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0405 BEARSE'S WAY - Health
405 Bearse s Way,-Hyannis'. t� o o = 1 ,i I i o � i r f o o a - 1 Aug 28 2017 22:53 HP Fax page 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name C Information is Hyannis `� MA 02601 8-21-17 required for every page, Citylrown State Zip Code Date of Inspection -.J 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 fortes A. General Information S�# `�t1lutrlrrrrrnr�r on the computer, a��-3 ,(H of lyq ��/i use only the tab 1. Inspector: ��``J. ..........S4 i key to move your cursor-do not James D.Sears _ JAMES '-__ use the return key. Name of Inspector Capewide Enterprises * ' Q Company Name -P '•.PY rl.... C, �P 153 Commercial Street ���i� SINSP101111�` Company Address �* Mashpee . MA 02649 Cityrrown State Zip Code 508477-8877 S1623 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, aocurate 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 2.rs/ 8-22-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5ine.doc•rev.&16 Tine 5 Official Inspection Form:Subsurface Sewage Olsposel System•Page 1 of 17 �, VS Aug 28 2017 22:53 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name information is required for every Hyannis MA 02601 8-21-17 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 0 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 system is a 1000 Gal.Tank D Box and three chambers. 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.646 Me 5 Off cid Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Aug 28 2017 22:53 HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner information Is Owners Name required for every Hyannis MA 02601 8-21-17 page. Cltyrrown 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): I ❑ 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): I 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(1xb)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.6116 Tate 5 Official inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Aug 28 2017 22:53 HP Fax page 4 Commonwealth of Massachusetts Owe Title 5 Official Inspection Form )WSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name Information is required for every Hyannis MA 02601 8-21-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall unless the Board of Health (and Public Water Supplier, ff 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 coiiform 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 IMEW is less than 67 below invert or available volume is less than flow t5ins.doc•rev.8(19 Title 5 official Inspection Form:SuWu Laos Sewage Disposal System•Pape 4 of 17 Aug 28 2017 22:53 HP Fax page 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name Information is required for every Hyannis MA 02601 8-21-17 page. Cityfrown 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 certmed laboratory,for fecal coliform bacteria indicates absent and the presence of ammonla 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 2000g pd- 10,000gpd. ❑ ® The system fik.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•row.6116 Title 5 Otficlai Inspection Form:Subsurface Sewage Disposal Sya'em-Page 5 of 17 Aug 28 2017 22:54 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information is required for every Hyannis MA 02601 8-21-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes° or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ❑ ® Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interlor 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.aoc-ay.5116 Title 5Official Inspection form:Subsurface Sewage Disposal System-Page of 17 Aug 28 2017 22:54 HP Fax page 7 Commonwealth of Massachusetts . Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name information is required for every Hyannis MA 02601 8-21-17 page. City/rown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and three chambers Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes .® No Water meter readings, if available(last 2 years usage (gpd)): 2015-9,700 Gal's Detail: 2016-8,600 Gal's Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/industrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): canons 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: ISlre.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I I i Aug 28 2017 22:55 HP Fax page 8 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information is required for every Hyannis MA 02601 5-21-17 page. Cttylrown 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: NA 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): t5ns.doe-rev.6/16 7dle 5 ORael Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Aug 28 2017 22:55 HP Fax page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information Is required for every Hyannis MA 02601 8-21-17 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information; Tank 1992 permit#92-291/D Box and leaching 2005 permit#2006-370 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1619 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.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 4 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 Gal. Precast H-10 Sludge depth: 3" t5ins.doc-rev.W6 Title 5 WNW Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Aug 28 2Q17 22:55 HP Fax page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name — information Is required for every Hyannis MA 02601 8-21-17 page. City/rows 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 27 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle $ Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape-Plan Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and covers at4" below grade, In and outlet tee's. No sign of leakage or overloading. Note:Take should be pumped. 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 l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 11 I i I Aug 28 2Q17 22:55 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information is required for every Hyannis MA 02601 8-21-17 page. City(rown State Zip Code Date of Inspection D. System Information (cant.) 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 contact(required). Is copy attached? ❑ Yes ❑ No I t5ins.doc rev.6/16 Title 6Offiicial Irrspectlon Forth:Subsurface Sewage Disposal System•Page 11 of 17 Aug 28 M 7 22:56 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information is required for every Hyannis MA 02601 8-21-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must he opened) (locate on site plan): I Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"xl6"x2' Below grade w/one line out. Box is clean and solid wlcover at 4". No sign of over loading or solid carry over. i 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: Mns.doc•rev.6/16 Tills 5 omclal bWwlcn Form:Subsurface Sewage Disposal System•Page 12 of 17 Aug 28 2017 22:56 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 405 Bearses Way Property Address Mark Hufna el Owner Owner's Name information is Hyannis required for every y MA 02601 8-21-17 page. CdyfTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is three 3050 infiltrators (10'x29'x2') Ck D Box and camera out to chambers. No sign of over loading or holding water. 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 Mne.doc-rev.5118 TIUe 5 official inspection Fame Subsurface Sewage Disposal System-Page 13 of 17 Aug 28 Z017 22:56 HP Fax page 14 Commonwealth of Massachusetts -- Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name information is required for every Hyannis MA 02601 8-21-17 page. City/rown State Zip Code Date of Inspection D. System Information (cost.) Comments (note condition or 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.): 15lns.doc•rev.6116 Title 5 Official Inspectlon form:Subsurface Sewage Disposal System•Page 14 of 17 Aug 28 Z017 22:56 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 Bearses Way Property Address — Mark Hufnagel Owner Owners Name Information is required for every Hyannis MA 02601 B-21-17 page. City/town Stale 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 AL) E B 4 1 3 - s 7 3 l5ins.doc•rev.&16 Tithe 5 Official Inepecti2n Form:Subsurface Sewage Dispose System•Page 15 of 17 Aug 28 �017 22:57 HP Fax page 16 Commonwealth of Massachusetts 51 1 w Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Forth•Not for Voluntary Assessments 405 Bearses Way Property Address Mark Hufnagel Owner Owner's Name information is required for every Hyannis MA 02601 8-21-17 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to hig ground water: 11'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 8-9-06 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: T.H.on Design plan 8-9-06-11' no G.W.. Bottom of leaching at around 5' below grade. Bottom of leaching at 6' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Aug . 28 ;017 22:57 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 405 Bearses Way Property Address Mark Hufnagel Owner Owners Name information is Hyannis required for every MA 02601 8-21-17 page, City/Town State Zip Code Date of Insp ection 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 V t5lns.doc•rev.6/16 Tile 5 Official Inspadon Form:Subsurface Sewage Disposal System•page 17 o1 17 tNE Town of Barnstable 1p� do Regulatory Services Thomas F. Geiler, Director • &UWSTABLL 9� 'AM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8-17-06 l� Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. i Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 8-15-06 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 405 BEARSES WAY, HYANNIS, MA based on a design drawn by -1 (address) Shay Environmental Services, Inc. dated 8/15/06 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Col CARMEN c (Instal er's Signa o E. N� . SHAY C No. 1181 FG/S.TERCP � S . esigner's Signature (Affix amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form i 4' -TOWN OF BARNSTABLE A LOCATION 7 45t�y -7-- (� SEWAGE# � pU VILL?AG'E A.-ti4 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE N I � SEPTIC TANK CAPACITY _..f-LEACHINGrFACILITY:(type) ' � 0�0 fcl►a.� �,� (size) NO. OF BEDROOMS OWNER J ^' .PERMIT DATE: [L `—Q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility(If any wells exist ion site or within 200 feet of leaching facility) Feet ;Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) Feet FURNISHED BY 3 � _57 No.ACO (0 Fee VY THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer:� PUBLIC`HEALtH-D1 ISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYfcation for Mizpozal bpotem Comaruction Permit" Application for a Permit to Construct( . )Repair(�Upgrade( )Abandon( ) O Complete Systemlrtdividual Components Location Address or Lot No. -}0.- '50—oyv-:R`3 l0 PfY Owner's Name,Address and Tel.No. RqA 4-r4t S, M(-'Jr MAQ-ic vAJ1i—'nrq(D6l_ Assessor's Map/Parcel a4 Z I � i✓ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. " 5 3A Type of Building: Dwelling No.of Bedrooms 3 Lot Size ,5►U®0 sq.ft.- Garbage Grinder(AIM Other Type of Building No.of Persons (a Showers( V�Cafeteria(✓) Other Fixtures Design Flow gallons per day. Calculated daily flow a) Oy- gallons. Plan Date (o Number of sheets Revision Date Title 0SQ . C. 5 v z Size of Septic Tank a Type of S.A.S. i N Ct LAV_4TV" Description of Soil" &2c =rM G &CwN (b' x a9' x 2.' . Nature of Repairs or Alterations(Answer when applicable) a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Etwironmental Code an¬ to place the system in operation until a Certifi- cate of Compliance has been i 'y is o f Heal Sig d Date Application Approved b Date to , Application Disapproved for the following reasons Permit No. Date Issued bQ No. Fee 00 r` THE COMMONWEALTH OF MASSACHUSE ' �"�� Entered in computer: TTS '�' 1 3 �\I 5y.__- t Yes 1 PUB'LICiEALTi' IVFSI�ON -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppffration for �Dtgpogaf *pgtem Construction Vermtt Application for a Permit to Construct( c )Repair(��Upgrade( )Abandon( ) El Complete System fdividual Components Location Address or Lot No. 405 �QCK g.Q S l �3 A Y Owner's Name;Address and Tel.No. Pei :1 HgpAr4N( S , 1%-A1� MPQK. �,.IFNAGE� n� k Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 64 B- S � \O J t);'lr�Cl-1 1p to Type of Building: Dwelling No.of Bedrooms _ Lot Size 15,t34 0 sq.ft. Garbage Grinder( �' Other Type of Building No. of Persons (, Showers( J/Cafeteria( `� Other Fixtures t Design Flow ,`�iC� gal ons per day. Calculated daily flow � � ncL gallons:'" Plan Date D. 1 14-bil Number of sheets I Revision Date �' Title C !��''" y Size of'Septic Tank � �� � �� Type of S.A. D%cri tibn of Soil J ,. I C 1 x 2l / ?g. -. -•'" Nature of Repairs or Alterations(Answer when applicable) `A • G i I 1 i Date last Aspected: � t 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 Pot to place the system in operation until a Certifi- cate of Compliance has been issued by-this-Be ENT - f Signe Date Application Approved b Date �p Application Disapproved for the following reasons r f Permit No. 13G n Date Issued ` --T-------------.,---,—_-----.----.—.— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiftcate of CompItance {- THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded'( 4� Abandoned( )by (" at _ _ ��t has been constructed In accordance "`•�_ with the provisions of Title 5 and the for Disposal •ystem Co stru o ie'm tt'No.400!v - elated )10 IP 1. Installer Designer ' The issuance of this permit shanot be construed as a guarantee that the sy ill ti• a designed. --Date Inspector - V ` No._inn& 3 t 'Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mt2;Po!5a1 *pgtem Congtructndio ermtt _ Permission is hereby granted to Construct( )Re air( )Upgrade( aon( ) System located at t ► n�{--� ��v� and as described in the above Application for Disposal System Constructi+n Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions'or special conditions. Provided: Construction must be completed within three years of the dClhis Date: �o Approve Town of Barnstable Department of.Reoatory Services Public Health Division Date �. . . - KAM $ 200 Main Street,Hyannis MA 02601 161 .6 J60 i�4 Fee Pd. Date Scheduled i Time i ,foil Suitability Assessment for S`pwdQe D' 1' Witnessed By:,= Performed By: LOCATION& GENERAL INFORMATION Location Address ,�}(j SZe�SeS W Owner's Name *-fN CO— �O\T\ 06 Address S Assessor's Map/P4rcel: aQ.a. I ti I Engineer's Name ca Qm;c� ; NEW CONSTItU&I ION REPAIR I Telephone# Surface Stones Land Use Slopes(%) Distances from: Open Water Body t" ft Possible We c Area�—ft Drinking Water Well Drainage Way ft. Property Line j _ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests locate wetlands in proximity to holes) I -1'P2 i �t © ,Bch Depth to Bedrock Parent material(gedlogic) `t p r Weeping from Pit Pace 'v • Depth to GroundwaWr. Standing Water in Hole: i ,I Estimated Seasonal3jigh Groundwater D& RMINATION FOR SEASONAL HIGH'WATER TABLE Method Used: Depth to soli tnotdes: ln' In. Dep Depth Observed standing in obs.hole: 1. in, Groundwater AdJuettnent Depth to,weeping from side of obs.hole N , Adj.faetor,,...��- Adj.droundwater Leval Index Well# Reading Date: Index Well level - PERCOLATIPN TEST DataB vlpxyme�lo_t 4t1 Observation � Time at 9" 3Xll►►:. -.------' Hole# Time at 6" Depth of Pere Time(V-61 - Slart Pre-soak Time.0 a . End Pre-soak 0 °� Rate MinAnch �MGI Failed. Additional Testing Needed(YIN) Site Suitability Assc$sment: Site Passed Site Fa ; Observation Hole Data To Be Completed on Original: Public Health Division Back ***If ercola�i0n testis to be conducted within 100' of wetland,you must first notify the P prior to beginning. Barnstable C4#servation Division at least one(1)wedk �_-_._ i....l.N\I ISM - '. •\� DEEP OBSERVATION HOLE LOG Hole#*/ Depth from Soil Horizon Soil Texture Soil Color Soil Other - ~ Surface(in.) (USDA) (Munsell) Mottling (Struciure,Stones,Boulders. tGravel) ZXo'l�iCN } 23j (a S(NQI B Ll - 1 lj�sLk SEa •b i L`3 G��o ct.�-e.� :DEEP OBSERVATION HOLE LOG. Hole#0 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) i (Munsell) Mottling (Structure,Stones,Boulders. nsi t %Gravel) 1oYQ, i : ra, . � L5 to ya s 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) {USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) ;DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisigency, Qrnvel) Flood Insurance Rate Map: / Above 51)0 year flood boundary No_ Yes ; Within 100 year boundary No Yes. Within 100 year flood boundary No Yes Depth of Natutaft Occurring Pervious Material Does at least for feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed r the soil absorption system? Y� If not,what is the depth of naturally occurring pervious material? Certification I certify that on. XQq (date)I have passed the soil evaluator examination approved by the Department of nmental Protection and that the above analysis was performed by me consistent with . -the required ing expertise and n e escribed in 310 CMR 15.017. Signature Date Q:1SEP'I1CWERCF ORM.DOC I Commonwealtth of MosSOCtwsettS John Grad Executive Office of ErMormentof Affoirs D.E.P. Title V Septic Inspector Department of P.O. Box 2119 Teaticket,MA 02536 Environmental Protection (50 -81� G• o _� b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ��/�' PART A `e e 0 CERTIFICATION 199? Property Address: 406 Bearses Way Hyannis Address of Owner: HUH�Slge� Date of Inspection:2119197 (If different) T f Name of Inspector:John Gracl Wlllshire Credit Corp. V Company Name,Address and Telephone Number: 9 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of Inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection Is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is ` _ Conditionally Passes performing at the lime of the Inspection.My inspection does _ Needs F rther Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Fells septic system and any of its components useful life. Inspector's Signature: f4 Date: 2119197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] SYSTEM PASSES: x I have not found any information which Indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal,cracked;structurally unsound,shows substantial infiltration or exfiltration,or tank failure is Imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 405 Bearses Way Hyannis Owner: W111shlre Credit Corp. Date of Inspection:2I8197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D) SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 405 eearses way Hyannis Owner: wlllshire Credit Corp. Date of Inspection:2118197 D) SYSTEM FAILS(continued) _ 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). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 405 Bearses Way Hyannis Owner: Wiltshire Credit Corp. Date of Inspection:y18197 Check if the following have been done: X Pumping Information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. nlaAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was Inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based'on existing information or approximated by non-intrusive methods. x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 405 Bearses way Hyannls Owner: Wilshire Credit Corp. Date of Inspection:2I8197 FLOW CONDITIONS RESIDENTIAL'. Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No . Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: rda Last date of occupancy: 2 months ago COMMERCIAL/INDUSTRIAL: Type of establishment:_ad Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nla Last date of occupancy: Na OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain APPROXIMATE AGE of all components,date installed(if known)and source information: roxi nately 5 ears. Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 405 Bearses way Hyannis Owner: Wilshire Credit Corp. Date of Inspection:2118197 SEPTIC TANK: X (locate on site plan) Depth below grade, 6' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7"IN 4'10- Sludge depth:7' Distance from top of sludge to bottom of outlet tee or baffle: 20" Scum thickness:10" Distance from top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 8' Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system now and then maintained every year. GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 405 Bearses Way Hyannls Owner: Willehlre Credit Corp. Date of Inspection:2118197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction:_concrete_metal_FRP_other(explain) Dimensions: rda Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n1a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 405 Bearses Way Hyannis Owner: WIIlshlre Credit Corp. Date of Inspection:2N8197 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,-if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: n1a leaching fields,number,dimensions:n1a overflow cesspool,number:nla Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The overflow was empty at the time of the Inspection It is structurally sound.Shows signs of being 314 full. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: nla Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: nla Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (revised 11115195) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 405 Searses Way Hyannis Owner: WIIlshlre Credit Corp. Date of Inspection:2118197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' fl �\4 PA O - l At WO Ac ff 37 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 1 Ili 5195) 9 TOWN OF BARNSTABLE r ' LOCATION 1GS lJje4r-je- r Zia y SEWAGE # _ ' ILL,f GE_ &4e4/I,2I J ASSESSOR'S MAP & LOT _6-7 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) / Oo / ! NO.:'OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �,� . DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: -30 '7-1 VARIANCE GRANTED: Yes No L,--' r 5b _ Ii .X �o ` ASSESSORS MAP NO: PARCEL NO: ....30.00 THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH Barnstable Conservation OepartmentrOWN OF BARNSTABLE sionw r 9 i u��a1Works Tomitru.rttnn JIrrafit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System_ at: _40� Bearses Way Hyannis_-•_•__--•__._._____ _ -•.----....__....................._..---- •.----- --.._.....-••-•-•...-----.....----•-••----•---•-•--•-•------------........------.........:..------ - Location-Address or Lot No. POU1 1 rd t, ......................—.......................................................................... .......... ------------ ............... .........»..... J.P.Macomber Jr. Owner Address W ...........................••-----_----•. .......•... ...•---.....-•-•--••....................•-- Installer Address Type of Building Size Lot............................Sq. feet Dwelling X No. of Bedrooms.............2....._..............___.__..Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures ---------- -------------------------------------------------•-••--•••--•-•--•---••-•---------••----•-•---•-•-------. -----•-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid'capacity____.._.....gallons Length................ Width................ Diameter................ Depth................ 04, W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a ................-------•••••-----.....--•--•--•-----••••--••-•--•----------••.......--•-._...........---•-••...-•--••-••-••-•----••---•--.........--••...... 0 Description of Soil........................................................................................................... ............................................................ x Sand--& U ...GXa.Ve-I ...... W VNature of Repairs or Alterations—Answer when applicable.............................................................................................. 1-1000 gallon tank distribution box 1-1000 gallon leaching pt- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has bee isss d by the board o ea h. - Signed . ----- . .../..x....��... . .. .. ............ ............... .......��.3/92.---------- - � ��� Dace � Application Approved By ............... ............................... .................... ...(®..�.. ... Application Disapproved for the following reasons: ...........................................................................................................•------------..........---... ................................................................................................................................................................................................................ ........................................ Da g� e PermitNo. ...../;.Ta..-d............:-.................. Issued .............................................................c....... Dace G 7� Fss... ....30..�J'J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE lw 30�„►-- �1.Z Applirattun for Binpuuttl Work.5 TouBtrnrtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 9.5... is.............................. Pouliat Location-Address or Lot No. Owner Address <................................................... --------••••.................................................................................... t Installer Address d Type of Building Size Lot............................Sq. feet U DwellingX-No. of Bedrooms.............. .............._.._....__....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................•--•---••-•--... - WDesign Flow............................._-!........_gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity..........._gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (Z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ...-•-••-•----••--------•--.....-••••••---...-•--•••---••--•-••••••-•...........•--•......................................................................... 0 Description of Soil..................... .............. -- -------- --------••------------------•--------------------------•---------------.-.----------. --------------------- ------- U W ...............................................•••-----•------------•--•...._......•••-•-.....•--•--...........------......-----.........-••-•••--•--•---•---••--••••-•-•..................-----•--••.. Z. Nature of Repairs or Alterations—Answer when applicable............................................................................................... -1_-1� Q...... ta, _s.tx. .but.iQn Q?� �•-�!?�!? il4n �e : _hi ...pit.a................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issuVd by the board of ea h. Signed .. ....���/% ..�.. � .... . ........ -----. .... 2,1 �.2.......... -. . re G Application Approved By ..-------- (�' J -.- �................ ��..:�'.I..a7 .. Daze Application Disapproved for the following reasons: .......... .......... ................................................................................................................................................................................................................ ........................................ Dare PermitNo. .....ram .. .(................................ Issued ------------..................------......----.............re..... Date 1� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (111,er#tfiutt#e of Tarayltttn.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kXX ) by------J:P his c mib£r....Tr—i....................................................Insr....aller ... ...----------..............------...................---.....---.........................-----..........----.........--... at ...... 5...!PAT as---Way....Hyannis has been installed in accordance with the provisions of TITLE 5 The St e Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ..�.-..���,)......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /... .......................... Inspector ........-----------.............................................................................. DATE.....................................7. ...... r G� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE...,....,.,...:.:...... Diupuuttl Workii T-Fundrnstiun hermit ' Permission is hereby granted.........J.P.Macomber J r. .. .............•.... ..................... to Construct ( ) or Repair X) an Individual Sewage Disposal System at No.. n �:x' es -W��..Hyannis -------•----•--------------•---------------------•-•--•-----------------------....--•-••---.... Street as shown on the application for Disposal Works Construction1 Permit No..1Qa-- __ Dated.......................................... ••----••-----------••---••...........- 1L::Z---------------------------------------•---••-•- Board of Health DATE.............. �.`- FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS _ switchb+o�rd'" ' ' MaP ainY *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A ALL OURET PM FROM THE �+ �hlse 10' min. from PROFILE YIEII OF LEACHING SYSTEM DI51RDUTION BOX SHALL.es: 12• 1E COVERExisting Foundation to septic tank D-M � � SET ttvrl foa AT LEAST 2 FT. Ssptie tank covers mwt be Not to Scale ,�-'•- .._..�. ,..+ -•a ' be TOP OF FOUNDATION = ELEV. 100.00 (Assumed) ,nhin 6 in. of fkdahed grads wfthin 6 in. of fxrieAsd grads 3-S OUTLET ' - i Grode over Septk Talk-96.25 Grade over D-Box- 9d00 over SAS- 9600 1010CKOU75 +•'^" "'� r to f 1/2• wish"O m^"Slime SS- OU1L£T ' 12' INLET +' � 4•PVC(CAPPED)INSPECTION PORT TO BE Zr 6- hikes Rd.. _... ('�405 Baarsas Wey S- 0.02 3 HOLE H-10 3, MmrNrxrrn Cover INSTALLED AND TO BE VATHN 6.OF GRADE BOX Tap OF Spitwn-Elev. 95.75 12' EXIST. S=O.Ot or oveter 15 s• 4- - SCH. 40 T 1.7s• $ a 1,000 GAL Ss o.ol• Tint SEPTIC TANK 15' p� foot I TION CROSS-SECTION 7 F FROM EXIST. FDINIDA ar 24 Effective PLAN SEC ,� rn N o s' • En eves "i Sidewall CONCRETE FULL FOUNDII o H-10 - 0 0 > °o' °�' o 0 3 Unit Q T 21' ! o{ 0 1, 3 HOLE H-10 DISTRIBUTION BOX SYSTEM PROFILE 6 In.of 3/4--1 1/2- Z 3' 4 3' ,,i NOT TO SCALE cornpocted.ta _o o N 0 � ns Not to Scale S W 10' E 'c Effective vldar o Effective Li•ngth GENERAL NOTES 6 lnof 3/4--t 11r o SOIL ABSORPTION SYSTEM (SAS) e conVocted am 1. Contractor is responsible for Digsofe notification. Verification of Utilities NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELLOW GRADE m° INFIL'�RATOR MODEL 3050 (H-29 LOADING)/ SUMNER & DUNBAR and protection of all underground utilities and pipes. Tast Haft 1 E1ev=67.00 (OR EQUIVALENT) 2. The septic tank on j distribution box shall be set Ebttom of Bott ni �� _ NONE OBSERVED NOTE- on 6" of 3/4 -1 1/2" stone. o NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30- /EFFECTIVE HEIGHT IS 24" 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation PERCOLATION TEST P 1 1376 by carmen E. Shay - Environmental services, Inc. 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan Date of Percolation Test: AUGUST 9, 2006 and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S.. C.S.E. Results Witnessed By. DONALD DESMARAIS, R.S. 6. If, during installation the contractor th encounters any soil conditions or site conditions that are different EXCAVATOR: Shay Env. Svcs. Percolation Rate: Less Than 2 MPI O 36" from those shown on the soil log or in our design installation must halt do immediate notification be made to Carmen E. Shay - Environmental Services, Inc. Test Hole Test Hole No. 1 NO. 2 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. DEPTH SOILS ELEV DEPTH sons ELEV. 1 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. O 98.00 0 9&00 I 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. sandy sandy j 10. All solid piping, tees & fittings shall be 4" diameter Loam Loam 10 YR 3/2 10 YR 3/2 r` I Schedule 40 NSF PVC pipes with water tight joints. 0"_6• Ae 97.501 0"-6" As 7.50 w I 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy Sandy Properties Within 150 Feet. Loam , 1 10 YR 5/6 10�s/6 N � � THE PROPERTY LINES ARE APPROXIMATE AND e-36" Be 5.00 6•-36" Be 5.00 I COMPILED FROM THE SURVEY PLAN GENERATED BY I WHITNEY do BASSETT OF HYANNIS, MA TEST HOLE #2 ENTITLED " PLAN OF LAND IN HYANNIS, MA OF LIZZIE MAE HIGGINS C.5 coarse I ELEV.= 98.00 1941, PLAN BOOK 65 PAGE 101 Sand 2.S Y 7/4 2.5 Y 7/4 W � � Failed 50.00' DATEDJUNW, 91.00 38 84" C, 91.00 I Leach Pi �,9$ AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN LL- I ,® 0.5• IT H EPTI BRPOSE OTHER THAN O THE C SYSTEM INSTALLATION MEDIUM ME" I �� Sand Sand _ v•�•' - �s-. *�:;Ea.;;L.V o� EXISTING LEACH PfT' TO BE PUMPED OUTdc REMOVED 2.5 Y 6/6 2.5 Y 6/6 13 87.00 Se- 132 57.00 I 1 -' • • • ~ 2" TEST HOLE #1 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE ELEV.= 98.00 FROM THE EXISTING LEACH PIT TO BE DISPOSED L00, I O OF AS PER BOARD OF HEALTH SPECIRCATIONS. 1y� GRAV,EL'� EXIIS T.- 000 gat. WETLANDS ARE PRESENT ViTI IN '2-0-0' OF'TFHE PROPERTY _ Perct DRDdEWAY i Septic Tank -PROJECT BENCH MARK Depth to Perc: 40" to 58" TOP OF FOUNDATION ASSESSORS ' 292 PARCEL 75 Perc Rate= 2 MPI `� ' � ELEV. _ 100.00 (Assumed) LEGEND Groundwater Not Observed I _ _- __-_ I O � O No Observed ESHWT i i I -I ADJUSTED H2O Elev. = None MuFlicipall of e 104X1 DENOTES PROPOSED SPOT GRADE 2-16• DIAM. ACCESS MANHOLES B%ISTING o DENOTES EXISTING 3 BEDROON x 104.46 SPOT GRADE HOUSE �``-. _• = - _;:=<< 1j. b i t1405 pL PROPERTY LINE gsP PROPOSED CONTOUR INLET pp• I Fs I ` - -------- ------ ND _98 - -- -- -97 EXISTING CONTOUR ACCESS i __ _ • DISTla9U1M eax A LEACHM COMPONENT �-•c-�--.r r r•r-•+�•�-►-a SET DEEPER THAN 6 NICHES BELOW FINISHED LOT' i�"�'A `�..t-s'_c.:::c .•.:c _:�- '""��' GRADE SHAM.BE RAISED TO NTHIN THE COVERS FOR THE SEPTIC TANK, FINISHED 8•OF I ® DEEP TEST HOLE & STEEL REINFORCED PRECAST CONCRETE ( 5,000 Square Feet INSTALL TUF-11E GAS SAFRES OR EMALS PERCOLATION TEST LOCATION PLAN VIEW s-24• �„�COVERS PL� 50.00' 6 FOOT STOCKADE FENCE 4• ,; v` REV.: 8/15/06 - per BOH check List on 8-15-06 • - •rnK dearonce saET ` INLET �1-7 e• mk-T- 2• m1n. Net to whet r a \\\`��------------------------------------------ LOT P LAN 1a•e,trLFT L>� P 5• -7- os ..... = ���, OF PROPOSED SEPTIC SYSTEM UPGRADE .1 B-jO-A Sf�'A� WAY PREPARED FOR -7:.. ._a - ',t°-.t ems. -r: '�� �" •- -! 4'-1a' (40 FOOT RIGHT OF WAY) MARK H U FN AG E L CROSS SECTION END-SECTION #405 BEARSES WAY TYPICAL 1000 GALLON SEPTIC TANK NOT TO SCALE HYANNIS, MA Design Calculations PREPARED BY: Number of Bedrooms: 3 Equivalent to 330 Gol./Day (330 Gal./bay Min. per Title V) CA ARMEN E. AJ HA l Garbage Grinder: No E ./J Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) 6H Y �' NVIRONMENTAL SERVICES, INC. Septic Tank : - 2 x 330 Gal./bay = 660 USE EXIST. 1,000 GAL. Septic Tank. SOIL ABSORPTION AREA: Using percolation rate of Q min./inch 0 20 40 50 �F RR�o P.O. BOX 627 Bottom Area: 0.74 gal/sq. ft. x 290sq. ft. - 214.6 gallons EAST FALMOUTH, MA 02536 Sidewall Area: 0.74 gal./sq. ft. x 156 sq. ft. = 115.44 gallons I S4NIT,kR%Pa Providing- = 330.04 gallons TEL/FAX : 508-539-7966 Use: (3) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, SCALE: 1"=20' SCALE: 1"=20' DRAWN BY: CES DATE: AUGUST 15, 2006 (4' W x T L) TO BE USED WITH 3' OF WASHED STONE ON THE SIDES AND PROJECT#SD952 FILENAME SD952PP.DWG SHEET 1 OF 1 4' OF WASHED STONE ON THE ENDS.