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HomeMy WebLinkAbout0010 BELL ROAD - Health ss . + Hyannis A 292 — 226 ------------------- ti . F o b s � C s e Q a TOWN OF a:RNSTABLE LOCATION t® ' T(04P SEWAGE # VILLAGE k �s ASSESSOR'S MAP & LOT ZQ2-2Z.( INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY too 0 LEACHING FACILITY: (type) '�' (Size) l fig/ NO.OF BEDROOMS BUELDER OR OWNER PERMITDATE: 026(Y6 a5e4 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 .BCD-`Fick- E14V - f Kspecf° h s t 'h O � C7 N v 3 TOWN OF BARNSTABLE LOCATION a ' G��X,66 SEWAGE# — ' VILLAGE ,-"'/Z ASSES SOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) ��� (size) �3 --k' NO. OF BEDROOMS OWNER PERMIT DATE: /� 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) E Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �1 ,N ^ T No. 00 V�S fs_ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB.LE, MASSACHUSETTS Yes pprtcatton for �Dtgpogal *pgtem Congtructton permit Application for a Permit to Construct( ) Repair( ) Upgrade(A<Abandon( ) ❑.Complete System LJ Individual Components Location Address or Lot No. ���� �� /7 y Owner's Name,Address,and Tel.No Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'r773 -0�d �J' r Type of Building: Dwelling No.of Bedrooms —`' Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building �f 1'- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -7 -1 0" gpd Design flow provided -� d Plan Date �"-�-� `O Number of sheets > Revision Date gp Title Size of Septic Tank �Xlf'���" 6� -1"0 A© ��,ll, Type of S.A.S. Description of Soil 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 Certificate of Compliance has been issued by this Bo of Health. Signed Date o Application Approved by Date �' �'� — � Application Disapproved by: Date for the following reasons Permit No. X0® 0 Date Issued — 1-7 e J ��� __m__;-,.v.k�+.....-'L.-.r._ti�„,_,s•� 7���"`^!-r�.?r rj;,••:..�:.r'.t's^- �'t�.f�,�t.•.,�„��s +y,_.^�x'.^1n1.7.1uy;`.,:..-+.: , �,.,a. .. s , . i -/ ^ �/ ^ z is ;s ., '�I J Fee F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �Btgposal 6pgtem Construction Permit Application for a Permit to Construct O Repair( ) Upgrade Abandon O ❑.Complete System 2J Individual Components I L' Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 9� ` L 5" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 677,3 '0.4•yip l�' �rah, �.� Type of Building: i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other T f -P- e o Building G��' No.of Persons YP g Showers Cafeteria Other Fixtures Design Flow(min.required) 3 —1 0" gpd Design flow provided -� lea gpd Plan Date �"�—� ' Number of sheets > Revision Date Title Size of Septic Tank �%�1'✓r'T�/� 6r �e O 0 9,4l Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r 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 t Compliance has been issued by this Bo of Health. Signed Date Application Approved by Dateay Application Disapproved by: i Date for the following reasons Permit No. A 00 — ® X S Date Issued - -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the/On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( � y Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. A oo%— O 1)-5 dated 1- 1 / Installer �/ e ;�� t/� Designer #bedrooms \ Approved design flow 3' f� gpd The issuance of this permit shall+not be co'`strued as a guarantee that the system w unction a/sj�des'gned. G'/�j, (' Date 1 t Inspector /1/ JI'I ——————————— -- ——— No. o?-00Z ���) Fee t( 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS h5pomt *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Abandon ( ) System located at ./O .gze,--- Ge":b f!Y and as described in the above Application fof Disposal SysteT onstruction^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 date of this ermit. r �:. Date �— — -o Approved by / I Town Of Barnstable �......pFSHE..p. -. Regulatory Services Thomas F. Geiler,Director • lA-EtW.SFABLE, s Public Health Division QA. 16�9._ 100 rFp A Thomas McKean,Director 200 MAin Street,Hyannis,MA 02601 Office:.508-862-4644. -Fax: 508-790-6304 Installer & Designer Certification Form Date: /l Designer: Installer: Address: . _ G �W�� Address: T was issued a permit to install a (date) (installer) septic system at_IT10 OLt, 6��N�o W based on a design drawn by (address) rrnn flfl dated 'VV esigner) 1-certify that the septic system referenced above was installed substanti ally according to 116 design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. b. I certify ythat the septic system referenced above was installed w1th' a1or:changes ( .;e, greater thau.l 0' lateral relocation of the SAS or any vertical:relooafi.on of dny component of the septk system)'but in accordance with State&Local:Regalations. Plan revision oT certified as-biii'lt`oy designer,to'follow. •tN'��Mgs� dAVID- s (Installer's Signature) ; �• n .. 1VI1SON rn No 1ID66 er s Si attire tam Here .e ersS . (D � ) (Affix '9%,-;. P. .) PLEASE R7ETURN TO BARI�tST'AET�E PUBLIC.-HEALTR.DIVISION, CERTINC ATR OF' COMPLL NCE WILL`N®'F ]E SSUED,i BOTH TDIS'3FOR1tiI A5_ RU-MILT KA ARE RECEIVED STABLE PUBLIC A�C,T DWISI®lid THANK YOU. , Q:Hea1ti/Septic/Designer Certification Fonr, T ,; O Town of Barnstable P# Lgz Departiment of Regulatory Services = Public HealthDivision Hate s ♦ t,Hyannis MA 02601 Date ScheduledP 2-20ITime Fee Pd. So i Suitabillity Assessment for Se age D' osal o \/ l�•1,Performed By:_ Y t Witnessed By:.. � � LOCATION& GENERAL INFORMATION Location Address 4G��Lz 0-?a Owner's NameY0411S Address Assessor's map/parcel: j —p10 Engineer's Name'ef)-d.? NEW CONSTRUCTION REPAIR L,-" Telephone#., l Land Use 'l"�Y/yV I a Slopes(95) Surface Stones Distances from: Open Water Body ft Possible Wet Area / ft Drinking Water Well ft Drainage Way � ft Property Line,"-/ 2 ft Other 11____1 ft SKETCH:(Stree name,dimensions of lot,exact locations of test holes&,perc tests,locate wetlands fn proximity to holes) LL 0 h- I Parent material Bolo 'c (g � ) y / Depth to Bedrock / --Depth to Groundwater. Standing Water in Hole: t �V Weeping from Pit Face Estimated Seasonal High Groundwater 1fla f ' - - " DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: r-rt s Depth Observed standing in obs.hole: In, Depth to soil mottles:• E-2-a In. c') "g Depth to weeping from side of obs.hole: in, Groundwater Adjuattrtent ft. CD t Index Well# Reading Date: Index Well level, Adj.factor,•,,,Y,9,. Adj:Oroundwater fi el,,,,e, PERCOLATION TEST Date Time � � Observation q� Hole# 6 /1 Time at 9" Cn r7. Depth of Pew Time at 6" Start Pre-soak Time @ ` --/ 71me(9"-6") ' End Pre-soak RateMinJlnch � � !° Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. iteGravel) L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency,%Gravel) 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) I1 r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stores:Boulders. Consisten J t I.. I I Flood Insurance Rate Map: / Above 500 year flood boundary No_/Yes Within 500 year boundary No ✓= Yes Within 100 year flood boundary No /J__ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us_atgttial exist in all areas observed throughout the area proposed for the soil absorption system? L+� If not,what,is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ nental Protection and that the above analysis was pe orm by me consistent with . the required training,experti an exp ri nc described in 310 CN 15.017. Signature i Date Q:\S.EVnMERCFORM.DOC 1 q Commonwealth of Massachusetts --'• W Title 5 Official .Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form- Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the computer,use 10 Bell Road-Hyannis, MA 3o /- Sao only the tab key Property Address to move your Gladys Swindell-Casey cursor-do not use the return Owner's Name key. P.O. Box 2486 Owner's Address Hyannis MA 02601-7486 City/Town State Zip Code �r Date July 15, 2005 of Inspection: Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental t Company Name Na 43 Triangle Circle '- Company Address s Sandwich MA �'102563 7 t� City/Town State Z;i Zip Code 508 364 0894_ c, cz� Telephone Number Certification Statement: r-� I certify that I have personally inspected the sewage disposal system at this addless and that t 1f-r 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 eq4. July 15, 2005 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2107.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4„M A. Certification (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 orexfiltration 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: t5-2107.doc-11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2of16 Commonwealth of Massachusetts Title 5 Officia1, Inspection Form o Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health). ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: . ❑ The system required pumping more:than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the,Board of Health): El 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)(4)that the system is not functioning in 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 N 6-2107.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts r Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form, A. Certification,(cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100,feet of a surface water supply or tributary to a surface water supply. El 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 septictank'and SAS and the SAS is less than 100 feet but 50 feet or more from a private water.supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no,other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: s t5-2107.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 r - Commonwealth of Massachusetts i v Title 5 Official Inspection Form - - Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection D)System Failure Criteria Applicable,to All Systems: You must indicate "Yes" or"No".to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspoolEl " ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded.or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ . Any.portion of a cesspool or privy is within a Zone 1 of a public well. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ N Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No. El ® 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. t5-2107.doc• 1.1/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection E). Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within.400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section,E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: t5-2107.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 6of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Check if the following have been done.You must indicate "yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? . ❑ N/A 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, including the SAS, located on site? Z ❑ 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(3)(b)] t5-2107.doc 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15,,2005 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): n/a_ Number-of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110,gpd x#of bedrooms): n/a-no plan Number of current residents: 2 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 ears usage d 195 gpd ( Y 9 (gP )): Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design,flow (based on 3.10 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): t5-2107.doc'•11/2004 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection General Information Pumping Records: owner 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, o+ be*, 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) El Tight tank. Attach a copy of the DEP approval. . ❑, Other(describe); Approximate age of all components, date installed (if known),and source of information: Age unknown,-information for current system not available at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2107.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System-Form C. System Information (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction ❑ cast iron ® 40 PVC El other(explain): Distance from private water supply well or suction line: 20+ feet Comments (on condition of joints, venting; evidence of leakage, etc.): 2 sewer lines appear structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): 1 Depth below grade: feet Material,of construction: ®concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate;of Compliance? (attach a copy of El Yes ❑ No ;certificate) Dimensions: 8.5 ft x 5 ft x 5 fl(1000 gallon) 2 inches Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32 inches trace Scum thickness Distance from top of scum to top of outlet tee or baffle 10 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? Probe to top of tank 6-210Tdoc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form - X Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.)' 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 grader Material of construction: El-concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2107.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont;) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes. ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution.Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site.plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2107.doc 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)�(locate on site plan, excavation not required): If SAS not located,,explain why::' Type ® -leaching pits number: ❑ leaching chambers number: ❑ Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool - number: El 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.): Soils above leaching pit appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Pit was opened and found to contain 42 inches of effluent in a six foot effective depth unit. t5-2107.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 10 Bell Road Property Address . Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on.site.plan) Materials of construction: Dimensions Depth of solids Comments (note'con'dition of soil, signs�of hydraulic failure, level of ponding, condition of vegetation, etc.): r - f t5-2107.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4,1M C. System Information (coat.), 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r LEACH O Per LOCATIONS A B a 1 36.5 Ft 20 f t z SHED 1. 2 40 f t 14.5 f t SEPTIC a 3 61.5 f t 11.5 f t TANK o i EXISTING DWELLING # 10 u, J H I BELL ROAD NOT TO SCALE t5-2107.doc 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (corit.) 10 Bell Road Property Address Hyannis MA 02601 City/Town State Zip Code Gladys Swindell-Casey July 15, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 13+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ® 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: A hand augured test boring showed no groundwater to an elevation of 11.9. The bottom of the leach pit is at elevation 16.6. Applying a groundwater adjustment of 2.1 feet(Index well AIW-230 zone D, June 2005 reading= 22.1) demonstrates that the bottom of the leach pit is above adjusted high groundwater elevation. t5-2107.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 16 of 16 S ; (COMMONWLAL�1'I:] )F M. A8SnC1.1.1JS1,L I.S "R rah J ExT,,CU PIVE OFi, ,j0F ENv1RONMENTAL 11VU(.0 r DEPAR'T'MEN I' OF I:NV11iONMIaN'I'AL I'It0' 1'I0N � ,r >� ONE WINTER STREET,'I309TON:MA 021109 (617) 2'1'l-fi)[t Se 9 1999 350 MAIN STREETOF WEST YARMOUTH, MA �150 TRUT),ya COXF h3 . 508=775-2800 Pcret.:i ry ARGEO PAUL CELLUCCI A �t Governor V1� 13 S I RUIIS �, ��i Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART A CERTIFICATION MAP 292 PAR 226 PROPERTY ADDRESS: 10 BELL ROAD, HYANNIS ADDRESS OF OWNER: DATE OF INSPECTION: SEPTEMBER 15,'1999 DAVE BISBEE NAME OF INSPECTOR : RICHARD K. CANNON I am a DEP approved system inspector.pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 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 CONDITIONALLY PASSES NEEDS FURTHER EVALUATION THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: SEPTEMBER 20,1999 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(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 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. NOTES AND COMMENTS: SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. a - revised 9/2/98 1 .. } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 10 BELL ROAD, HYANNIS`. Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15,1999 INSPECTION SUMMARY: Check'A, B,`C, orD: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR . 15.303. Any failure criteria not evaluated are indicated below., COMMENTS: r B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. Th P P e System,upon completion of the replacement or repair,as approved by the Board of Health will pass. 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,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is 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. ' Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or.uneven distribution box. The system will pa 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 revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 BELL ROAD, HYANNIS Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15,119991 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF'HEALTH: N/A 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 IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT 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 ANY) . DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER,THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has 'aseptic tank.and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a'surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone Y P P 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water Supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method' x used to determine distance ° __(approximation not valid). 3) OTHER - revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 BELL ROAD, HYANNIS . Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 D] SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of sewage into 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 over- loaded 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 times in the last,year NOT due to clogged or obstructed pipes) Number of times pumped + Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater Elevation. 3 Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a Surface water supply. Any portion of a cesspool or,privy is within a Zone I 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. a E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following; The following criteria apply to large systems in addition to the criteria above: 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: 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 mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further;information.A revised 9/2/98 4• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 BELL ROAD,'HYANNIS' Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks 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. X As 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,including 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. The"size and location of the Soil Absorption System on the site Has been determined based on:.. X Existing information. Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)115.302(3)(b)] _ ' X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System, revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 BELL ROAD, HYANNISp Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 FLOW CONDITIONS; RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S:A.S., Number of bedrooms(design) 3 Number of bedrooms(actual): Total DESIGN flow Number of current residents: 4 Garbage r'g grinder(yes or no): NO Laundry(separate sy stem) r no ( P Y ) (Yes o ) YES If yes,separate inspection cared . P 9 Laundry system inspected(yes or no): N/A Seasonal use(yes or no) NO , Water meter readings,if available(last two(2)year usage(gpd): Sump Pump(yes or no): NO . Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 15.203) Basis of design'flow Grease trap present:'(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: ; Last date.of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source,of information: -1997 System pumped as part of inspection:(yes or no) `NO If yes,vol ume pumped: Gallons Reason for pumping TYPE OF SYSTEM ,v X 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) s. I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other _ 1 , APPROXIMATE AGE of all components, date installed (if known)and source of information: 1994 h, Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 `. W SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) _ Property Address: 10 BELL ROAD, HYANNIS Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 . BUILDING SEWER: NIA . (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line ° Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan), Depth below grade: 22 s Material of construction X concrete metal _;Fiberglass _ .Polyethylene other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28 Scum thickness: 1" - Distance from top of scum to top of outlet tee or baffle: 12 Distance from bottom.of scum to bottom of outlet tee or baffle: 17,, . How dimensions were determined ASBUILTAND.TAPEe. Comments: w » (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.) TANK AND COVER 22"BELOW GRADE,OUTLET BAFFLE,NO SIGN OF OVERLOADING. GREASE TRAP: NIA (locate on site plan) Depth below grade.- Material of construction concrete meta`I . Fi ber lasso Polyethylene — — g — — other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee'or baffle: Date of last pumping: Comments: (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.) revised 9/2/98 ' 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address_: 10 BELL ROAD,HYANNIS Owner. BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,brat time,of inspection) (Locate on site plan) > Depth below grade: Material of construction Concrete — metal ,_,Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Y Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) ` Depth of liquid level above outlet invert: 0 « . Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS NEW,9"X15",32"BELOW GRADE.ONE INLET,ONE OUTLET.BOX WAS INSTALLED SEPTEMBER 16,1999. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,'condition of pumps and appurtenances,etc.) revised 9/2/98 8 n L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 BELL ROAD, HYANNIS Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type Leaching pits,number: Leaching chambers,number. Leaching galleries,number. Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: v Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE(1)1,000 GALLON PITj PIT 28"BELOW GRADE COVER 4"BELOW GRADE 30"WATER IN PIT CESSPOOLS: N/A r (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of,solids layer:• K: Depth of scum layer., Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (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.) revised 9/2/98 g SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 BELL ROAD,HYANNIS Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) , 6 f1`� .O revised 9/2/98 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 BELL ROAD,L HYANNIS Owner: BISBEE, DAVE Date of Inspection: SEPTEMBER 15, 1999 - NRCS Report name ~ Soil Type Typical depth to groundwater ' USGS Date website visited Observation Wells checked Groundwater depth: 'Shallow Moderate Deep SITE EXAM Slope Surfa ce water Check Cellar, a Shallow wells Estimated Depth to groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting;property;observation hole'basement sump etc.)- " Determine it from local conditions Check with local Board of health '_• '" Check FEMA Maps Check pumping records Check local excavators,installers Use USGS;Data - 1 Describe in your own words how you established the'High Groundwater:Elevation.(Must be completed) revised 9/2/98 11 T WN 9F BARNSTABLE LOCATION /0 SEWAGE VILLAGE ASSESSOR'S MAP & LOT ;? INSTALLER'S NAME & PHONE NO. [ Ar?�C7 �/ C7�C.� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) r .�'f,+/, n> (size) 6xi NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,¢ y,S DATE PERMIT ISSUED: -- � �� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � c 0 r 1 � J t' J• r l L - cLL T -gOF BARNST BLUE R� ! /' a LOCH."i'i0•N D SEWAGE # �' VII.LkGE I�f� �/� ?ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO. fid UIVC" SEPTIC TANK CAPACITY ®�' �( �'��•� C�°/�!I t��'' LEACHING FACILITY: (type) (size) NO. OF BEDROOMS— BUILDER OR OWNER PERMITDATE: OMPLIANCE DATE: Separation Distance Between the: d; Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 4 Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by p + n � O O G� �o � , LOCATION J SEWAGE PERMIT NO. VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r �. 1� � C� _- . i u W � � 1 J I � i V Q 1� � � �y , � t .� . $15.00 No.............._... Fxz............................. THE COMMONWEALTH OF MASSACHU SETTS BOARD 'OF HEALTH ._..Tomn.......................OF...............Bar na.t abj.q--------- firation for �ispsal Works Tonstrurtion ram ri_ Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: . ............... ..............jjygnnis. Ma. 02601 ............................. .................................................................................................. Location-Address 1.No. ..............I)LLY�ld...Bizhe..e.................... ............................ ..10 Bell St. HYZ�nis Ma. .....................................................2........................................ owner Addres' ...... 9.P00.) 128 BishoiJs Terracer Hyannis, Ma. .......................... ......7----------------- ............... ".....2...............***........*"**......... Installer Z�Iess Type of Building U Size Lot---------------------------Sq. feet Dwelling—No. of Bedrooms ..........................................Expansion Attic Garbage Grinder Other 0 —Type of Building ............................ No. of persons Showers Cafeteria 4 --------------------------- Other fixtures ..................................... .................................................................................................................. Design Flow............................................galloi�is per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length....... Width................ Diameter._._____.._.._.. Depth................ 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 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I...........:...:minutes per inch Depth of Test Pit..____._...__...____ Depth to ground water_._____..............__. f14 Test Pit No. 2.................minutes per inch Depth of Test Pit.._____.__._._..__.. Depth to ground water______..._.............. ............................................................................................................................................................ 0 Description of Soil--...................................................................................................................................................................... �4 .................................................................................................. ...................................................................................................... ................... -----------------------------*--------------------------------------*-----------------------------------------------*--------------------"------------------*------------------------U Nature of Repairs or Alterations—Answer when applicable......1.000---gallo_U...0 .U.f V IQ X.................................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed In-dividual Sewage Disposal System in accordance with the provisions of TL Ili LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued he boar Ith. Signed.. ...... . .. ........ ....................................... ....... ..................... Application Approved By........ .._2_�. ... '� .a.' Date .................... .. ............................. JIJJIR ---A-Date Application Disapproved for t4.e following reasons:............................................................................................................. .................................................a...........-.--.-..G...o...S..................................................................................................................................... Date Permit No........... -q-------------- Issued................--------- ..................................... Date ------------—----------- tFizs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......... yarn ..... .................... _1nlstable Appliratiou for Eliipniial Vorkg Tomitrurtiou Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........-- n - -t --•-• f •-- �-- �y q--------------------•--•-------•-------------•--•--------------------•----------•--•--------- V1 i...il. .�Location-AciE �.��5`� �i> V���"t or Lot No. Owner t�ddrK. ♦+......................... 1 R t, ; 93 5e�v1e19------=------------------------ 12-8...3lsheps 'Fe a� > ;s�:,-•------ nsta er •i Ad r ss UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—T e of Building -------- No. of YP g -------------------------------------•----_persons-----...------------=----._showers ( ) — Cafeteria ( ) d Other fixtures .......................... W Design Flow................7-------------- .............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 ( ) 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........................ M •---•-----------------------------------••-----------------•---------•-•-•----....-•---••---•-............................................................... ® Description of Soil................................................................................--------------=--------------------•-------------------•----------------••------------- x C� ..............................=.......................................................................................................................................................................... W li V Nature of Repairs or Alterations—Answer when applicable11aafl---ga:1.1.0-n...Qvfr2i0Vj_______________________________________ - --------------------------------••-------------------------------•--•-------•-----------------------------...•-------•.•••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system,in operation until a Certificate of Compliance has been issued by the board of health. S/i'gned.. .......................................................... ^-- -................ Application Approved By.....- t�° t ,�+ r" to > �� Datf •--•••-•-------•--------••••.•..--- .....--•-• y -••----- • Date Application Disapproved for the following reasons-......................................--......................................................................... . ......................................................................................................................................................................................................... Date PermitNo............. ........................................ Issued...----.....---------------.........---------------..... Date —THE COMMONWEALTH OF MASSACHUSETTS - -- - — BOARD- OF--H-EALTH—. .....Try-Vaxa........................OF.......�.xngtablg.............................................. %rErrtif iratr of TuutpRafirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepaireA ( ) by....A,�aP�-•_ry� � � tC x'ILJ ------------------•-•-•------------•----------•---------...-------------•----•----•-----------••----------------•---------------••-. Installer at........-0... : r--•---....I;T-c'Zn't1is.....Ma ....... --------------------------------------------•-------------------------•-------------------•---•------------------- has been installed in accordance with the provisions of TITLE -5 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 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.--••--••-•--- ........................r-5................................ Inspector..-•------ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y. rITI ,� • r'.� � t.rj. .�......................OF......----�.Z'1'!fiatc'lb e........._................................ No......................... . FEE..:. ' ........... Permissionis hereby granted................................................................................................................................................ to Construct �� ) or•,Repair£,( ) an Individual Sewage Disposal System r . ............................ ' Street as shown on the application for Disposal Works Construction Permit No.._.:__:.._~:..::_° Dated_________________________!. __:.._._.. , >• _.. �•✓,y, tom...,.•(. `} ....t .. .- Board of Health DATE = 1_l�-��� = - ;• FORM 1255 A. M. SULKIN, INC., BOSTON ASSESSORS MAP : PARCEL: 2z-+c, TEST HOLE L O G NOTES: � -- FLOOD ZONE: / O j , �,��,/� SOIL EVALUATOR:- L ' 1) The installation shall comply with Title V and Town of Barnstable Board of WITNESS :-F)bW A JI A40I � REFERENCE: �� sty.= 2/2 s�� �,j j DATE Health Regulations. -" 2) The installer shall verify the'location of utilities, sewer inverts and septic r�o,C,� z � � �+ PERCOLATION RATE: .L 2�E � t � �C.� _ _..___._� :_ ___ ;_._ ,�_ components prior to installation and setting base elevations. 1Z. ?� ''L, 5(,. '� 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first - TH- I TH-2 two feet out of the d-box to the leaching shall be level. �..n:f u3 5 to-10 �� 4) This plan is not to be utilized for property line determination nor any other �► l ,, If t. purpose other than the proposed system installation. $ 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. L 0 CA T 0 N MAP( ,��5. �' 6 7) The property is bounded by property corners and property lines. . 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt 2� �- of payment for the plan and installation based on the plan shall be deemed t ` ( approval of the design flow by the owner. r 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed . _.._��_.���� :.�. --� sand per Title V specs. � - 20 7 J 10) System components to be 10 feet from water line. Sewer lines crossing the r 1 -- ------- ----___-- ___-_ water line shall be sleeved x'itli 4 inch SCH 40 PVC with ends grouted if applicable. ;` S E P T f C SYSTEM DES ! G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the -/ ,� owner to ensure such. ` FLOW EST`iMATE f 12)The installer is to take caution in excavation around the gas line. 1 The installer shall verify the location, quantity and elevation of the sewer BEDROOMS AT ��� GAL/DAY/BEDROOM -�.�AL/DAY lines exiting the dwelling prior to the installation. U ✓ --- -"" r SEPTIC TANK t3bll AL/DAY x 2 DAYS - 6&OGAL 3Z f USE / OGALLON SEPTIC TANK- - ----- - ------ Fy SOIL ABSORPTION SYSTEM �k�zo f h'AN _ SIDE AREA. BOTTOM AREA: 1 Z F`� {F0, Ga R; iv SYSTEM SECTION r 5 MAIV : OF • a ^ GALL 1 2 �,- r► - n SEPTIC TA KSoTk S I T E AND SEWAGE PLAN J 4 IN- LOCATION : � I C: Sir i I PREPARED FOR : J tt -� �� a SCALE: I w t DAV i D B . MASON DATE: 1 z I DBC ENVIRONMEN AL DESIGNS EAST SANDWICH . MA Z �- DATE HEALTH AGENT ( 508 ) 833- 2 1 77