�a5` 4's ..�!%1;�,b;� � r.��x';�i��TiYlr�� Sketch In the ,village.of 100 or'more feet from any:source,of water supply.' s t 20 feet from b'uildmg: 10 feet from property line r , "71 - -� � _ _. � _ R _ _ � � __ f�. _ j� F',.T �r �T J�•\ �f• _ _ 'L l4l , • /n :• '. No:" 'OFFICE OF 'T'H'E- OAI F~[-9EAL'["H_ -OV THE - �: 81aasT - TOWN,OF BARNST.ABLE, MASS. .' ' '" ■tea, � - �-' SE E DI P`OS PE 5IT . Permission is grarited.;to to construct ' t+�-?✓ ' �- .. - T - � �r ,.t : . Sketch, Upon the Premises, of t1-r In ':the.village of 1;00,or more feet from any source of water supply . ti , AA� -.x 20 •feet from, building s , 10 feet from prope", line - ,ffiaer � is •�:�. r, w, rti ' � — � '�� �.3.'-1'.- .: f.l�6�ti. •�'��F d� _' 7: _+_ - _, ����1�7` _s•_ '1'�'�_•*y ,r"�_ r�_z __�- � � N T �6 C) a . i - x v i a.� '•."�. :� it ,. d .... . ..L -..^r,_ `1 r A�.�ti +. 't yi gv V+_ ok- Irk , • f y .; �'%�`�t4t`�`" s ,��tt` t �� yr., �,3 ,yi i� x .•� �9 wr '� }'31. tit • .'t. t 4". ?S SY i F r i III_. i s-{j • x i �• t. e jf °� '�fn �ls7 a a T � `fig..♦ �..��� ':� k � - a� � M . 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M STATE rlle WAY � 26 D E51 G N DATA RISER 24"SQUARE W/S.S.CAP SCREW LID W N — --- CLOSURE - PAVEMENT u CLASS"C"CONCRETE 10" DAILY FLOW: (Za) BEDROOMS x 110 GPD P?Za� GPC o N - 95%COMPACTED FILL � < � PIPE TO BE LAID LEVEL FOR - r SEPTIC TANK:ZZaoGPD x 200% = -/` O JG. D - -' Z J 2' OUT OF DI5TRIBUTION BOXLr�_��,jI " USE: (iL' GALLON PRECAST SEPTIC TANK C — _..... �_ _ � ,LTA > __ ____.____________ ____ :___ _..-__ 4" SCH 40 PVC PIPE �/'y�i '���' ��"''J `/ -'� w_F � — (V (jL J ?/=i/t- DISTRIBUTION BOX: f,`�,�. �2 `v/UPS �T,41�:=,+a ,1s� a✓, �. om1w USE: DB-// C-" /-Zo) W c X w -- ( 0— T.O.F. h �p @ 3/4' - 1 1/2 DOODLE WASHED STONE w � 501L ABSORPTION SYSTEM: — R Q g / EL — - USE. °Z ---- - _ —_- TOP - - - --- - - @ /. r'/ TJ� elf-� II I , Ir . \ , ` v is° h OL J C7 . ,..C? - �•—2 � , _/ -- C:J' CO/-,/7"l�"/-� C� ��v C _=0... c.1� /.�—ZC� �:J.al.�/ ✓4.�- Cry, _J � yl � �. � --� �� � �y_ y,J 4y �J BOTTOM @ EL. ' 7 C`► ti.a/: a // / N5TALL cns aArr�E ` /5 IN OUTLET TEE 'CL. Ex '��% coo CAPACITY• T � �C>� 7�i J TTc=-rH-� C��- 1-2 IN.DIA.WASHED +� o —� — SURROUNDING CHAMBER J! 04,.J+.r� Lu : c� . 5 }�cJi "� Z .:.. 5 `� — CRUSHED STONE . ^- ;-t-r-r ,-i i;-i-,rr- -;a-;a- +-.-r-t u.- ;a:a:+-r+r' r-, ',1.-a -i: .i-`-, -a -._ 7� �Ti- •:i'.= A '�llJ .U,S•T�7. F"o2 jTo.✓E' � i SIDEWALL AREA• � � T T BOTTOM AREA ,� Sl 3 y/-'� 37 00 GT J��'/�C T-�i'/�//c AND INSPECTION ASSEMBLY FROM TO FINAL BOTTOM TH N/@ IfL. 7 71G� BOTTOM(THIS CHAMBER ONION --TYPICAL CUILTEC CHAMBER + 6"INTERNAL COUPLING L_4 OZ.NON-WOVEN FILTER FABRIC v INSPECTION PORT —' AROUND STONE SEPTIC SYSTEM PROFILE - Typica! Inspection Port Detail for Traffic Applications _ _ _ DEEP 08SERVATION HOLE LOGS \ _ ---- PAVEMENT � CULTEC; 1-2 INCH WASHED 95% COMPACTED FILL DATE: Sc,�T' 15 oor/ HEAVY DUTY CHAMBER CRUSHED STONE - CULTEC No. 410 FILTER FABRIC ON TOP AND SIDES OF STONE TEST BY: r WITNESS DEPTH PER j r L , PERC RATE: C z 1 8 DESIGN 14" l 1 8" MIN. ; / \ 14' MAX. - \�\ � MINI � DEEP OBSERVATION HOLE #I EL. 6" MIN. Dt!"TH - �� a -- 1 Ff ADM SOIL SOIL SC)IL COLOR SOIL OTHER F } ! HORIZON TEXTURE , (MUNSELL) MOTTLING ACE CHAMBER w ;� _ HEIGHT , r , r, _. .' -, , 6" MIN. �j .�/t _,. .--•-_ - --- — --=`--- -------'-"- - - 17 --- =//�• /mow �GN""�� ��. �,sy�/y ..` �� - 12" CHAMBER WIDTH - g^Typ. /�/o Lc�.4Tj C=ilGoual 7 -,F_'� 1 DEEP :'_35EKVATION HOLE #2 EL. t5e, p `�v► �x/�,��`X \ ` Paved Traffic Septic Detail f °K,)m SOIL solL SOIL COLOR so1L OTHER p HORIZON TEXTURE 1 ` `\ SUC,: ASV �n (MUNSELL) MOTTLING -�04 / 7 T s�L O� 35�� 4 DEEP (,B5ERVArION HOLE #3 EL. 1 I � � O O -� y � ��E 'THi SOIL SOIL ��, SOIL COLOR SOIL OTHER ,qNa P \ \ HORIZON TEXTURE �,t,/ovs^a,C3r9,Ol_ 5L,, G` (MUNSELL) MOTTLING :I l j g DEEP I�BSERVATION HOLE #4 EL. f11"0 H SOIL SOIL SOIL COLOR 501L Fi.(7M I SUFf'ACE HORIZON TEXTURE (MUNSELL) MOTTLING OTHER / nI To /,97c. ►---� �\ Sao � / - N_ o 3 OENERAL NOTES - l CONTRACTOR.TO f5E RESPON61 f5LE FOR THE LOCAT ION OF ALL UT I LI T I ES, rn At5OVC AND UNDERGROUND,PRIOR TO ANY EXCAVATION OR CONSTRUCTION. M r�� ,per/o� Tc �Ttal' 2. SEPTIC SYSTEM TO pE INSTALLED IN COMPLIANCE WITH 310 CMR 1500:TFLE V �i= Co,,t�>.-'vim=�i�-••/. � � 3. TH I S PLAN 16 NOT TO 13E USED FOR PROPERTY LI NE DETERM I NAT I ON / A. ALL DISTURBED AREAS TO 13E LOAMED AND SEEDED 51TE --- SEWAGE PLAN 5. CONTRACTOR TO PROVIDE 45 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS. � / I (o. EX 15T I�SEPT C SYTEMS TO f5E PUMPED DRY AND F I LLED W I TH SANP. fop, 7. SEPTIC SYSTEM 15 NOT DESIGNED FOR GARfMbE DISPOSAL. �S Gc�E ST PREPARED FOR __- ,���/��/?/��,�/ .� 1✓/G G-� c/. � �..cr�✓1'OM/mac//U� / r / - I SCALE: ti DATE: DRAWN BY: I 1"N JOB NUMBER: REVISION: �rJ p 7 SKEET NUMBER: / `'} WELLER ASSOCIATES /STE� I G45 FALMOUTH RD., SUITE 4C -�- P.O. BOX 4 17 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 -0 ( TEL.: (508) 775-0735 '-• FAX: (508) 775-0754 II EMAIL: trl5weller@comca5t.net PROFESSIONAL ENGINEERS LAND SURVEYORS