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HomeMy WebLinkAbout18-28 CAPTAIN COOK LANE - HYANNIS CONDOS 18-28 Captain Cook Lane (Bld'gi Center Village , n Hyannis A=274 014 a I SMEAD No.H163OR UPC:40259 sinead.com • Made In USA Commonwealth of Massachusetts ...t - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments gk Center Village: 18 -28 Captain Cook Lane, Hyannis, MA BUILDING 3 Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every > Mills,> page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul W. Davis use the return key. Name of Inspector Rosano Davis Sanitary Pumping, Inc. Company Name 9 Rocky Lane Company Address Cohasset MA 02025 City/Town State Zip Code 781-383-8888 SI49 Telephone Number License Number I � I B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails w ❑ Needs Further Evaluation by the Local Approving Authority f'— C0 - c W- 05/16/12 w m. Inspectors S nature Date ii5l f.., The system inspector shall submit a copy of this inspection report to the Approving Authority(Board C t d,'14alth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins 11/10 Title 5 Official Inspection Form: s ace Sewage Disposal System-P ge 1 of 17 f t Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M z Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners:: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every + Mills,� page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ; ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): P t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons Mills MA 02648 05/11/12 required for every > > page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntin est Property YManagement Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every Mills,> page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *'This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence-of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Center Village: 18-28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is required for every P.O. Box 340> >Marstons Mills MA 02648 05/11/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every Mills,> page. City/Town State Zip Code Date of Inspection C. Checklist Check if the fallowing 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 interior of the tank II 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): Number of bedrooms (actual): 12 units. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is required for every P.O. Box 340, Marstons Mills, MA 02648 65/11112 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 11 on average. Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ® Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings were not available at time of inspection. Sump pump? ® Yes ❑ No Last date of occupancy: Units occupied. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is required for every � p O. Box 340 Marstons Mills MA 02648 05/11112 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I General Information Pumping Records: Source of information: Property currently under regular maintenance schedule. Tank was pumped on 04/10/12. 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 I ❑ 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): Septic tank,soil absorption system. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340, Marstons A 02648 05/11/12 required for every Mills,� page._ Cityrrown State Zip Code Date of Inspection D. System Information (cont.) I Approximate age of all components, date installed (if known)and source of information: 39 years per previous inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 48"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Cast iron inlet pipe. Distance from private water supply well or suction line: No known wells in immediatearea. . Comments(on condition of joints, venting, evidence of leakage, etc.): Inlet pipe appeared to be clean and flowing freely. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: 39"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 2,000-gallon precast concrete septic tank. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'wide X 4'deep X 12' long. Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 65/11/12 required for every Mills,> page. Citylrown 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 A-100 Zabel filter in place. 0" Scum thickness Distance from top of scum to top of outlet tee or baffle A-100 Zabel filter in place. Distance from bottom of scum to bottom of outlet tee or baffle A-100 Zabel filter in place. How were dimensions determined? Measured with a tape. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Cast iron inlet tee and A-100 Zabel effluent filter with alarm on outlet tee in place. Tank was structurally sound and watertight and all effluent levels were at an appropriate height.There are no repairs recommended at this time. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M Center , Y Village: 18 -28 Captain Cook Lane Hyannis, MA 9 p , Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every � Mills,, page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owners Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every > Mills,> page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every Mills,> page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 leaching pits. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There was no surface wetness or breakout observed.There were no signs of hydraulic failure observed. Pit"D" had effluent 4" below overflow pipe; pit"E"was dry. SAS appeared to be in proper working order.There are no repairs recommended at this time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): i Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every Mills,> page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Center Village: 18-28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons Mills MA 02648 05/11/12 required for every > > page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I V w 9 6f X 6 wi k � o E A o - 56 -_ o o I _ L7 3 /V o'f'7b scaA t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of W i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is p O. Box 340 Mt Mills MA 02648 05/11/12 required for every � page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar I ❑ Shallow wells Estimated depth to high ground water: SEE BELOW feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: . Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous Title 5 Inspections. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: During previous inspections the high groundwater was indicated to be 19'-7" below grade. Clearly there is separation from the bottom of the SAS to the high groundwater elevation. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 I Commonwealth Qf_Massachusetts Title 5 OfficibillII ° n Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Center Village: 18 -28 Captain Cook Lane, Hyannis, MA Property Address Multiple Owners: Huntingest Property Management Owner Owner's Name information is P.O. Box 340 Marstons A 02648 05/11/12 required for every > Mills,> page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a k i t5ins-11/10 rifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �^ ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (781)383-1234 (781)545-2800 (781)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address 18-28 Captain Cook Lane Building 3 Center Village, Hyannis, MA Owner's Name Multiple Owners Owner's Address Huntingest Property Management 40 lndustry Road—P.O. Box 340 Marstons Mills, MA 02648 Date of Inspection 01/22/09 Name of Inspector Paul W. Davis Company Name Rosano Davis Sanitary Pumping,Inc. Mailing Address 9 Rocky Lane Cohasset, MA 02025 Telephone Number 781-383-1234 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ®Passes ❑ Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑Fails -' I Inspector's Signature: Date: 01/30/09 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 DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable and,the approving authority. E Notes and Comments: i , 1 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. i ' V V 1 _ Title 5 Inspection Form 6/15/2000 RIOSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM I PART A CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village, Hyannis,MA Owner: Multiple Owners Date: 01/22/09 r INSPECTION SUMMARY: Check A,B, C,D or E/ALWAYS complete all of section D: A] SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 3 I0 CMR 15.303 or in 310 CMR 15.3 exist. Any failure criteria not evaluated are indicated below. COMMENTS: I } B] SYSTEM CONDITIONALLY PASSES: 1 , _ 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. Indicate yes,no or not determined(Y,N,ND)in the_for the following statements. If"not determined','please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. t ND explain: _ 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. 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 ; ND explain: 1 The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced ' obstruction is removed I ND explain: } 2 Title 5 Inspection Form 6/15/2000 OSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ' CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village, Hyannis,MA ; Owner: Multiple Owners Date: 01/22/09 C Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board or 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)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 f 2) System will fail unless Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within.a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. The system has a septic tank and SAS and the SAS.is less than 100 feet but 50 feet of more from a private water supply well**. Method use 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: t 3 Title 5 Inspection Form 6/15/2000 ROSAN® DAVIS , 9 ROCKY LANE COHASSET MA 02025 ` (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS_ SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A Property: 18-28 Captain Cook Lane/Building 3 CERTIFICATION(Continued) Center Village Hyannis MA Owner: _Multiple Owners Date: 01/22/09 D System Failure Criteria applicable to all systems: You must indicate either"Yes"or"No" to each of the following for all inspections: Yes No { X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool_ _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow. 4 X Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s . Number of times pumped p p ( ) i ® X Any portion of the SAS,cesspool or privy is below the high groundwater elevation. _ X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to'a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. 1 X 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. [The system passes if the well water analysis,performed at a DE,P 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.] NO(Yes/No)The system I have determined that one of more of the following failure criteria exist as described in 310 CUR 15.303, fails. 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 now of 10,000 gpd to 15,000 gpd. You must indicate either"Yes"or"No"to each of the following: (The following criteria apply to large systems in addition to the criteria above.) 1 t Yes No i 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) 4 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617) 749-61.78 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village Hyannis MA Owner: Multiple Owners Date: 01/22/09 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 with 310 CNIR 15.304. The system owner should contact the appropriate regional office:of the Department. 1 } l . j - t This pale inRAUn le 5 Title 5 Inspection Form 6/15/2000 ROSAN® DAVIS ; 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART B CHECKLIST ' Property: 18-28 Captain Cook Lane/Building 3 , Center Village,Hyannis, MA. Owner: Multiple Owners Date: 01/22/09 Check_if the following have been done You must indicate"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 Were any of the system components pumped out in the previous two weeks?" X _ Has the system received normal flows in the prevous two week period? [ t X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) . X _ Was the facility or dwelling inspected for signs of sewage back up? r X _ Was the site inspected for signs of break out? X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles or tees,material of construction;dimensions,depth of liquid,depth of sludge,depth of scum? 9 X _ Was the facility owner(and occupants if different from owner)provided with informationn the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System on the site has been determined based on: Yes No X _ Existing information.For example, 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) [15.302(3)(b)l i E 9 i 6 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617) 749-6178 . OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION ` Property: 18-28 Captain Cook Lane Building 3 Center Village, Hyannis MA Owner: Multiple Owners Date: 01/22/09 , FLOW CONDITIONS RESIDENTIAL: Number of bedrooms(design): Number of bedrooms(actual): 12 units. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Number varies but typically 11 on average Does residence have a garbage grinder(yes or no): No T Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required) Laundry system inspected (yes or no): e Seasonal use(yes or no): No Water meter readings,if available(last two(2)year usage(gpd)):Water usage records were not available at time of inspection Sump Pump(yes or no):No ; Last date of occupancy: 01/22/09—Units were still occupied at time of inspection COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd. 6 Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial Waste Holding Tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: { Last date of occupancy/use: r OTHER:(Describe) PUMPING RECORDS GENERAL INFORMATION , Source of information: Property currently under regular maintenance schedule Tank was pumped on 11/17/08 Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-how was quantity pumped determined? Reason for pumping: I. TYPE OF SYSTEM _ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _ Privy No Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technolc.gy. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) No Tight Tank. Attach a copy of the DEP Approval LApproximate Other(describe) Septic tank,soil absorption system age of all components,date ir_stalled(if known)and source of information: 36 years per previous inspection age orders detected when arriving at the site(yes or no): No 7 spection Form 6/15/2000 R®SANQ DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-61 78, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village, Hyannis,MA Owner: Multiple Owners Date: 01/22/09 F t . I t i This page intentionally left blank. I g Title 5 Inspection Form 6/15/2000 i f ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C , SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA i Owner: Multiple Owners Date: 01/22/09 BUILDING SEWER(locate on site plan) Depth below grade: 48". Material of construction: X cast iron 40 PVC other(explain) 4" cast iron inlet pipe., Distance from private water supply well or suction line: No known wells in ienmediate area. Comments: (on condition of joints,venting,evidence of leakage,etc.) All piping appeared to be clean and flowing freely.No evidence of leakage SEPTIC TANK: YES(locate on site plan) Depth below grade: 39". Material of construction: X concrete metal Fiberglass Polyethylene other(explain)2 000-gallon precast concrete septic tank. If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No): (Attach a copy of certificate) Dimensions: 5' deep X 4' wide X 12' long. Sludge Depth: 2". Distance from top of sludge to bottom of outlet tee or baffle: Zabel filter in place. Scum thickness: 0". Distance from top of scum to top of outlet tee or baffle: Zabel filter in place. Distance from bottom of scum to bottom of outlet tee or baffle: Zabel filter in place. How dimensions were determined: Measured with a tape. ; Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Septic tank was pumped at time of inspection.Cast iron inlet tee and A-100 Zabel filter with alarm,on outlet tee Tank is structurally sound and water tight and all effluent levels were at an appropriate height There are no repairs recommended at this time GREASE TRAP:NO(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: ' Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.) 9 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE 1 COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM I PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village, Hyannis, MA Owner: Multiple Owners t Date: 01/22/09 ( . TIGHT or HOLDING TANK: NO.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) i Dimensions: Capacity: gallons Design flow: gallons/day Alarm Present(Yes or No) Alarm level: Alarm in working order v(Yes/No) Date of last pumping: Comments: (condition of alarm and float switches,etc.) , DISTRIBUTION BOX: NO.(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: NO.(locate on site plan) Pumps in working order(yes or no): t Alarms in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.) i f r f Io , LTitlenspection Form 6/15/2000 I • ROSANO DAVIS 9 ROCKV LANE COHASSET MA 02025 (61'7)383-1234 (617)545-2800 (617)749-6173 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane i Building 3 _Center Village Hyannis MA Owner: Multiple Owners Date: 01/22/09 SOIL ABSORPTION SYSTEM(SAS): YES.(locate on site plan,excavation not required) If SAS not located,explain why: Type: X leaching pits,number: 2—leach.ing pits in a series t ' leaching chambers,number: leaching galleries,number: leaching trenches,number, lengt : leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system. Type/name of technology: Comments(note condition of soil,signs o-hydraulic failure,level of ponding,damp soil,condition of vegetation,-etc.): There was no surface wetness breakout or si ns of hydraulic failure observed. Pit "D" had effluent 8" below overflow it it "E" was dr . Leaching ap Dears to be in ood workin condition.Recommend re airin cover on it "E"'as it is loose in asphalt. CESSPOOLS: NO.(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: t. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(Yes or No): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.' i l PRIVY: NO.(locate on site plan) r Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) f , )(I Title 5 Inspection Form 6/15/2000 f ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C Property: 18-28 Captain Cook Lane%Building SYSTEM INFORMATION(Continued)3 I Center Village,Hyannis MA Owner: Multiple Owners Date: 01/22/09 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. i 4 you(10- P O � , 8 71 SC�.11) 131[)l�C1�ll� 12 Title 5 Inspection Form 6/15/2000 , ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA + Owner: Multiple Owners Date: 01/22/09 f SITE EXAM Slope Surface water Check Cellar Shallow wells . l - Estimated Depth to groundwater: Greater than 19 feet Please indicate(check)all methods used b determine the high groundwater elevation: Obtained from system design plans on record. If checked,date of design plan reviewed: X Observed site(abutting property/observation hole within,150 feet of SAS) X Checked with local Board of Health-explain: Previous Title 5 Inspections. _ Check local excavators,installers-(attach documentation). Accessed USGS database-explain: You MUST describe how you established the High Groundwater Elevation: During previous inspections the high groundwater was indicated to be 19' 7" below grade Clearly tliere is separation from the bottom of the SAS to the high groundwater elevation. It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. i 13 LTitlenspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 ? 9 xf s` r (781)383-1234 (781)545-2800 (781)749-6178 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS�IVIiE +S' SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION - ' """- ;;", IC:10 Property Address 18-28 Captain Cook Lane Building 31 Center Village,Hyannis,MA Owner's Name Multiple Owners s Owner's Address Huntingest Property Management 40 Industry Road—P.O.Box 340 Marstons Mills,MA 02648 Date of Inspection Completed 1/19/06 Name of Inspector Jeffrey F.O'Connell Company Name Rosano Davis Sanitary Pumping,Inc. Mailing Address 9 Rocky Lane Cohasset,MA 02025 Telephone Number 781-383-1234 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: ®Passes ❑Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑Fails Inspector's Signature: �� Date: 02/02/06 The System Inspector shall surmita 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 DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable and,the approving authorit y. Notes and Comments:' ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 , Title 5 Inspection Form 6/15/2000 r ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (61.7)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 INSPECTION SUMMARY:Check A,B, C,D or E/ALWAYS complete all of section D: f A] SYSTEM PASSES: ' X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 or in 310 CMR 15.3( exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. , Indicate yes,no or not determined(Y,N,ND)in the_for the following statements. If"not determined"please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _ Observation of sewage backup or 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. 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 ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced _ obstruction is removed # ND explain: i 2 Title 5 Inspection Form 6/15/2000 r ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) � Property: 18-28 Captain Cook Lane/Building 3 , Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 C Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board or 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)that the system is not functioning in a manner which,will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet of more from a private water supply well". Method use to determine distance "This system passes if.he 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: 1 j ' r I 3 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 D System Failure Criteria applicable to all systems: t You must indicate either"Yes"or"No" to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow. } X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ X Any portion of the SAS,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to.a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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. [The 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.] NO(Yes/No)The system I have determined that one of more of the following failure criteria exist as described in 310 CMR 15.303, fails. 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. You must indicate either"Yes"or"No"to each of the following: (The following criteria apply to large systems in addition to the criteria above.) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply i 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) 4 Title 5 Inspection Form 6/15/2000 f ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners ' Date: Completed 1/19/06 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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t TDdO flMge 10 m9e mde malMy Deft Kmmlk t 5 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART B ' CHECKLIST Property:ert 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA. Owner: Multiple Owners Date: Completed 1/19/06 Check if the following have been done You must indicate"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 Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the prevous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum? _ X 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 on the site has been determined based on: Yes No X _ Existing information.For example, 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) [15.302(3)(b)] 6 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms(design): Number of bedrooms(actual): 12 units. DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Number varies but typically 11 on average. Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required) Laundry system inspected (yes or no): Seasonal use(yes or no): No Water meter readings,if available(last two(2)year usage(gpd)): Water usage records were not available at time of inspection. Sump Pump(yes or no): No Last date of occupancy: 01/19/06—Units were still occupied at time of inspection. COMMERCIAL/.INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd. Basis of design flow(seats/persons/sq8,etc.): ' Grease trap present(yes or no): _ Industrial Waste Holding Tank present(yes or no): _ F Non-sanitary waste discharged to the Title 5 system(yes or no): _ Water meter readings,if available: Last date of occupancy/use: OTHER: (Describe) i GENERAL INFORMATION PUMPING RECORDS Source of information: Property currently under regular maintenance schedule. Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: 2,000 gallons-how was quantity pumped determined?Sight glass on vacuum truck. Reason for pumping: To determine structural integrity and water tightness of septic tank. i TYPE OF SYSTEM _ Septic tank,distribution box,soil absorption system ; Single cesspool Overflow cesspool Privy No 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) No Tight Tank. Attach a copy of the DEP Approval X Other(describe) Septic tank,soil absorption system. Approximate age of all components,date installed(if known)and source of information: _36_years per previous inspection. Were sewage orders detected when arriving at the site(yes or no): No 7 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE , COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 I Mao 9miffe Amtem�nOMMIMyv Il(Dft HiMk . f 8 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane!Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 ; BUILDING SEWER(locate on site plan) Depth below grade: 48". Material of construction: X cast iron 40 PVC other(explain) Cast iron inlet pipe. Distance from private water supply well or suction line:No known wells in immediate area. Comments:(on condition of joints,venting,evidence of leakage,etc.) , All piping appeared to be clean and flowing freely.No evidence of leakage. SEPTIC TANK: YES(locate on site plan) Depth below grade: 39". Material of construction: X concrete metal Fiberglass Polyethylene ; other(explain)2,000-gal1on precast concrete septic tank. If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No):_(Attach a copy of certificate) Dimensions: 6' deep X 4'wide X 12' long. Sludge Depth: 2". Distance from top of sludge to bottom of outlet tee or baffle: 33". Scum thickness: 2". Distance from top of scum to top of outlet tee or baffle: 4". s Distance from bottom of scum to bottom of outlet tee or baffle: 22". ' How dimensions were determined:Measured with a tape. Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Septic tank was pumped at time of inspection.Inlet tee and outlet tees in place as required.Tank is structurally sound and water tight and all effluent levels were at an appropriate height.There are no repairs recommended at this time. GREASE TRAP:NO(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: k " Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) 9 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 TIGHT or HOLDING TANK: NO.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm Present(Yes or No)_ Alarm level: Alarm in working order _(Yes/No) Date of last pumping: , Comments:(condition of alarm and float switches,etc.) i DISTRIBUTION BOX: NO.(If present,must be opened)(locate on site plan) i 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.) i PUMP CHAMBER: NO.(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.) i 10 Title 5 Inspection Form 6/15/2000 I ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 SOIL ABSORPTION SYSTEM(SAS): YES.(locate on site plan,excavation not required) If SAS not located,explain why: Type: X leaching pits,number: 2—6'X 6' leaching pits in a series. ; leaching chambers,number: f leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensicns: 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.): There was no surface wetness,breakout or signs of hydraulic failure observed.Leaching appears to be in good working condition. There are no repairs recommended at this time. f CESSPOOLS: NO.(Cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: ' Materials of construction: Indication of groundwater inflow(Yes or No): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: NO.(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) i 11 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C , SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners ' Date: Completed 1/19/06 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. II W -6�or f A O � 56 ' 8 - 0 3D 5� NOIL17b scale 6()/'Idlr 12 Title 5 Inspection Form 6/15/2000 ROSANO DAVIS 9 ROCKY LANE COHASSET MA 02025 t (617)383-1234 (617)545-2800 (617)749-6178 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(Continued) Property: 18-28 Captain Cook Lane/Building 3 Center Village,Hyannis,MA Owner: Multiple Owners Date: Completed 1/19/06 SITE EXAM Slope Surface water ' Check Cellar Shallow wells i Estimated Depth to groundwater: Greater than 19 feet Please indicate(check)all methods used to determine the high groundwater elevation: _ Obtained from system design plans on record. If checked,date of design plan reviewed: X Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain:Previous Title 5 Inspection dated 10/28/03. _ Check local excavators,installers-(attach documentation). _ Accessed USGS database-explain:. I You MUST describe how you established the High Groundwater Elevation: a During a previous inspection on 10/28/03 the high groundwater was indicated to be 19' 7" below grade.Clearly there is separation from the bottom of the SAS to the high groundwater elevation.It was by this non-intrusive method that it was estimated that separation exists from the bottom of the SAS and the high groundwater. i t 13 Title 5 Inspection Form 6/15/2000 i , William cPUielerman' 141 STETSON LANE HYANNIS. MASSACHUSETTS 02601 617-771-1341 December 28, 1976 Barnstable Board of Health 397 Main Street Hyannis, Massachusetts 02601 REFERENCE: Barnstable - Subsurface Sewage Disposal Proposed 30 Condominium Unit. Addition to Center Village Condominium Complex, Old Strawberry Hill Road and Route 132. Job No. 73-410--Approval Letter Dated October 18, 1973 (Mass. Dept. of Public Health) and Sewage Permit #594 (Town of Barnstable) Gentlemen: This is to certify that the disposal facilities for building #3 have been inspected this day and found to be constructed in accordance with the approved plans in two sheets, the first of which is titled: JULIUS DOLINER CONSTRUCTION CO. 8.50 Boylston Street Chestnut Hill, 02167 SCALE: 1" 30t. DRAWN BY: T. LEVRONI DATE: 8-24=73 DWG.N ., , _S�P�-,; DWG. TITLE: SITE PLANK OF hrq`� CENTER VILLAGE CONDOMINIUMSS�tiP HYANNIS, MASS. 4 WILLIAM vi., Very Truly y rs, LIEBERNt.N No, 2397i O ���➢ s-rs `"5/ONA F� + W William ieberman, P.E. cc: Department of Environmental Quality Engineering, Mr. Fred L. De Fe Feo, P.E. Regional Sanitary Engineer, Southeastern Health Region, Lakeville Hospital Lakeville, Mass. 02346 Strawberry Hill Realty Trust, Mr. R. Anderlot, 477 Main Street, Yarmouth- port, Mass.. 02675. -07 /IF 7J No.......6.—Y.Y.... Ftimc ............... THE COMMONWEALTH OF-MASSACHUSETTS BOARD F I-6EALTH4-71/41 -- -r& - _ *....***' .......................... Appliration -fur Uiipuiittl Works Cnonstrurtion Vrrmft Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t ---_------------_-- -- ..................... --------------------------------------- oc i Addj scf Yot No. y. •�� ,/ (+4� ............ Owner Address ------. Installer Address Type of Building 3 Size Lot----------------------------Sq. feet U U Dwelling—No. of Bedrooms-.-_! ----------------------------------Expansion Attic Nd Garbage Grinder ( ) per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow....................{51)._..._........_gallons per pet-son per day. Total daily flow.....h0 _a_......................... WSeptic Tank—Liquid capacity p2.®_Q&allons Length................ Width_.............. Diameter___----. --_-_- Depth-------.__----- x Disposal Trench—No. .................... Width-------_-___---__-- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.____->�_---_-_-- Diameter.....xe?_51�� Depth belo inle .....5�_...._..._. of "lea ing area---&_F..sq. ft. Z Other Distribution box ( ) Dosing to ) d D� 2�—� Percolation Test Results Performed by..__-. _ _6i�r- .,.._. .�D........ Date__.. .............�.._. Test Pit No. 1----------------minutes per inch Depth of Test Pit----------.✓--------- Depth to ground water-------.-.-.-.-.._..___- (� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-.----_-.---.-_._.___ a -------- --------------------- -•---•--- -• --- - 4La Description of Soil -- -- Cf:Ct� �'1G�_...._ _�'�_�✓ Ps - -------------------- -------------- U ---------------------------------- --- -- ------- ---- ---- ---- - - - W ------------- -- ---- 1` ^��-- �---- x = ' U Nature of Repairs or Alterations—Answer when applicable.---------------------------------------------------------------------- -----------------------. ------------•----------•----•-•-----•-•--------------------------•------••--------------------------------------•------------------------ ------------------------------------------ ----------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is d by boar of tl i/ne - ` •. •-----------•--....... Date Application Approved By........ Date Application Disapproved for the following reasons:......... ------------------------------------- ---------------------------------------•- ---------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued...................... ................................. Date C-7?4 No.......f........ .... Fsic....A-2..;-........ THE COMMONWEALTH OF MASSACHUSETTS BOARD PIF HE Apphrtttion -for liii o,5ttl lVarkii C on.strurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �t Q -!�! l .0 ( .. - ,e /c�_S-_r U-a...t............ -( � ---- = -------5 e .----------------------------------------------- Loc tiori Add ss [/ ✓/ _ _r( (A Pry'� ! ,-�.0 CG 1j_ .t-S' �?? / ,_:_ �_ rGyT vw "1,1 ?u�r file f J( !! Address ....... Installer Address U Type of Building �"3 Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms-_w -----------------------------------Expansion Attic (\(U) Garbage Grinder ( ) aOther—Type of Building ..._----------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------ --------------------------------------------------------------------------------- W Design Flow--------------------r76--- ----_----..gallons per person per day. Total daily flow-----1.4.d-------------------------gallons. USeptic T.-:iik—Liquid capacitye, 1-f allons Length---------------- Width..._.._---_--- Diameter_..............- Depth........._..... xT Disposal Trench—No. ................... Width---.�.------...._.- Total Length...........--------. Total leaching area......._,.-.._._.sq. ft. , Seepage Pit No...... . .:--------. Diameter.-.._---- v. Depth be w in t------ --------- To 1 le ping area...._.. ---sq. ft. Z Other Distribution box ( ) Dosing t �r� Percolation Test Results Performed by. 0 __. ��-'.G�D Date.. r 7 Test Pit No. I................minutes per inch Depth of 'Kest Pit.....-.---..-....... Depth to ground water-...__------..__..---. (� Test Pit No. 2................minutes per inch Depth of Test Pit.....-..-.---------- Depth to ground water. ......--------------- -..----- ------ ----- ------------------ ---------------------------------------------------------- _ . _n �f--` t0Description of Soil------- b------- -------------- U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..-------------------------------------------------- ------------------------------------------- ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bees) iss d by thee'boa - of e It f� ` ned.', --••`... Dae / 4APPlication Approved BY - - - - --•--•- --.. -- -- . - -- --------•--- --- -------- Date Application Disapproved for the following reasons:.......................---------------------•-------•---------------------------------- --------- -� .. ____ ----------------••--••-••---------•--•--•-•---------•--•----•----------------•-.---- Date PermitNo......................................................... Issued...................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS C� BOARD OF EALTH ...!/.. .... ..........OF................ ... .............. ........................................ Q,rrtifirtttr of TIMplittnrr TH IS C -RTIF „ Th 'theAndividual Sewage Disposal System constructed ( ) or Repaired ( ) �. Insa ........ __ ,-.-ea t r t� . ....... .. . has been installed in accordance with the provisio s of :T XI of The tate Sanitary Coc _as described irf the application for Disposal Works Construction Permit INo . -__��.'�.............. dated...... ....1p-71r...........••... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector-------------------------------------------------._...----••--••----•----•---.----- THE COMMONWEALTH OF MASSACHUSETTS O 1 BOARD F HEALTH G �— ......... ..1'' i.........OF..... ....... - ....... 1 No. ..... FEE .-�............... i� tt tt1 hfi njalzu2e Urtort Vrrmit `Permission ............. is ereby granted..-..... !.. -_-____ �. --------------- - to Con u )�Repair an Individual � ge is-po stem Gat No ✓1 Stretf as shown on the application for Disposal Works Construction Pern ' �- .... ted..�. - __________ ---------- ---------- ��`J� �� Board of Health 1, FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r Q PAA No.._ O `r Fps..... ... LTH MAS THE BOARD AOF OF HEALTH TS TOWN OF BARNSTABLE Appliratiun for DiuVuuttl Workri Tomitrnrtiun Frrntit Application is hereby made for a Permit to Construct ( ) or Repair (0<) an Individual Sewage Disposal System at: .....---•-•.-•••......--•••................•-•---••••••--•-••--•-•-••-•-•••-•....•-•---------••. ............................. Location- dfess f» ✓t ld-•A'��C.......--/_ __. UiJ�� �°'� oi+ Y® ... r_..k!N a JVI 1 C. Owner Address Installer a r_.. � Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------------------------------------.----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------. Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------------------------------------------- -----------------•-----------------------------•------------- w Design Flow......................................::..gallons per person per day. Total daily flow..------------------------------------------gallons. WSeptic Tank—Liquid capacity�.gAgallons 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 ( ) 0-4 Percolation Test Results Performed by..........-............................................................... Date........................................ a a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fr Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 ...........................................................••---....----•-•-•-•-------.......------.......................................................... 0 Description of Soil........................................................................................................................................................................ �4 U w UNature f Repairs or Alterations—Answer when applicable.._ --___✓4-_....../0_04! ...... 4 '?._..e�'T �!J -.c��....!.... `-- -� --•-•-.../Z- .__......���-•----�.. +_istiJ ....-J -.*S%% rYl 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 Compliance h been issued by t board of health. Signed ............... : :. .. ... ............- --------------------------- Date Application Approved By ............... ------ ... ..... - --1 .....��L� ........................................................... Date Application Disapproved for the following reasons: ................. .. .............................. --. ................... ............. . . ............................................ . ............................................. . ............................................................................ ........................................ Date PermitNo. ------cy..`-1P---"---- -------------------- Issued ..................................... ............... . Date 9►- _(gbh � u (��2_ a�ti- vI � - o rU� 30 — No..... 1_..__....... THE COMMONWEALTH OF MASSACHUSETTS �r BOARD OF HEALTH �J C' TOWN OF BARNSTABLE A ptiratiun for rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: - Cc f vl t,Ln C'_ t.10a�� ,9LDk Lt\J ....----•--------•-•-•---••-•---••••- _. . ..•. -•-----•------•------------•---------•-•- ---•••------•--•----•--•------•-•.. ---- .... ............•----------..... ....... Location-t)tddress or Lot No. C ti.r,�lL v l cL�� �1 cal :�s� --rLLv�sP y ©�s,-y� ;ZA ------------------------._.....•-••-...•. -- -•-••--•-•-•......-- ----•• - Owner Address --------------------------------------------•••-•----------- ---•-•----•----• -------•- .......................................... Installer Address Type of Building Size Lot____________________ q. feet I.� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures _______________________________ _ _ d -------------------------------------------- ----------------= w Design Flow............................................gallons per person per day. Total daily flow-------\.....................................gallons. WSeptic Tank—Liquid capacity.)4.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........................................ ,.4 Test Pit No. I................minutes per inch Depth of Test Pit-------------F---- Depth to ground water........................ 0-4 0 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R. •---•---------------------•------------------------------------------------_•-.---.._..--•------------------------•----------•---•-•-----------------_..... ODescription of Soil........................................................................................................................................................................ x U w UNature QQ•f Repairs or Alterations—Answer when applicable.._ ._ ��jf_......L._ -'____ f_ _ . _17 -- .................................................... 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 Compliance ha been issued by the board of health. Signed --------------- - `.......- U ............. ............. Dare Application Approved By ............... �r�. ..�.- L-y>� Date Application Disapproved for the following reasons: --------------------------------------------------------------------------------------------------------------- k q Date Permit No. --------l--`•,/----- 1!,0,(---------------------- Issued Dare -------------------------------------------- ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO( WN-OF'BARNSTABLE Qxrtifi ate Of (ILIUMPlianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ------------------------------ ----- ---------- -------- Insr.Jlrr ___... � r ^ � u� € � `-� C/-� / va 7L_ / 6L J - F .------ >tS� . .. .._._........_._. . - ..... . .. ..._ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No- ---------- y._-..l .n .... dated ---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE/��.. ^--� . -------------.... Inspect u� .. :.r_ 1, J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE ... �iu�usttl ur�u �un,��r�r#iun ��ermi� Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair O an Individual Sewage Disposal System at No.. 11A - ? <,_ T C:. v — S..:. iJ c..................C_.....( -i h p `5 ..I JN�� Street as shown on the application for Disposal Works Construction Permit No._?�✓-&(I(I__ Dated.......1�.-A 1____ '4......... - --------------- _;--------- .._..--------------- - ---------------------- / '�� Board of Health DATE-------•----`--�'-------=--------•�------•------....---•.................... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION L,ev SEWAGE # 5'�O'-L64 VILLAGE j ASSESSOR'S MAP & LOT-v,)-7y-6'/! a INSTALLER'S NAME & PHONE NO. 0QYt;;--CVr4-r-1 � R= SEPTIC TANK CAPACITYl�ii LEACHING FACILITY:(type) )p rT— (size �P>f®9 NO. OF BEDROOMS PRIVATE WELL PUBLIC ETAW R BUILDER OR<QNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - a VARIANCE GRANTED: Yes c No- 3 Ab P , 7-S