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HomeMy WebLinkAbout0008 WESTON CIRCLE - Health 8 Weston Circle, Hyannis F A 27.1 185 r E P d Commonwealth of.Massachusetts ` H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town State Zip Code Date of InspectA 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 A. General Information filling out forms cSA#r on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection f� Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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: E. Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the oval Approving Authority 4/5/2017 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 at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System--Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The dwelling located at 8 Weston Circle Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 500 gallon chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 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 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town 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. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ 12 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ 0 Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts w r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 M , 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does 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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 • Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name ,information is Hyannis Ma 02601 4/5/2017 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information" (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts w r Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 2005 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1.5feet 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: 1000 gallons Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 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 3" Scum thickness 3" 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 10" How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 . Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 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 ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 • Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2x500 gal ❑ 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.): s.a.s. consists of 2 leaching chambers. Leaching facility was found dry at time of inspection with no signs of past hydraulic overloading. 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 17 . Commonwealth of Massachusetts W W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M Sve, 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town 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.): t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q eA-L 1 0 Z d ' 3 At Z3 13 r 27-f o A 2 Z8 4 A 3 ,Yo a3 zy r s� A-( Ys t6ins•3113 Title 6 Official hupection Form Subsuftoa Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: ,Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s� 8 Weston Circle Property Address John & Katherine Garafoli Owner Owner's Name information is required for every Hyannis Ma 02601 4/5/2017 page. City/Town 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 t i i r z, a t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL Z� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 6rD0 44 het. LEACHING FACILITY.(type) ('��=� /U�[4 5 (size) /3 ,,� NO.OF BEDROOMS OWNER k&Cq PERMIT DATE: COMPLIANCE DATE: 2S d l 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 leach' g facility) Feet FURNISHED / Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 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 Michael Catalano use the return Name of Inspector key. Inline Inspection � Company Name 20 Mendon St. Company Address Blackstone MA 01504 Cityrrown State Zip Code 508.883.5423 SI 743 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 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 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•09/08 Title 5 Official Inspection Form:Subsuifece Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 8 Weston Circle Property Address Krec; LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ .N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation 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 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Citylrown ,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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: ,t 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 ❑ H 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 Y day flow t5ins•09/08 Title 5 Official Inspection Forth: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 M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable _ MA 02061 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El Z 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 inspectedtfor 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? P P P 9 Y The size and location of the Soil Absorption System (SAS)on the site has been determined based on:. ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue .approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M , 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is Barnstable MA 02061 required for every i page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: nfa Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection'required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: a e Commercial/Industrial Flow Conditions: Type of Establishment: 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? ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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): I' t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M 5 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: >611 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: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown 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 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 How were dimensions determined? 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: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 -7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is Barnstable MA 02061 required for every page. City(rown 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 ❑ 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.): l 1 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M , 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Citylrown 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is Barnstable MA 02061 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information(cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ® Shallow wells Estimated depth to high ground water: 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: 2005 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i' M 8 Weston Circle Property Address Krec, LLC Owner Owner's Name information is required for every Barnstable MA 02061 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION LL,i EsTn„I CIoer SEWAGE # Zoos— 0 6_ VILLAGE--, ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO., 1,4,J SEPTIC TANK CAPACITY \. Jr 4 a inn r,g LEACHING FACILITY: (type) 2— st Le cd (size) NO. OF BEDROOMS_ 3 cHAwd BUILDER OR OWNER W/Coh: M d&o V d PERMITDATE: COMPLIANCE DATE: Separation.Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by_ r-9111 i i tW�sTorJ Ci�P�1E. f - ,1 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 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: A. General Information When filling out forms on the J computer,use 1. Inspector: only the tab key to move your Vance Steve Young cursor-do not Name of Inspector use the return key. Company Name Q P.O. Box 1592 Company Address Manomet MA 02345 City/Town State Zip Code 508-759-5603 S1686 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5113/09 Spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '"""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 5�� I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/ahvrays complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 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 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is y required for Hyannis MA. 02601 5/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due 9 P 9 to broken or obstructedpipe(s) or due to a broken settled or uneven distribution box. System will y 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. 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 tins•09t08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 0 icial Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 wafter analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6'below invert or available volume is less than%day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is H required for annis MA. 02601 5/13109 - y every page. City/Town state Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate ayes" 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 norma[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 ® El 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. El I ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail unoccupied for 3-6 months Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per da . P Y(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•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 4 Shared system (yes or no) (if yes, attach previous inspection records, if any) ElInnovative/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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 4yrs per as-built dated 3/21/05 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >150feet Comments(on condition of joints,venting, evidence of leakage, etc.): no signs of leakage Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8x5x5 ' Sludge depth: S" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I r Commonwealth of Massachusetts . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. Citylrown State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 2" 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? measure stick/estimated 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 INTEGRITY OK INLET AND OUTLET TEES OK .LIQUID IS LEVEL WITH THE OUTLET INVERT RECOMMEND ANNUAL PUMPING 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•09/08 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 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is y required for Hyannis MA. 02601 5/13/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (coot.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address p Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. i Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX IS LEVEL AND DIST. IS EQUAL.. .INTEGRITY OK NO STAINING ON WALLS OF BOX ABOVE THE INVERT LINE AND NO EVIDENCE OF SOLIDS CARRY-OVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'M 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ Teaching pits number: ® leaching chambers number: 2 ❑ 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.): not exposed, but soil is very dry in area with sparse vegetation. Cesspools(cesspool must be pumped as part of inspection) Qocate on site plan): Number and configuration z 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. CityrTown 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.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Wash Mutual via N E Prop Solutions Braintree, Ma. Owner Owner's Name information is Hyannis MA. 02601 5/13/09 required for every page. City/Town 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 � 9 j � I �3 a 1 � _ w r5-ro.J c 4c1E t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 13 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: 2/23/05 + Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) El 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: per as-built on file 1 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Weston Circle Property Address Wash. Mutual via N.E. Prop. Solutions Braintree, Ma. Owner Owner's Name information is required for Hyannis MA. 02601 5/13/09 every page. City/Town 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION (,ywow G��c �� SEWAGE# ,;796✓5'-a4r VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. Lli SEPTIC TANK CAPACITY �1sT/fy� L- LEACHING FACILITY:(type) — J'E'©QY l dq//!�',���size) NO.OF BEDROOMS. AL owNE>z PERMIT DATE: �' `���� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I 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 f`. TOWN OF BARNSTABLE LOCATION 4,t-t Enb;i �'I�G�.0 SEWAGE # ZooS—0 Cll VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 n e p a-,;Z LEACHING FACILITY: (type) 2—So n (size) /.3'Y Z5'�X Z' NO. OF BEDROOMS 3 cHA�dr.�s BUILDER OR OWNER to ICOLo. M)9X o yfig PERMITDATE: Z —Z2j-os- 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 P �y ' C4 k can TOWN OF BARNSTABLE LOCATION R LdL .S/' A-1, 0/�4,L-,� SEWAGE # VILLAGE ,f�21&AI I S A ASSESSOR'S MAP & LOT 7( 1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY D U d L ACHING FACILITY: (type) _ (size) N . OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200.feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Q o O v TI- Gy LOD v,or w wa' W`rw�.s er v No. W✓ ^� (D / Fee_ NE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mfi6 pool 6potem Construction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) O Complete System DKndividual Components Location Address or Lot No. wSj� �I-@CLE Owner's Name,Address and Tel.No. Assessor'sMap/Parcel k-f„/, ='37b6-J CjAC19 2 I /epr- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. B�t1a�J c Ie155*6W6 ogk-d� maVse i3,eA K Aj '�-'�• so8?*2 ay �o. BoN 90/ . SoF 36Z-2yZ2_ EO'(f S19..0 fv[C Type of Building: Dwelling No.of Bedrooms _3 Lot Size sq.ft. Garbage Grinder(wc) Other Type of Building j) No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //a gallons per day. Calculated daily flow 3 513 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank V . 00, Type of S.A.S. O�Ppc4sr(21 -rod p&a Description of Soil o= /2% ,� /o,g,, 5.��� /? = 3S' `A-—e,£e e B 3 f - "3 2 4 c WOW.:FA-0 Nature of Repairs or Alterations(Answer when applicable) �u,P � s e,N�s�.4(L m-.7& sr ay „9,44a( 7 —SOD CSA 1 ��g�T- 4,0,Aze C44&4A&Q_— 143 7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of 77 Heal Sig Date 2— Z3 —oS' Application Approved by Date Application Disapproved for the following reasons Permit No. a420S —0 °T Date Issued 1, No. �\� � ��rt-, Fee T 9AGMMONWEALTH OF MASSACHUSETTS ' Entered in computer: Yes PUBLIC HEAL-TH`DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS 01ppYication, for 33igozar &potem Con.5tructiou Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Crmplete-System [P'Yndividual Components ' Location Address or Lot No. !' •r r�, r t���_. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel �'1` +� L-/, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1 - c.i "rc . / (: .,;It � � +,..'. � - ! �•-c f�1J/ , rN,j ejt.tr-y r" ... .:C G.. Type of Building: Dwelling No.of Bedrooms = Lot Size sq.ft. Garbage Grinder(cv,) w Other Type of Building n t.t., ; ; No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /r r, gallons per day. Calculated daily flow :3 �73 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 7- Type of S.A.S. i ,c , r (4 l Description of Soil , J ems Nature of Repairs or Alterations(Answer when applicable) 7 r"'(1,1t r 111JrI Jt c/" '+r ? "it a Date last inspected: Agreement- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Sig ed Cf mow' Date Z n Application Approved by Date 'a 3 ) Application Disapproved for the following reasons Permit No c;�eoos —o(oT Date Issued D3 c) 5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(X )Repaired ( )Upgraded(y ) Abandoned( ' )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer ', C: k� Designer ,C•i, , ,o k+ + P The issuance of this permit shall not Ve construed as a guarantee that the system wi a ti n as designed.' Date /��'� Inspector No. �""5 —`' `� / ' Fee ! oO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS =i!5#0al *pgtem COtt!5tructiott Permit Permission is hereby granted to Construct O Repair( )Upgrade(x )Abandon( ) System located at ~rL J c/c 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 conditio ns. Provided: Construction must be completed within three years of the datpermf. Date:_ 3 6 Approved \ I 9 COMMONWEA LTH OF MASSA._,HUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIIRS , t DEPARTMENT OF ENVIRONMENTAL PROTEfCTIOI' y FAILED INSPECTIONF+u c - -- TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A k CERTIFICATION JAN 1 1 2005 TOWN OF BARNSTABLE Property Address: r v HEALTH DEPT. Owner's Name: ._n `1AP �- Owner's Addres : UARC I �i J ,4 (%,)&0/ r Date of Inspection: Name of Inspect . please print) I le rkmT jC� Company Nam&115177 ( . Mailing Address: O 7 Telephone Number: 0 `7-7/- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my " training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority .Needs 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. 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 n the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 . i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address! Owner: _ Date of I spection: . 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 15303 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. 4 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is.structurally unsound, exhibits substantial infiltration cr exfiltration or tank failure is imminent. System will pass inspection if the existing tank.is replaced with a-complying septic iank as'approved by the Board of Health. *A metal septic tank will pass inspection f it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank.is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in.the distribution box due to broken or obstructed pipe(s)or due to abroken,settled or uneven distribution box. System will pass inspection if(with. approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system.required pumping more than'4 times a year due to broken or,obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstru:tion is removed ND explain: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner?1spp2ectiom" Date o 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 wili pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)than 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 aseptic 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 I 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 DAP 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: i i 3 Page 4 of I 1 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) Property.Address: Owner: Date of In pection: \ ; d(. . 15— D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each.of the following for all inspections: Yes No i/ /Backup of sewage into facility or system component due to overloaded or clogged SAS or.cesspoof e� Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool t/ _ 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 o"below invert or available volume is.less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ V/Any portion of the SAS, cesspool or privy is below high ground water elevation. _V 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 l 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 coliform bacteria and volatile organic compounds indicates that the well is.free frotr_ 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.] (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 nust serve a facility with a'design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ 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 3-10 CMR 15.304..The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CHECKLIST Property Address: 8 (. � Owner: -- Date of I spection: ` 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 VWere.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) V _ Was the facility or dwelling inspected for signs of sewage back up? ✓_ Was thesite inspected out'? it in ected for sto ns of break o b Were all system components,excluding the SAS, located on sate i/ 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 owneri.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 _ — 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)] 5 Page 6 of 11 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �(� A Owner: , Date of I spection: [7� OW CONDITIONS RESIDENTIAL Number of bedrooms(.design): . Number of bedrooms(actual): �-•� DESIGN flow based on 310.CMR 15.2�)3 (for example: 11:0 gpd x#of bedrooms): V Number of current residents: Does residence,have.a garbage grinder 1yes or no) Is laundry on a separate sewage system( es or noW [if yes separate inspection required] Laundry system inspected es or no Seasonal use: (yes or no, ... Water meter readings;if available(last 2 years usage(gpd)): 0341 7 /Z- Sump pump(yes or no): Last date of occupan [ L ./�f%L ✓1 �� j, COMMERCIAL/INDUSTRIAL/ 0 Type of establishment: Design flow(based on 310 CMR.15.2,03): gpd Basis of design.flow('seats/persons/sgft,etc.): 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: I `�/ V Was system pumped as part of the in pection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for.pumping: TPOF SYSTEM Septic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system.(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the.current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy'.of the DEP,approval —Other(describe): p roximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriv:ng.at the site(yes or no): 6 Paae 7 of i 1 ` OFFICIAL INSPECTIONFORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) r Property Address: laea- Owner: Date of In ection: BUILDING SEWER(locate on site plan)"X Depth below grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or suction fine: Comments (on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal.]ist age:_ Is age confirmed by a Certificate of Compliance (yes or no):_(attach a copy of certificate` Dimensioi,t. `�•� I �P V S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom f outlet tee o�baffle: How were dimensions determined: . ,( e,j 7 Comments (on pumping recomme dations, i let and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert evide ce of le age, etc.): y06 " GREASE TRAP/h(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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10A, a Owner: Date of In pection: TIGHT or HOLDING TAN . (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): - v 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 distrihution tc outlets equal,any evidence of_solids carryover,any evidence of kage into or out of box, PUMP CHAMBER/ )(locate on site plan) Pumps in working o✓✓rder(yes or no): Alarms in working order(yes or no): Comments(note.condition of pump cham7:)er, condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S Owner: Date of In iion: 1 SOIL ABSORPTIO 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: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of por_ding, damp soil; condition of vegetation; 1 4 p CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and confiQuration: Depth—top of liquid to inlet invert: Depth of solids laver: 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.): PRIVYA(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.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 'x, Owner- Date of 4p�ection: C SKETCH OF SEWAGE DISPOSAL-SYSTEM Provide a sketch of the sewage disposal systerr;including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 101 feet. Locate where public water supply enters the.building. i sf✓J � ----. 1' �I l /o 'i'�n I i Y�`� .l �-nil � a 10 Page l 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert Address: Y Owner: Date of I spection: 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) VAccessed USGS database=explain: You must describe how you established the high ground water elevation: /� /�,�r•���� Tip®oar le' L,- , 5, / 1 f j I 1 I i 1 i 1' i 11 Permit Number: Date: Completed by:. -7 W HIGH GROUND-WATER LEVEL COMPUTATION Site Location:_ /(/� (�/✓ri�(� Lot No. Owner:_��� / �1Q Address: Contractor: �Orr' 6/�GT� ���s Address: ,5�. - Notes: STEP 1 Measure depth to water table l� tonearest 1/10 ft. ............................................................................... .Date month/dav/year I STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: 0 Appropriate index well................................ .................. OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to 2A water level for index well ........................... month/year ear STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ........................................-................................................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water q 7level at site (STEP 1) ............................................................................................................. / Figure 11--Reproducible computation form. 15 }t A � ` if U � r i .i 4 i 4 . j P }1 . �4 a j{ a s .. �•2 f.1 j X i :, Vv , Il Town Of Barnstable Regulatory Services . Thomas F.Geller,Director .......... . Public Health Division s i • Thomas McKean,Director 1 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790=6304 Installer& Designer Certification Forth Date: .- Z/- e. Designer: 6 Akkk-,A) UA E !JEA ka - Installer: g,;, ) c., k,.ss r y.6 Address: p e a,e Q A i Address: ���T s.4,.Jdw��t`y�j/ Cza'3•J t.loSr �•.��?u..r,� On 2- e?-o r- g V was issued a permit to install.a (date) (installer) septic system at p w gsr�rCr, based on a design drawn by (address) A f dated Zl�- L�o' (designer) I certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. ����N Of`MAssq D cy , (Installer'sSignature) All 0 ��GISTER J �l SANITARNA (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC S�ALTH D SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOT111 THIS FORM*AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE P R LIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer:Certification Form I f ' TOWN OF BARNSTABLE LOCATION, I�t E Tfl�. C/��(�c- SEWAGE.# 2ooS-o C VILLAGE 6 Jj s- ASSESSOR'S MAP & LOT KV -/OT''r INSTALLER'S NAME&PHONE NO;, 1,40 k41 SEPTIC TANK CAPACITY EXl -_r / a-A asr LEACHING FACILITY: (type) 2- rLsd M (size) /�3'����X Z' NO. OF BEDROOMS 3 BUILDER OR OWNER al/CoLo. wr ilk o y d PERMITDATE: Z-ZR-os- 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 off_�► .Gz _z 9'>2._ 2-or— ,i c7��idr glbl I s62 �✓ - No..........1.O-Z... w Fx$...!2.5...—�... THE COMMONWEALTH OF MASSACHUSETTS C ' BOARD OF HEALTH .......OF....A6a. 11.Y.L.......... .s� �&.AppIiratiun for DiipuuFal Works Tanxitrurtiuu rnmit Application ' h eb made for a Permit to Construct ( ) or Repair ( ) an I dual ewage Disposal SYStezn at: �� ....... Loca Addr s � ... . ........... _........ ............ "..... .............._.............--.� F�... ° 1 h�}�----•------------•••. ......... r — Address a ._. ......... ......... � Installer Address Q Type of Building Size Lot. /_/.y�- -•-•-----._Sq. feet Dwelling Te�No. of Bedrooms _•....................Expansion Attic ( ) Garbage Grinder (vj: Other—T e of Building No. of persons............................ Showers a YP g ----•------- --------- P (� ) — Cafeteria ( ) QOther fixtures -------------------...................................................... W Design Flow .._......_ ..~........ allons per person per day. Total daily flow......... ....... ?:.................gallons. __, WSeptic Tank Liquid capacity./ ...___-gallons• Length............... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width............_....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./----------- Diameter........... Depth below inlet.......... ...... Total leaching area....oR—0---J-sq. ft. Z Other Distribution box ( Dosing tank ( ) ---- Date..�� a Percolation Test Repu1ml�rPerformed by...... _-s✓Y�j _i................... -.17 ..._____---_-..-_ Test Pit No. 1................minutes per inch Depth of Test Pit.....-----.......... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•--• I_---)-_-------•-•-•-------•--•-;- --j---- -.. -------•----•--------- ----- ------- Description of Soil-- g .. --- ••-----__--_-'= -'-. _ . �------=---------------------------------.. U ® ��-- 4�/9iTI e SO 6 q/ - .---- x2...../ ,--------- 4)( --------------'--------------------------------------------- ----------------------------------------------------------- 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 TI.T E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be 'ss�u'ejddby th board of health. Sied... .•..�... ........................................... 7./..�../. -...._.... Date Application Approved B ..---.•.... '5�==-1-�- 74:_ = PP PP Y•--•-• - ••- ---- 1��.._._ Date Application Disapproved for the following reasons:----•---------••---------------------------------------------------------------------------------------••......- ---------------------•---..................-•-•------•-. ------------------------------------------------------ Date Permit No......................................................... Tssue&---/ 7! .` S Date �_ I No. Fss.....?..:5'--�. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , t ,�, py iratinn for Binvon,al Works C�onn�xnr�inn rrani� Application is_h re y ade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal stem at: ......... --.--• ............................... . .................... Lq �!./ Loc G46j ............................................ Owner Address a :.:: •.:.. •--------------•----• ----•-......--•--•---••• Installer Address // t U Type of Buildi Size Lot-__V ..............---- Sq. feet jap Dwelling VNo. of.Bedroo :2..,.�..............Expansion Attic ( ) Garbage Grinder ` a Other—Type of Building a ...... No. of persons............................ Showers Cafeteria OtherfipiftiMgs ..................................-•--------------•------------------------------------------------ -- ---••---• DesignFlow.}_.. ..... .. W L ,gallons per person per day. Total daily flow.........� " . .............gallons. WSeptic Tank Liquid capacityi gallons Length............... Width................. Diameter -----__-----__Depth... x Disposal Trench l�o _ Width.•.. ............ Total Length........ Total leachmg.ar --W sq ft. Seepage Pit No Diameter._..___.._".... Depth below inlet.................. Total leaching p g o46 ft. Z Other Distribution box:(; Dosing Percolat 1N►�rPerformed by - � ) � /Vy¢ - est u .::. M"T ... Date....'...................... TestpPit No. R___.,---- .....minutes per inch Depth of Test Pit..................... Depth to ground water........................ Grq Tesf�Pit No."2._i`...._......minutes , per inch •De th of Test Pit._._._....._p p _.. Depth to ground water....:................... .... . ........................................... es�rL i o o ,r V ��`---------- ------- ------------------ ----- c ---•---• •-•--------•------•-•-•---•---••••----•-•---••--••---•---•----------•- W #-- -----"" �L U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------- --------------- --------------------•-•------------•-----------------••--•--•...................................................---------••-------•--------------------------•-•-•......-•-----•-• Agreement. y The undersigned agrees..to,.install the aforedescribed Individual Sewage Disposal System in accordance with ?the provisions of TIT.Lip 5 of,the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of'Compliance has b issue byte board of health. S .....__ /......... - x'�• Date Wr .'Application Approved By.... .� PP PP V------------7-------------- � /Date PPlieation Disapproved for:the following reasons:.................------•-----••-------------------------------------•------- ---••----• . •--- ••----••. Date Permit No .__...._. Issued_.................... •--•-•--•--- -�f ------- Date--•---•.-----------...••--•---- THE COMMONWEALTH OF MASSACHUSETTS w: BOARD OF HEALTH .. ...... .OF........: ,�Ct! .......................... Tntifkatr of f amplianrr TI,F ; I TO CERTIFY, That the Individual Sewage Disposal System constructed (�'or Repaired PO ( ) by......V.K. : r-- ---------------------- ns alter • has been installed in accordance with the provisions he m.r rof'The State anit d P &_' / S FY e scribed m the i" application for Disposal Works'Construction Permit N --•_-_• ____ dated` u.:---- ----------_.___..............._...... _.. THE ISSUANCE �OF,:THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO' N SATISFACTORY. DATE..................................:.._...............-------•--•-. ......•. Inspector --•----•----•-•-•---------------•-------------•--•--...•--...-------•....--------- T E COMMONWEALTH OF MASSAC USETTS 7 BOARD F HEALTH �G .! .........OF...... No.... FEE....:.... in�rar kn Teilnotnuliou Vamit Vs s 64r is hereby gr ted °_..... ........ ..................................................... to C ( or ti' i ivul 1 Dis al Sys ti at No. == 1 �t .... str t as shown on the application for Disposal Works Construction Pe No __.__ ___. .Dated.. �-t. ......... ...... L � w..---•-. •-_----------------- + Board of Hea �DATE......................................................... FORM ,1255 HOBBS & WARREN.-INC.. PUBLISHERS r L,&tL:q Low = 110 V. 3 + SSO G•Rn � 1' 1IC = 33Od 1S0 r7 P.D. it E- t o �.L.U S OD 6 M i SQGu/AL- jv-E.A. = t50���.� 1 i s ;i i i 1 y 1��0 ' SF C�.P.�. Off. Bvr T0AA A SEE SD S��'. � 1 0 � � SO G.PD. i � I if � , ; I ` -- ( .g ;�' �, , ;:�, • TOTAL -C>Ej.%6W 42S G..P.D. o &L -oal��r � r 3 ,t=w TT w Iuc�1.eT►o�J szo-t'ar: r l"�u 2�tlll' otz is t ���,StA ��� ', � I �,.��,V�•�._.-... �5� i� f ' ,� 1 t ; r: t {. i { fj f1Q .r/ 'r � ,} I f �t r ! i 17�'r RtCti' 11 = BAX1GR N �'.l� 1 ,1' �{�1..tiil� � i.i t :-:, f Y ;. , { r i I � 1• '{ � S.~ ,f E No.2?'048 '}• • y, ��I i j I �: t 1 1 { i r � t'�(�I�' r��r� 1�. �t•i i 3 - q t.1 1' f- i.e: f'. I tee• . 97. , '. 'T1=5T 3 f � i s t • i.- To�I;Fwv ��po,d t `• S�F1S01 t QrRj°E' 1;)ISY.. IW GrAL QG.7 Of # t o r f LAB OP l SA 44 STOrJ�c 1 • , � i tit ` I I" � ` J ,. is ,}r C.EQZ'tF1ED pl.oT t ...a� ` 1.OGATIOt`J , . 7 1 I I C-Mlz-rIFY TkA:Ir Tlac �-ov+JZ;&T*lC) .5"ow W t PL4 R���IZEti\tc>= �E. "Mn6a G(:VV%pLVG ' W ITk TWGr 51Ue.LiwC-- I I Ati.Jn SETl3��IG: >~[4vIQErVt�+� �, Ot TNT. :: I ;, � '±- � •�'" �'j. � f I . -raw►. of �,A2�J„7`Q� � , • { 1 ����T. ,� f3 . CJA7E ,t i ! ( TI-ItS ` C7C.A►.1 IS' �-IU"C We- 0S.T.E 2 1l.l.Cz a 14�ASS. i . F i. 'tlJsrn �•c..r_�•tr �.ur��i►;=Y ,� TcaC: :c�F�:;, �5, S1.taauL�► nNl s { __ 0f 6 �� LOCATION ,wg, ' SEWAC. E PERMIT NO. V-1LL-A`GE 1NSTAlL It-'St NAME ... & A,"RE$,:SIle M U I L D E R Qk .. -OWN ER,_.. I� QATE ERMIT ISSUED DATE ''-CO�M ►LIANCE ISSUED e � o T No...................... FRic........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town table Town ......OF...........BarnS. ---------------------------- -------..........Appliration- for Biavasal Works Tomitrurtion Urrmit .Applicatio is hereby made for a Permit to Construct (X ) or Repair an Individual Sewage Disposal System at: .................zi.. ....�JCAO., ...... ----------------------Hyaimiz-PAU.......................................... Capricorn 1�99* Add or Lot No. ...........................................:M.!E�t......................... ...*...7b.5.. ....H-var ................. Steve Lebel Owner Address .................................................................................................. ................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..........-9..............................Expansion Attic Garbage Grinder P4 Other—Type of Building X4Mh............ No. of persons............................. Showers ( 2) — Cafeteria 04 Other fixtures ...........................................................................................................................................7.......... Design Flow............55..........................gallons per-person per day. Total daily flow.............330......................gallons. 9 Septic Tank—Liquid"capacitPPQ..gallons LengtA'.k....... WidthA*.10'.'-. Diameter_.............. Depth.5-'..8....... Disposal Trench.—No- -------------------- Width_.-.------...-----.. Total Length..-----..-..-.-.---. Total leaching area....................�sq. ft. Seepage Pit No----I............... Diameter.--.6............. Depth below inlet...6.............. Total leaching area....266.....sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by-----Eldr-e-d9la..Enginaering........... Date__11.7n2.5:n81............... a Test Pit No. J, 2.0 minutes per inch ' Depth of Test Pit....1,21!........ Depth to ground waternone...enc.ounte eR 44 Test Pit No. 2... per inch Depth of Test Pit.N/A---------- Depth to ground water---YVA............ P4 ---:..................................................................................................................................................... 0 Description of Soil.................0.1.......2.9..........loam..&...tapsoii----------------------........................................................... U ....................................................2 .i. ..........Q.,......MeAlum...Y.e2lo w...sancl.................................................................... ..................1.0.......-____12.........med,,...white..dand ............................ ...... . /txw4.c.ejd...of_..graV.e.1/M...Wester-.at 12' U Nature of Repairs or Alterations—Answer when applicable.................................................................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 1 T4 I-E '5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of C I*an has been-issued bX the bird of health ApplicationApproved By.... ................. ........................................................................ ..... .. . ........................... Date ti 0' "ompian_ S,I n( ....... ... /,Z --------------- A following Y Application Disapprove or e following reasons:................................................................................................................ ................................................................................................................................. ....................................................................... Date PermitNo......................................................... Issued....................................................... Date r � k z, .ri, ` No. ......... FEs.................... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town......... .....oF...........Barnstable Appluation for Dispuiial Worka Tonotrnrtinn ratnit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: \ 1 E.� ✓' •---•--•- ...... ��s::.::1�...�.�a-----�.�,.�-------- ----------------------- . Capricorn ocat n-Address or Lot No. ea t - 1 rust ....................-•--••----•-----•• -•------y--- -•------------•---•----- �65 Fal�nauh Aaci. .I:i,Ynnis................ . w Steve Lebel Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U. Dwelling No. of Bedrooms........... .Expansion Attic Garbage Grinder A4 Other—Type of Building _raneh............ No. of persons............................ Showers ( 2) — Cafeteria ( ) Q' Other fixtures ---------------------------------------------•••-- -- d ------------------------•---- .... ............ -------------- w Design Flow.............55......................... 00 h... gallons per personn per day. Total daily flow.............330......................gallons. 04� Septic Tank—Liquid capacity1---0.-_---•.gallons Lengt :.........:.. Width-_4'.-.10."_ Diameter................ Depth._58_..... Disposal Trench—No..................... Width...:................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....1______________ Diameter....�..._._..... Depth below inlet..:b.�___.:_...... Total leaching area._._.2( j....sq. ft. 2 Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed b .....Eldr-e-$ e..-En inezr ... Date_.1.1-2- `�a Test Pit No. 1. minutes per inch Depth of Test Pit....12!......._ Depth to ground waternOne...janc. t@ - f= Test Pit No. 2...NIA..__minutes per inch Depth of Test PitY/A.......... Depth to ground water_Y .0 ........... e ..........................................................................•...---.......--•---......-----..........-----••------•-••----•--...---...•---- O Description of Soil.................... �----'--.2�.........lOs'i.Ill..&...t0.�18.0-�.................................................................................. U ••••......-•--•--•-••---••-•--••••......---•••. .. Q-.------.medium-�e1] ow._sand---------------------------------------------------------------------- x ...............................................1o......-----1-2 -- - __--........aned,t---�thite-...sandf__tre.ced--of--gavel/no...water---at 12' U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bird of health. Sign � � --. _.1. .:3. r .._.... •_.. e ApplicationApproved By... ........ ......................................................................... .... ....--- Date Application Disapprove f VT he following reasons-----------------------•--------•----------------------------------------------------------...--•-•------•------. --•................••---•••--•--•--........•••--....•---••••---•------•-------•---••......_..--••-------•--•••••••••.--------•-•--•-------•----••••-•••••--- ............................... Date PermitNo..................•---•-----.....----•-•--._.....---_._. Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................Town.............OF...........Barns.ta b1�......................................... Trrtifiratr of Tantphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) bY----.....S ave..Nebel.......................................... .................................4............................................................................ Installer has been installed in accordance with the provisions of T r' 2odThe State SanitaryCo escribed in the application for Disposal Works Construction Permit No. '". ..:.............. dated_ __ ._ �___._.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM W L FUNCTION SATISFACTORY. DATE--`3 ..y. -.--._... :._.. Inspector.. -----------•-•----•---------------------------------------......... THE COMMONWEALTH OF MASSACHUSETTS 3 i BOARD OF HEALTH .�.fool', ......dawn........................0F...........Barnstable.......................................... No.----•--................. FEE........................ Bispwi t Workiinn r inn r ntt Permission is hereby granted.........S eV-e---L-ebe1--•------------------------------•----- ---------•-------.---------------.----------------------••--- to Construct t ) or Repayyr ( ) an Individual Sewage Disposal System at No. LD '. t , ,� ' t �,-P'� •----........ _ C ....�._�.. ......... ..............�._ .._•__.__------......_._.. ...... ._..._ .___ Street A J`� �. as shown on the application for Disposal Works Construction Permit�..... ....... ated. ____._- ..._ .......... . �� DATE................................................................................ oard of Heal FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 OF 2W4 ®re•rE yo I t ss �No sunk` G//:E!Cz_ wA , .•'A+_ F- torh 0 1y G' 10 x SEP � Wo.O / 3 . TEST Gg�D+ --- j TF3M @ o 1 toy 4 S . (3 . Lc:) l L or I �f � LEGEND an • , CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO EXISTING CONTOUR --- O --- L-07 141C-Sr10/I R� FINISHED SPOT ELEVATION FINISHED CONTOUR 0 - MORSE v; IN No.10951 0 APPR®vEo = BOARD of HEALTH � DATE AGENT ►�e�°�' SCALE= / 3 D ' DATE LDREDGE ENGINEER'" COt NV �?,ar✓ev CLIl+NT - ( CERTIFY THAT THE PROPOSED EGISTERE REtGISTERED JOB NO. Fr1`znS' BUILDING SHOWN ON THIS PLAN- CIVIL LAND DR. A ,i4 •M CONFORMS TO THE ZONING LAWS i ENGINEER URVEYOR OF ®ARNSTA LE , CIS 712 MAIN STREET CH By J 122ti 8'L _ HYANN I S, MASS. 2 -. -- - SHEET-L OF A E G. LAND SURVEYOR NOTE /F E/TNER TKE S'-FPT/C TANk OR w' 20 FT. MIN. IEACN/1vG P/T ARE MORE 7WAA1 !2 BELow /O irT= /•�/k ::FRAOEj .A 24'O/AM ETER' CONCRETE COfiER Sj,/ALL BE BQOuGNT TO GRA DE. // .E:YTRA CpNGRETE q�PYC P/PE �yERVY CAST /RO/Y C01/ER .SHALL 49E USED /F/N ,DR/VEN/A Y COYERS '/B�oFR FT. 2 . M AN. CDNGRE'TE dAOE COVER CLEAN .SAND �:=: •�. - _ . . . BACKS/LL /OOC P/PE' -y M/N.PITGv. GAL. o • • • • • ••� / WASHFOSrONE "RON/rT. SEPT/C TANK D/sT. • b , , . . • • ,� . BGX o • 1 8 • r • • • � •� t s f • J • • • r 3l4"— I �2 ♦ p EFFECT/VC • • • • • • • • • ' 0 WASt/ED STONE •,_�_ DEPTH n �7d D • • • • • • • 1 !• o • �i JFl�jc 2. / • • a� • 1 • 1 • • • • • 78 x C'� F ¢v :4/T�/�"tY i a, • • r • . • • • p p PRECAST SEE'PAaE r - `. ��TL�{/�A-GlTy � - s p. • • • • . • • • • ® o P/7DR EQU/V, i lAvzArT MP 90.0 /NYERT,AT.Bf//LD/NG.. S•O FT. ; . !HEFT SEPT/C Ti4NK �I7.0 FT ry f? D/i41►'!. C SEE Ts+BULATIOA/� Ot/TLET SEPT/C 7ANk 1? /HEFT DISTR/B!/T/ON BOX 96 SECT/ON. OF GROUND P.(;47,eR TABLE P 0U7ZE7-D/37R .90WON BOX 1?6,4 FZ INLET LgACHMr, PiT 3�o FT SEWAGE 01SP05A L .SYS7AffM TABU.LA'r!D/V LEACHING P/T� /3ENcNM/t;2CuscA /MENs/oN A FT. SCALE %p /=D DES/G/Y CA,TRA1A [O'T5 7 $ I,y�xs/oN $ FT. NUMBER 0/�BEDROOMS 3 D/MENS/ON C ..f F7- G.+ReAGEDIsPoswL.uwlr r/o SOIL LOG So/,c. TEST TOTAL E.?T114A7-ED.FL0W 3 30 GAL- PAY SO/L TEST A/ SO/L TE57'�I 0T-7 NUMBER OF LEACIrlNG p/rS_l ^Ftev 19.3 ^-ELFY. 82 PATE OF so/ TEST SIDE LrACH/NG PER P/T J - SCrt PT. O _ y ' -- M RESULTS W/TNESSED BY'/R E J^ E`D3 I I B0TTOM,LZ4Ci//NG PER P/T 7 SQ. FT. G,�,4_..� O-4 sUf3��L_ f'ERCOLAT/O!v RATE#/ S S M/IVV/1IVGI+f TOTAL.LEACH//VG AREA ��'b S.Q. FT. S`� S° PERCOL1'1T/ON RATE iEb2 � �-� M/N.IINCH. � . ZiCU �'0 RBSERvFc EoCNI/V6 AREA SQ. F T IMzE r> i7 0�l / m AA . � ZNOF'�s 4 1Or/y,�s 5 _ /2 Z ID SANS �D T !// ar TO :v 7 / ! / Al i .< 'n ��1 PIfJ�VIHITC a, 4CRSE `j p C7 2A t/ - , I '4 T 'z to=12 "D EL DREDGE ENG/NE�R/NC CO l NC. to 2W4�� A p No.10951�Q<2 / <-WAvEL Q. I`L/ 5 -� ` --L �7.3 EL= -70. t 7/2 )"A/N ST. , HY9NN/S. MASS, h0 SUR�� ��� ` � ® ND GROlJNl7 yYi4TER ENG'OUNTFREo CL/ENT:FTZ 4•y cv DATE J 9 9- A t `•a'fa9�a Q GRO U/VO LVATER AT ELEi/ - .108 NO; crC Zoe SHEET Z OF Z S ASSESSORS MAP : 2�1 TEST HOLE LOGS' NOTES: EL G 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH O PARC I�7 da THIS .PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF X 0 SOIL EVALUATOR , IM Pt✓, C1-�7• C ShitNS1"LE BOARD OF HEALTH REGULATIONS. o � x: FLOOD ZONE : ON �Zi�Q,�p WITNESS • r- - R-E� ly, --+ =sue REFERENCE S(p(p0�'L DATE: FF P.J t 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, nd s PERCOLATION RAT : 2MItj ,{l � SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO �� GI.PrSS Pd INSTALLATION. o r SOIL tIA IliB .T1RrZ-o19 / cm ----- ---------- rl" - TH- I TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION R _ V ONLY, .AND SHALL NOT BE USED FOR PROPERTY LINE x� r �.. D ; 4�r + ©r V�IN`O t'� V►1[ �— ( G yil►2v ��($ uk�,q g Ir1 1 A 10� '�'! DETERMINATION. -- — - 1 1 p,So 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS H,nc 8 LOftM. SPECIFIED OTHERWISE) o B S ,( ' N 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A LOCATION MAP 0_1-.$) . A 1, GARBAGE DISPOSAL. M EbiVM E 6) SEPTIC TANKS AND DISTRIBUTION BOXES ('WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON C• A BASE OF 6"OF CRUSHED STONE. 7) EP5-P 44 . I, Alit+ PITS to pV j#4 F_jpj C,47*EO 5 I�EMov�-� PS-9-_P t-F�Y. WL A-&G W16t.G4-iJ AAW. Srt !D1 g. .�_�LJOr1__�_�wwh'[� w�.u.5_�!'��1_H__1.�D_�_Q�_I_�P _ I��P�,�•}1► SEPTIC SYSTEM DESIGN �� �10 wlrrLq-t� i- �1N 1501 or- PkoP ra�Nj. 10. �lo VA-pI"tES r-1eojt TITLE \1 oI -lb W n/ or- FLOW ESTIMATE �A izN5T-Pr6Ls BaAYLO or-_ h-i--T - .P-E S v)e!). 'x BEDROOMS AT I0 GAL/DAY/BEDROOM - 330 GAL/DAY I SEPTIC TANK %�GAi_/OAY x 2 DAYS - �OO GAL tyj.5TIlu E(6770JGI o ONE 1K Et PITS USE (Q2j GALLON SEPTIC TANK - ;)(IST1N(� . 9-4-&? 0r IN/ l�SUO y�ill� KIP SE,PnL_�>� i r- r-p-tL�, J��69 (�'� B6 IZEIuouE:O� (n�or� 1� SOIL ABSORPTION SYSTEM vR- flit 1,2-e,0 62 104.84 62 6 60 USim (2) S00 GaL4,pd PWA51- LC C1m136t-s # wl ic° ,jiu ` L I 2S S=DE AREA: [(ZA5) 2- +- (t3�Z�XZ- x 0,7LJr i \ BOTTOM AREA:- 25 x 13 X U •7�/ = Z o.So 13 .E , sN 353 G P 6 tt O ctj5:r7A.;y t •�'L se�rr� �,� , �� SEPTIC SYSTEM SECTION o . - `f+ Uwe �. `(IN y � EXIet S G � >� r3Q•,c,� cZA Nil ovc,s � Sb of 4n;ski — - thSfAtl �N BENCH MARK 7S g�llflt �' 5�.50 G FN 2„- t T TdP O62•ao+ L O / S �r EL �� TOP NUT OF HYDRANT �l tom. O L� l� D- 0 SS.t3 A EA = 11466 sf +- ELEVATION - 61.62 GAL CL l=1 �1 U USGS DATUM ASSUMED -I - SB•3D (�tr � 1LSf" tK , IASfal�ry SEPTIC TANK / 58.E W �G L_l t=11 Sf'v.� 1 � v�ntSS 6/ o j / ' fifer ^�Sn��_ 3j4'_I '� �vb�c 0 5� w / / (--25'L X l-S'cA) ---I 2.73 f t / / 'jj�on'aM o r- 7EST-,—to fit, SU s� 9 / -I, E/ j�OFMgss 23� 60p OF PAvEM I a�� o R E m SITE AND SEWAGE PLAN 8 ft ✓� E L� ..-� I , . 1140 LOCATION : � S G/sTE�a - q1VITARkP / PREPARED FOR : lGOI� /Ll�t�ayfl' DARREN M. MEYER, R.S. SCALE: W DATE: 2 / U� P.O. BOX 981 < EAST SANDWICH, MA 02537 W DATE HEALTH AGENT Ph: (508) 362-2922 3 W I i