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HomeMy WebLinkAbout0011 WESTON CIRCLE - Health 11 Weston:Circle Hyannis P A = 271 190 H Ii u 1 G A trYLI N F a No. G �/-U 1 Fee 7_+,- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—cam PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Applitation for MispoSal 6pstrm Construction Vrrmlt Application for a Permit to Construct( ) Repa`�Upgrade( ) Abandon( ) ❑Complete System ndividual Components i Location Address or Lot No..// c/02 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel A 71__/ a / Installer's Name,Address,and Tel.No. Designer's Name.Address,and Tel.No. Type of Building: I f j� , o4 Dwelling No.of Bedrooms �( '�Loti ize sq.ft. Garbage Grinder( ) Other Type of Building 1 0.of Pers s Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) pd D gn flow provided gpd Plan Date N er of she Revision Date Titlej,j�j//� Fr Size of Septic Tank• " /d�T�ri��0®®gyp,', Jype of S.A.S/C�e'?40-'�4C Description of Soil y Nature of Repairs or Alterations(Answer when applicable) G�c �iJ'��" '�®/� � �/j'ea •/�� G ®!i ems, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H h. Signe Date 6 0 Application Approved by Date Y 7 l Application Disapproved by Date for the following reasons Permit No. a,01 7 .2 C Date Issued G✓ y I Y �Y+'ty"`"w°'h.ffi ��.yx'/+N°f.r-r-r�rr�.,.._n. ^f:^,:.h Yr-r.. ,r ti. :♦ .tiry.•:y'-ta-.a"r,,:.� r.y�fia. ,4r}. .; . . c, . . .s +. cr` �` ii.`:t ?,ry'� ° i,...i.:t..��.�r�'" . No. ! Fee '. THE COMMONWEALTH OF MASSACHUSETTS -Entered in computer: Y PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS 0(ppliLatlon for ;Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No;// p p.Te' � CLOY Owner''ss Name,Address,and Tel.No. Assessor's Map/Parcel "� � �r r �^"r 6i�' '7 0�pop? Installer's Name,Address,and Tel.No. Designer's Name Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot 'ize / sq.ft. Garbage Grinder( ) a Other Type of Buildingc � , o.of Pers.©ns Showers( ) Cafeteria Other Fixtures h.T Design Flow(min.required) gpd D ign flow provided gpd Plan w Date N er of she s Revision Date 1 Title Size of Septic Tank.eX e- ;77 00-1�l61'049 0:;oeo Type of S.A.S#C ��','G, ,r'�✓'+�'✓'°''.`�'y�t'r/�'�9a"'� Description of Soil _ ! t - Nature of Repairs or Alterations Answer when applicable) Date last inspected: 'a' A reement: s fA, 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 system in operation until a Certificate of ,r Ak Compliance has been issued by this Board of Heath. r" t011 Signed Date Application Approved by t s VL Date 7 1 7/7 Application Disapproved by Date for the following reasons d U 7 — r* ( Date Issued Permit No. _ - - - - - ---- --- - - - -- ----- - ' -- ---- ---------- - i THE COMMONWEALTH OF MASSACHUSETTS j �o BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) r Repaired Upgraded( ) Abandoned( )by .0" Z eo1.+1 e��� TAG cJ gd6y 0..-C,6c' at A''+�+E./".71 Gr "ji-I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,� 0 a0 dated 3 I Installe4_..1,,W 4 O e4:, 4 Designer #bedrooms 04 r d-Oer Gn f Approved design flow — d� 6, gpd The issuance of this permit shall not be construed as a guarantee that the system will fanctio designed. fl' i�� Date' �� �� Inspector No a.G(�' �t)( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction i3ermit Permission is hereby granted to Construct( ) Repai °( ') Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of this permit. Date �'b- 3 / Approved by ! � i Commonwealth of Massachusetts Title 5 Official Insp ectibn Form ' .11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address 1 Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020, page. City/Town State Zip Code Date of Inspection t' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 1514 on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name key. 19 Hummel Drive Company Address South Dennis MA 02660 City/Town State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails SNovember 17, 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 1 c Commonwealth of Massachusetts' l�� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 11 Weston Circle Hyannis M -271 P- 190 .� Y u— Property Address Christopher Poire Owner Owner's Name information is required for every Y 11 Weston Circle, Hyannis MA 02601 November 17, 2020 Zip de D f In a e. Citylrown State p Co ate o Inspection P9 C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System stem 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This i guarantee r warranty on the future working conditions of leaching, pipes,Inspection s not a gua a tee o ty g g, p p , components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 2) System Conditionally Passes: ri n i El one or more system components as described in the"Conditional ti on alP ass 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 tan 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -[Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, y Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to AR Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts is Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P - 190 Property Address Christopher Poire Owner Owner's Name information is 11 Weston Circle, Hyannis MA 02601 November 17, required for every Y 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This � asses system if the well water analysis, performed at a DEP certified Y p Y laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not ® 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. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 11 Weston Circle, Hyannis M -271 P - 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 � page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 19=,000 gals. g ( y g (gpd))' 18=,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occasional useDate t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitarywaste discharged to the Title 5 system? ❑ Yes ❑ No 9 Y Water meter readings, if available: N/A Last date of occupancy/use: N/ADate Other(describe below): N/A 3. Pumping Records: Source of information: No pumping info available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P - 190 u Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: D-box and leaching were installed to existing tank on 5/20/04 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line.: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �= Fig Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P - 190 Property Address Christopher Poire. Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"with riser to 6" 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: 5'X9'X6' 1000 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness thin layer 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 16" How were dimensions determined? probe/measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: N/A p g feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions. N/A Capacity: N/A gallons Design Flow: N/A gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I �I; Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 u� Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis ;MA 02601 November 17, 2020 page. Citylrown 'State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments(note if box is level and distribut on to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order. No evidence of solid carry-over or backup in the past was found at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 v Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 infiltrators withstone ❑ leaching galleries number: 30'X 10' X 10" ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P - 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers had a low water level present at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �u- 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 `J Property Address Christopher Poire — Owner Owner's Name information is 11 Weston Circle, Hyannis MA 02601 November 17, 2020 required for every -— --- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 oy 3 a ` alp � r3V ` 3y ( 3 ✓ L/z ' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P - 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, Hyannis MA 02601 November 17, 2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10.0'+ 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: 2004 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: Test hole recorded on plan showed no water found at 10.0'. Bottom of leaching at 3.8'was found not to be located in the high groundwater elevation at the time of inspection. System installed to plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form T �I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle, Hyannis M -271 P- 190 Property Address Christopher Poire Owner Owner's Name information is required for every 11 Weston Circle, y Hyannis MA 02601 November 17, 2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts °?�/�! / W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmen v,:e 11 Weston Circle Property Address h+1 Chris Poire �' Owner Owner's Name information is H annis MA 02601 6/26/2017 r, required for every y ry page. City/Town State Zip Code Date of Inspection h�"A iu5�1 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. Impgoutf When A. General Information fillip out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key.=A Company Name 4 Glacier Path Company Address rem East Sandwich MA 02537 Citylrown State Zip Code 508-833-2177 S 1287 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 zl==01� June 29, 2017 Inspector's Signature 1 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.doc-rev.6/16 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 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. Cityfrown 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 information and obsrevations contained within this report represent the condition of the system only on June 26, 2017 at noon and does not idicate the condition of the system from this point forward. 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.doc-rev.6/16 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 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 Y2 day flow l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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 ❑ ❑ 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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 ude laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: 2015; 76,000 gallons and 2016; 82,000 gallons Sump pump? ❑ Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): r G ease trap present. El 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. Citylrown 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: Board of Health 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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: 5/20/2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): � Depth below grade: 30"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon typical Sludge depth: 6" t5ins.doc•rev.6/16 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 11 Weston Circle M Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. Cityfrown 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 26" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 2 Distance from bottom,of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): After inspection, system was pumped for maintenance pumping purposes. Effluent level with outlet invert. Grease Trap (locate on site plan): Depth below grade: feet 14 Material f a o 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• P 9 p Y Page11of17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every YH annis MA 02601 6/26/2017 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 Level with 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.): No solids carry over. Distributin box deteriorated. New H-10 distribution box installed with new riser& cover. 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.doc•rev.6/16 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 c�M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-infiltrators with stone around ❑ 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.): Viewed internal with camera and no standing effluent. No indication of failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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.doc•rev.6/16 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 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is H required for every y annis MA 02601 6/26/2017 page. Citylfown State Zip Code Date of Inspection D. System Information (cost.) 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface 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 °wM 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: 20 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: Groundwater contour map ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Utilized groundwater contour map Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 11 Weston Circle Property Address Chris Poire Owner Owner's Name information is required for every Hyannis MA 02601 6/26/2017 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 i t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE r ` LOCATION /% W,4 S1 d/d <r/" SEWAGE# .2ih)q-as Z VILLAGE b yA#1Y0 F ASSESSOR'S MAP&LOT-2 7 - 1?0 INSTALLER'S NAME&PHONE No. Arch G D 7,75' b Z SEPTIC TANK CAPACITY f} o0 LEACHING FACILITY:(type) I NF I L F ro r S `i (size))0 X to NO.OF BEDROOMS BUILDER OR OWNER (_,UfJbPrhi PERMITDATE: `l,�/O y 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 0 �4G 53 ;z http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=271190&seq=2 6/29/2017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsu rface Sewage Disposal System Form Not for Voluntary Assessments Assessme '11WESTON CIRCLE , L-1-1 LI9 V1y. Property Address Owner JANIS GOLD 6A owner's Name information is Owner's required for MA 02601 12/15/07 every page. Cityrrown State Zip Code Date of Inspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important- Whenlling out filling A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not Name of Inspector use the return p key. DOUGLAS A. BROWM INC Company Name t� R.O. BOX 145 Company Address GENTERVILLE MA 02632 -�I Ctty/Town State Zip Code 508-420-4534 M S 14297 Telephone Number; i License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addrest and that the information reported below is true, accurate and complete as of the time of the inspection. fhe inspection' was performed based on my training and experience in the proper function and mai tenance'of ohAsite sewage disposal systems. I am a DEP approved system inspector pursuant to S ction5�340 of Title 5(310 CMR 15.000). The system: Co ® Passes ❑ Conditionally Passes ❑ Fae ❑ Needs Further Evaluation by the Local Approving Authority v� ca Jr. 12/15/07 4n.pes 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. Title v Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. City/Town 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: ® 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. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 2 of 15 f Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner owner's Name information is HYANNIS required for MA 02601 every page. City/Town 12/15/07 State Zip Code Date of Inspection B. Certification (coat.) B) System Conditionally Passes(cunt.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board ofHealth(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.ry . PP Y• ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public wat er supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply I well. Title V Inspection Form.doc•OWN Title 5 official Inspection Form:Subsurface Sewage Disp osal posel System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". ti 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: Yes No Backup of sewage into facility or stem component due to over❑ ® Y Y p loaded 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 ❑ ® 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts lopTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is required for HYANNIS MA 02601 12/15/07 every page. City/Town State Zi Code p Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Fonn.doc•08/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA every page. City/Town 02601 12/15/07 State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? i ® ❑ Were all system components,104Kcluding 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)] Title V Inspection Form.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •'< 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is required for HYANNIS every page. Cityrrown MA 02601 12/15/07 State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms 3 (design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 1/06-240GPD Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title Y lnspxtion Form.doc•U8(Ufi Titre 5 official Inspection Form:Subsurface Sewage ojs{_SW S ystam•Page 7 of 15 Commonwealth of Massachusetts logTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: INSTALLED 5/20/04 OFF AS-BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•W06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is required for HYANNIS MA 02601 12/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 siteplan):( Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene - El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ---------------------------------------------------------------------------------------- Dimensions: 1000GALLON Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle _ 34" Scum thickness ' 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tide V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 11 WESTON CIRCLE Property Address JANIS GOLD Owner information is Owner's Name required for HYANNIS MA 02601 every page. City/Town 12/15/07 State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK COULD USE 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 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): TWO v kqxmfim Form.doe.oaros Title 5 Ofiicral►rmpectlwi Form:Subsurface Sewage Disposal System•Page 10 M 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for VoluntaryAssessments is < 11 WESTON CIRCLE Property Address JANIS GOLD Owner owner's Name information is , required for HYANNIS MA 02601 every page. Cityfrown 12 State Zip Code Datee of of Ins Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No i Title V Inspection Forrn.doc-08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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: FOUND OBSERVATION PORT, INFILTRATORS ARE DRY AT THIS TIME. Type: , ❑ leaching pits number: ® leaching chambers number: 4 ❑ 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.): OPENED OBSERVATION PORT INFILTRATORS ARE DRY AT THIS TIME Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '( 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection locate on site plan): ) ( p ) Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is HYANNIS required for MA 02601 12/15/07 every page. Cftyfrown State —ZipCode Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. AD - ate A F- -3`t AF — Lt.z A c� ,3E _ al C& , 331 0 � Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments x` 11 WESTON CIRCLE Property Address JANIS GOLD Owner Owner's Name information is required for HYANNIS MA 02601 12/15/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ® Shallow wells Estimated depth to ground water: 5.04FT ++ feet Please indicate all methods used to determine the high groundwater 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: BOTTON OF SYSTEM AT 54.1OFT--BOTTOM OF TEST HOLE AT 49.06FT NO G.W ENCOUNTERED TWO v MsperAon FormAoc•a8706 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System Pape 15 of 15 Town of Barnstable �Op tHE Tp� y�P ti� Regulatory Services IARNSfABLE Thomas F. Geiler, Director MA 9$A 9 6 ,0 Public Health .Division TEv fir" Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Town of Barnstable Regaiatory Services Thomas F.Geder,Director ,u Public Health Division ' '• Thomas McKesi Director 200 Main Street.Hyannis,MA 02601 Fax: 5oa-790-6304 Office: 508-862-4644 Instal er&Desi ner Cert�cation Form r Date: � i3 2� Installer: Designer: � VI • ��'�t�-I Address: Address: 1;D On n�/r jr Cd was issued a permit to install a (date) (installer):_ \�M04G - septic system at sell onJa riesign awn- y- �(- (address) VAAt)CV l,rl� dated 5 _ - ` / (designer) I certify that the septic system referenced above was installed to itantially teral relocation f the the design,which may include minor approved changes such disb*ution box and/or septic tank. 'c em refea�nc the ed above was installed with major changes (i.e- , i I certify that septa greater than Local.lateral relocation of the SAS or any vertical relo ation of any component but in accordance with State&Local Regulation& Plan revision or of the septic syst,eon �follow. �� t certified as-built by designer . �f Si G .S a7 .i (Designer's SignaSure) (Affix Designer's Stamp Here) PLEASE RETURN TO BARIYSTAB + PUBLIC HEALTH DIVISION. CERTIFICATE TMS FORM A" OF COMPLIANCE BY 1'IIE BA L M TR DIVISION. BUILT CA ARARE RE THANK YOU.. Q:Health/SepticlMsignerCertification Form TOWN OF BARNSTABLE �. LOCATION 11 G 'L sad/x/ c /" SEWAGE # 2dv y-as �] VILLAGE t�!,YiYN1.SF ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A I'c/1 CG d 71 S SEPTIC TANK CAPACITY /y'oo LEACHING FACILITY: (type) /'N f L rr a r (size) 30 NO.OF BEDROOMS BUILDER OR.OWNER b PERMTTDATE: 5, Iz O y COMPLIANCE DATE: S o2r1 v 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 LRehr 94 G - 3 cf 4G o y3 134 ;z I TOWN OF BARNSTABLE - LOCATION lI, GYL' S�� l /' SEWAGE # 2-ooq,a,� 7 VILLAGE y,d'yer i l f ASSESSOR'S MAP & LOT 7 `120 INSTALLER'S NAME&PHONE NO. A/'C/f G d 7 Z� SEPTIC TANK CAPACITY .1 y Oo LEACHING FACIL=: (type) B N E i L rf"A rQ P;f _ 41 (size) 30 x to NO. OF BEDROOMS BUILDER OR OWNER Uz, b 1 PERMITDATE:. 7 N COMPLIANCE DATE: S d2d v 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 4 d � c � O � A � � � �� � � w � � � � w� � � ,� � � °Q t No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes v PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Oiitpozal *potem Con!5trurtion Permit Application for a Permit to Construct( )Repair( )� Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Add r Lot No. C // // Owner's Name,Address and Tel.No. 11 VI 5'7 0.0/ .ec% i �Q,►U CJ'U ij I//—= A T d Assessor's Map/Parcel oZ7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 77-/ - SAS o J Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building TT No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil . i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: �~ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Boar ealth. _ Signe Date ✓� Application Approved Date Application Disapproved for the following reaso s Permit No. Date Issued F3 _,V3 J i y ' V � Y No. // 1� D Fee .� THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer: Yes ,PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for tizpozaf *pgtem Construction Permit Application for a Permit to Construct( )Repair( ;-)-Upgrade( )Abandon( ) ❑Complete System El Individual Components i Loca o Addr s Lot No. mac% ,� / Owner's Name,Ad ress and Tel.No Assessor's Map/Parcel - o C 2 Installer's Name.Address,and/Tel.No. Des' ner's Name,Address and Tel.No. /{ A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets { Revision Date Title \ + Size of Septic Tank G' 's ` Type of S.A.S. Description of Soil G Nature of Repairs or Alterations(Answer he applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the'Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued-by,this Boa d-ofTiealth.-= Signed' ._ Date O Application Approvedy /` �d �f. G'G 6 fJ Cvt,� C� Date Y ` / { Application Disapproved for the following reasons 7 s AilIrn� Permit No. r Date Issued l V v l ! , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded( ) Abandgned( )by H /� S ?D �✓ r/1G at has.,kje n constructeWcrrdance with the provis' ns f it e 5 an -the for Disposal System Construction Permit o. V� �� ated 5,p Installer �` - © �g Designer ���__2'Z Pr't d The issuance of this `ermif sh 11 not be construed as a guarantee that the s wi 1)function s e tg e . Date S �l/ q, Inspector 's No. r Fee �✓���_ I! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 3Digpog;ar *pgte(ongtruction Permit Permission is hereby gra led to Construct( )Repair Upgrade� )Abandon( ) System located at ni A-' (_S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc 'on s b� o Pleted within three years of the date of th`, •__11 Date: vI Approved b _. � � PP Y LOCATION sIwAGE 'ERMIT M0. VILLAGE &If ilk I N S T A LLER'S MAMU, i ADDRESS GUILDER OR OWNER ' D A VE, P E R M,tTF 1,3-S U'E D OAT E COMPLIANCE ISSUED 3 zj �� 1 o/ nh I oti \ g� Nod_.3 3 r..... Fxs..t� ....... ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town....................OF........ rris. bl e ,fie �tr�a�ilan for Elispnaa1 Works Tomitrurtion thrmit 'Application is hereby made for a Permit to Construct .* ) or Repair ( ) an Individual Sewage Disposal System at: 10 Weston Cir. • ..,rcQ t 3M -•---•--•----......--•---------------------------- - n s rA ..._.. - Location-Address or Lot No... Capricorn.Rea1 Y..4xu --------------•------- .. 1'almauth--mad,...H a.r-nLa................... ����• � Address . Owner -- w Steve Lebel --- 14 14 Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms----•-.3------------------•------•-. P ( ) Garbage ( ) p,,, Other—Type of Building ranch--------------- No. of persons Attic Showers Cafet ria W Other fixtures ..........................................................................................-------------------------- •-----------------------•.......... W Design Flow..........5,5-......---------------------gallons per person er day. Total t Diamete.daily flo -33a_:--_----- Dept-----gallons. WSeptic Tank—Liquid capacl:P00.....gallons Lengt&.. x _ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � 1 Seepage Pit No_____________________ Diameter.(_'_._...._...... Depth below lnletb!_.............. Total leaching area.2b6........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.E.jdr.Edgp---Inig-i deer- g-------------- DatI.1_ 5-8.1....•......••.._.. Test Pit No.<..2x0-----minutes per inch Depth of Test Pit-l_2.!........... Depth to ground wat"one...a3£ounterd- (z, Test Pit No. 2N A- .1A......_minutes per inch Depth of Test Pbl� ------------- Depth to ground waterrV-a............... eQ Pa' =------------------------------•---•-------•-------------------.....--------••-..................---......................................................... 0 Description of Soil..............Q--'-._..---•2•-'-------...lo=... ...to-pse ll-----•---•----------------------•----------••-------------•-------------------....--- � 2_.1....-...10'------medl=-Yellow...sand-----------------------------------------•......------•---------------•--- W -------------------------------------------1-0-1-------121------med,....vuhi:t;e...sands/tr-a-ced---o ----g-r:vel/no.wa-te-r---at 12' UNature of Repairs or Alterations—Answer when applicable................................................................................................ -•------••---------------------•------••-.......---------•------•••---•--------------•--..........---------------•----------------------•----------•--------------•-••---------•------..........------ Agreement: The undersigned agrees to install the. aforedescribed Individual Sewage Disposal System in,accordance with the provisions of TITLL 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Complian�e has been issued by the, oarg of ealth. PreS . 1 $ S ned. Application ApprovedlJolhe By.. -• ---=-•--------•--•------------------------•------••-------------..._......-- 1.12' �'�---••------ Date Application Disapprovowing reasons:...------••--------•---•---------.•------------•------•-----•--------------------------•-----•-•--------------- ..................................--......................•..--..................---------...........................__............------.................._.._•._._......._.....................-_-.._. Date . i PermitNo......................................................... Issued....................................................... i Date No................-....... 4/0 F�$..... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........T own...................OF.........Barns.table----------...._.....------------...........----- AVVV iratinn for Biupnuttl Works Tutwumunit trruti# Application is hereby made for a Permit to Construct !C ) or Repair ( ) an Individual Sewage Disposal System at: ........Lot...#14.---.....1120 tan..Li Location.Address or .............. I ; iaY ;..................._ Logo. ........ alax1aarn..Re ty-...Tr-uat.........................• ....76.5..Falmouth...R,c�a.d.,....I�yar s-.......------- Owner Address a Steve Lebel.... -•---• • ........ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......... ................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ranch.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) a' Other fixtures ____________________________ Desi n Flow............ . ...........................__-gallons per person per day. Total dail flow............ gallons. W g r3}r g P P P Y Y ��4--•--•----------------- 9 Septic Tank—Liquid capacit 0.0.0....gallons Length_AS......... Width4:'.1.Q"._. Diameter________________ Depth.!$"...._. W Disposal Trench—No..................... Width..:................. Total Length.................... Total leaching area....................sq. ft. x . Seepage Pit No._.I................ Diameter..b'..........___ Depth below inlet.(-!------------- Total leaching area._2........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...Eldredge-•-£n -1nec-ram Date-1_1:2. 81................. 1_4 Test Pit No. �..2._0---minutes per inch Depth of Test Pit-_12!._....... Depth to ground watenorle...e2=counter- (il Test Pit No. 2.r1�A__...minutes per inch Depth of Test PitDIA..._.____.__ Depth to ground water_-rV.a.............. e ODescription of Soil...............Q!----—---2'---------laa4&--&...tope&11-------------------•-------•-----------••------------------•---•------------------- -----------------------------------------------2'...= 1C'------me•di.=..yal ow••sand--------•--------------------•-•--------•-------------••-•••--------•--- W -•---•-------------------------------------10.1---------1-2'-------med....whi.te.---sand/t-raced--- -#'--gravel/no---water--at 12' VNature 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 TiT.:= y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Complian e has been issued by the board of alth. ^� �, . O8 C "Application Approved By_ ./ Oe Date Application Disapprovi f the following reasons----------------------------------•---------------------•------------------------•---------------._......••_..... ----------------------------------•---------•--••--••-•-•••-•--•-•....-••-------........----•-••----•----•-.......••......------•-----------------•----••-••-•------•---•-•-------------•--••-•---•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............Town...............OF..........Ra-r a.t.- b18........................................... %Tlrrtif irat a of Tounplianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by--------S-Ueue...Label-•--.---••----•----•......................•-----•••--------••----••-•----------------••-----•-------------........__...-----•---•---•••------.....---------•- Installer at---------Lo-t-_#.....................•--•-•-••-----•••----•-•----•--•••-----•--•-------•-•------------._.......---------Hyannis-----pd FdA----------------------------------- has been installed in accordance with the provisions of TIT j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------___...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE I SYSTEM YVIYL FtMCTION SATISFACTORY. 0_ �/ .� ZS DATE. ,._.... Inspector .-----•............... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....To n.........................OF......... G ...... $a.rrls-#able............................................ No.................:. FEE........................ Diopouttl Works Tunutr ion amit Permissionis hereby granted--------S-t-eve---Le-b'e1--•-•--------------------------------------------------------•-•----•-------.-..-.-.----------.-.---- to Construct4 ) or Repair ( ) an Individual Sewage Disposal System at No........ street :_. ... . ------•. ... --••-••-•-•- •-••-•-•--- .. -------------•-- as shown on the application for Disposal Works Construction Permit ,. Dated'..._':��._ '�_.___...: ------------------ _........................................................................... _ 'DATE..................... --`-Z��' �-------------•--------------•----• Board of Health` ,f FORM 1255 HOBBS & WARREN. INC., PUBLISHERS • G ,Fly IU U FrzlWj Pz"po sEo '�" ±I f o XS- 0 J � �l>T J4 � � �odxL o imo �7-- k PIT --- i j 00x7 110► Ii N z;�, TEL .J OF M . is y tfo.29874 L4 QPST��yO�'y` Mp s U LEGEND CERTIFIED PLOT PLAN ' EXISTING SPOT ELEVATION ®x® EXISTING CONTOUR ___ 0 ___ N OF y�cr ��r is Y✓.�57Av c.r�cLE FINISHED SPOT ELEVATION FINISHED CONTOUR 0 P Mr�nr�/s WEI RG IN No. 366 APPROVED , BOARD OF HEALTHE if o,;` 4 TONAL EN \ DATE AGENT SCALE, i = 30 DATE ► i-�-�� L.DRE'DGE ENGINEERING CO. IN CLIENT. I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. OIZQs BUILDING SHOIWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER ,SURVEYORS DR.BY OF BARNSTA 1�E /MASS. 712 MAIN STREET CH. BY, H YA N N. I S MASS. • SHEET_L OF 2- DATE ,Rf0. LAND SURVEYOR ,•._E�Cs•ii.vG P/T ARE /`?ORC Tf•J9.`/ /2BELOry /D f'T. M/�/• �.?AOE, fa 24 �0/A.'ilETER COYCRE?'� CCVE-P Sl/ALL BE BROUGHT TO GRADE ��GONCR&TE 4�1197YC Pi Pr 1&-/EAVY CAST /A:"O,Y C iE? j EL= Ib 2.0 1 r .4 Y- 4 '4 CAST ��P/pz , .. ` icoo /� • J'� - =�v MIN. P/TC/V 1 0 I . • i d :7 / D/ST, o • -1 SnFO 7�.ti a SEP C TA ��•• I � ' , 9 • D i a i D A ♦• t O • " - ♦ D t • • DL°PTi•/ • • ► ' • v oN.4S,YEJ STO,YE i Bas x 2,s = 4-11 vl(� a. ► • � • • • • • , I p ,a v PQEGaST SEF-PAGE /NV4w/TT ELEVATIONS ° •� ' ► ► 9 • • • . I aQ o �8•SA I:o = -76 C�If) , I VYERT AT DU%d 0/NG 99•S FT 6 /=T D/.4M. � -` EL= 9 L-S PTCAPA--rrY : S49 's/D INLET SEPTIC 7i4NK 99.3 FT - F• I o F77 D/AM. C(SEF Tf#.gUL 4T/ON> -OC/TLET SEPTIC TANK 9- 1 FT. /NL.ET,D./STR/AUT/ON QOX 9 8 9 FT. SECT/O/�/ O.�' GROUND W,4 r-A'R 7A,54 E O c/TLETD/STR/B[/T/ON MX 9 8.-7 F7 /NL6T LEACN/)VG ,C'/T 98.5 Fr SEWAGE 015I00-SA L SYSTE M LEACHIlVa PIT TipdULA7lON DES/GJ'V CRITERIA SCAL-E %s~ _ / O" DJME/V-TIOA/ A O/r/ENS/OJV $ FT. "V 44i/4ER OF BEDROOMS 3 D/HENS/ON C-�F T. tit i d G.aRaA6Z,015P0-S• Z- SO/L. LOG TOTAL =LOry 3 GAL.1DAY SOIL TEST */ SOIL T.ES7-4t2 SOIL TEST . IN[/MBFR 4F 4-4CN/N6 PITS_ I f'ELEY. 100.5 -ELFY. DATE OF SOiL TEST 12 1�• >�� S/DE LrACH/NG PER !a/T I68 SQ, 1'-7 LoA/v1 RESULTS is//TNESSED BY �3orron+ so. FT. O-2 E,ra�oiL PCI�C04AT/ON ,LATEAt TO7i41_ LEACH/N�i AREA S SQ. FT. Pelt COL-AT/O/✓ RATE ALL 2 .zESER{/EL✓4C4�/NEARER SQ. FT. 2 L H OF '• PAVE A OF n ASS9c ��P�� 9Q" L-o'T' 1 - WC STe>,J G t�cL� pqL' BERG ', 8 -11 Wt1"tom N U d D 4�o ' 66 40 � S,M+ EL DREDGE ENGINEERING CO,I NC. GOsrER oQ` S STE G�� I =L_ = $8.5 7/2 MAIN ST. NYavivis. ��lvSs. S�ONpL EN �Nc G�govivv :v,4TLaR ENCOUNTE.eEO CL/tEA 7-: Tf�Q DRTE al 67. 83 �I GROUND 1-vATE.Q AT ND.• 6ilcls SHEET Z-OF Z i TOWiv'OF BARNSTABLE LOCATION A-S tO� 60.1c SEWAGE # VILLAGE ! �1 S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /nJ5,0Pr,h0 J OoExlc s . 31.0u)^0 SEPTIC TANK CAPACITY AQX q6*116� LEACHING FACILITY: (type) IWIIII-lab!'s (size) H '30X/0/2 N,O. OF BEDROOMS \ BUILDER OR OWNER J cAN r S PERMITDATE: COMPLIANCE DATE:IlXL�I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 2` S 2 00'1 1 G Q o ® 7� 7N T \1 I -Ti ff ASSESSORS MAP : 1 NOTES' YA 2 TESL HOLE LAGS �N,.U4u PARCEL : ( (Q 1) THE INSTALLATION MUST BE IN COMPLIANCE WITH �1Rna '" "° , THIS PLAN 1995 MASSACHUSETTS TITLE V & TOWN OF �, "� V O 14 � °"� FLOOD ZONE : NOIV Z/4'�-(� SOIL L E ALUAT R �. 1V1G� w W I TNESS Gr .. )I '.r';_ �tI"� BOARD OF HEALTH REGULATIONS. U�44``��,.� � " ° + REFERENCE : i �,((p'7�? DATE : I -?c, 2 2v o L 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, h PERCOLATION RATE : J14 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION.! pLUUFRRY NIL!Rp U�ids [ }$e ~ '! � �/�� ,,. n� OORA AY 9 p ,f 4 y GL"k� .,<> _T .J D V6s� L s O1 Y �D• °"I—w- " aJ O" TH- I Cj�; o(o TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL, NOT BE USED FOR PROPERTY LINE A L,0A PAw 10� DETERMINATION. ll 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION MAP ,l 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A :;s Jc(o IS GARBAGE DISPOSAL. �lV 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C SamJ Y,2 R MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON Z C 5q, A BASE OF 6"OF CRUSHED STONE. 7 P_N (�G1L !?" /� tv o G w U 6srm 12-4J -C> ), N�O�J_..P.�uA'1'�_..wEu.Rs.�w�i�1.__iSo off- T4 pose ._f �A�H-��tk.. SEPTIC SYSTEM DESIGN �� �v��t' J�s.�I���_�J...__ratl__o_� P �os�►�_(,E ,9�tti±�� ._.:.__.._.,._. j (0) NO 'Z6$7" .� -I' FLOW ES1' 1 MATE '1 _ 3 BEDROOMS AT I (U GAL/DAY/BEDROOM - 3`30GAL/DAY Q- ( I SEPTIC TANK v GAL/DAY x 2 DAYS GAL I USE I,0,:�>GALLON SEPTIC TANK — 6YJS71tJ -�£Pu!C w I�Soo G+ . ejEPt1�- SOIL ABSORPTION SYSTEM. EX1 STW e 3 B 12 PA prv <, v S F DE A!*iEA <I v)-Z <? C, 7 = I I . q N BOTTOM AREA: x (b X 0>?L( _ Z22- ftC, G l' \ N SEPT I C SYSTEM SECT I x o 30 �tF\Q • ♦ p ' t /� � ? 1FY,., 10,1 ` Tt lilh �.{-1 0,dt. ,fa !'l/Mlil/ �•4(Y130( O►'� lnst4 1 ,t*" 13 �jtl 1 `a of�„�y�,J,radt �X1STt�,J 6,77 `'10 C�15T7 �� 'Stone_ D-BOX S(.SO - GAL S�O,�7 In t °r *-5 C �t1/Ar v+v SEPTIC TANK Tt ep s-n aJ 76 POP CdNC. /3uD. (.-Ci � C�F"1�-�.. od l� -J � ' S I T E AND S W A E L A N �LZN OF MASS9c N �a,► vvaslu� L.00AT I ON : (�l)�ST�nJ �o DARREN S C_jKC& I \ O/STE�� PREPARED FOR : COrvS7", SANI7AR\Pa (}1 SCALE : / 20 V�2.0 t✓ Y�( 4 DARREN M. MEYER, R.S. (0 _ �- q-N� �gxT�(L 43 VINE STREET DATE z P L y DUXBURY, MA 02332 J&-ri 21) (�n DATE HE HAG Nfi (781) 585-0293 -----------