Loading...
HomeMy WebLinkAbout1081-1087 FALMOUTH ROAD/RTE 28 - Health 1081-1,087,`Falmouth Fad (Rte 28). Hyannis ,J"'.- �A _� 250rO06 e 1 I tl f 1 1 " p f� k ' y I TOWN OF BARNSTA.BJ ilJr :�'I I: CN r f^ SEWAGE # ,� f (�� Vl,.LA GE n 5 ASSESSOR'S MAP & LOTi _. I14S1ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I-A I_ h f xU4 LEACHING FACILITY: (type) Gy (4r,[ 7,Vd Q')C NO. OF BEDROOMS � � � !A, j BM DER OR OWNER ,�%j C)� �� 1-2 V 2 D X QMLACE'.DAEP RMITDATE: W3 _ Separattion'Distance Between the: TVf ixti.�urr Adjusted Groundwater Table to the Bottom of Leaching Fac' i Feet ,-*Private Water Supply Well and Leaching Facility (If any wells'ezi y, :!77 on site or within�200 feet of leaching facility), (� Feet. lidge of Wed.and and Leaching',Facility(If any wetlands exist �I within 3W feet of leaching facility) 'S Feet FL—nished by _ � o L4 X 3 ca ti n fi E Q Olk, � eN x 9k w' TOWN OF BARNSTABLE LOCATION 1��1 ' �0 �EWAGE# �c VILLAGE ASSESSOR'S MAP&PARCE --,WL —G&A INSTALLER'&PHONE NO. „ \� G�,�IiC �{ 7`( 4061 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 0 0 A-K G rl q lA I% 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) I Feet 60 Edge of Wetland and Leaching Facility(If any wetlands exist within e 300 feet of leaching facility) // Feet FURNISHED BY A) l� (o0 i®B Bed u � ' o a 6 (0 9 4.+ l a97 Pt"VA ► g, No. (Nl�� � 1 r� �✓_6'60 •� e) ;91✓d� Fee .00R THE COMMONWEALTH OF MASSACHUSETTS � Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA�SACHUSETTS Yes P y -(G � I�I�ILa ion for ]Disposal 6pstem Construction Permit d,e�u.i 0.7 ,, Application for a Pe iti4n to Con ct( Repair Upgrade( ) Abandon( ) ❑Complete System F, ndividual Components Location Address or Lot Q 'i Owner's Name,Address,and Tel.No. v. k; Assessor's Map/Parcel Installer's Name,Adcjress,and Tel.No. � y . Designer's Name,Address,and Tel.No. SGc��- r'Gst.11�'C �G Type of Building: Dwelling No.of Bedrooms PJA Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) /�( ► Other Fixtures /� v Design Flow(min..required) A p gpd Design flow provided / gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C&v6 f s Date last inspected: `Sk c Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sig Date '�'0 . Z'I Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued Z {p - No. AAfetX � � �i�+ r� Fee Ns " ..O© THE COMMONWEALTH"& MASSACHUSETTSGV� Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes I C5 (��,jgp ligation for Disposal �pstetn Construction 3permit h GQ�t P�` c�v- 1 a 7 Application for a Permit to Cons ct 1( Repair,(Upgrade( ) Abandon( ) ElComplete System [: Yndividual Components _ "1 Location Address or Lot Owner's Name,Address,and Tel.NO-FAN 4 1 Assessor's Map/Parcel Install'er's Name,Address,and Tel.No. Sl* 4 (X)(OQ Designer's Name,Address,and Tel.No. 0. U\r G a a n rt ,s Typeof Building: a �, Dwelling No.of Bedrooms J A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures , r DeS' low(min.required) A gpd Design flow provided gpd � I Plan Date,' Number of sheets Revision Date y Title Y 1i t " _Size of Septic Tank- Type of S.A.S. Description of Soil T -4. Nature of Repairs or Alterations Answer when applicable) Date last inspected- �S e C Agreement: i w The undersigned"agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ,..„ accordance with4he provisions of Title 5 of the Environmental Code and not to place the system in operation until'a Certificate of Compliance has been issued by this Board of Health. Si ed Date -7 •"~.Q •?• Application Approved by _ Date + I '�_J Application Disapproved by Date 4 c f for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS v ~ �- BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired, �U raded' g P Y ( ) P 6� 1 Pg ( ) Abandoned-(�)byar _, t'Ca at 1 r'l ) �1 A�ias been constructed in accordance with-the provi1ions�of Tit--1e"and the for Disposal System Construction Permit No. J " t dated -Iit Installer ,t"(" p�„C, Designer pP design f v/ gpd ' #bedrooms �'�' Approved desi flow The issuance of this permit shall not be construed as a guarantee that the system will function 0desi'grted. Date ( - Inspector ��j4- No v"y �3 ! Fee I r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal *pstem Construction 3permit Permission is hereby grante`do Co: t ct(�, Repair(`/)' Upgrade( ) Abandon( ) System located at ` , ' -� /� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions.' Provided:Construction must 'e completed within three years of the date of this permit. Date ( ?, 11J Approved by ' f ool� Commonwealth of Massachusetts °?Sb u - Title 5 Official Inspection Form a �' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �T, y < 1081 & 1087 Falmouth Road Property Address %y Alice Fardyi~ Owner Owners Name information is C�a required for every Hyannis Ma 02601 5/19/2018 0', page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms C 3 0 on the computer, J use only the tab 1. Inspector: key to move your cursor-do not . Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/19/2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °y 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 1081 & 1087 Falmouth Rd Hyannis is served by a shared Title V septic system consisting of a 1500 gallon septic tank, distribution box and a row of 3 Infiltrators and a row of 3 Cultecs. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y :❑ N ❑ ND (Explain below): t5ins-3113 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 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.. 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ O 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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank, d-box and Infiltrators unknown date of install, row of 3 Cultecs added 9/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Forth: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 1081 & 1087 Falmouth Road Property Address Alice.Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank needs to be cleaned now and should be done soon again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �y 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 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 , ° 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 Infiltratos 3 Cultecs ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of a row of 3 Infiltrators and a row of 3 Cultecs. No signs of past hydraulic overloading. vegetation was overgrown but is consistant with entire property. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. CitylTown 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.): I t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 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 1 'z as , Wroof �0A LO i�l A 6+ 4 � /a Cj ter c., jy �� , Z+. 3� I t5ins•3/13 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1081 & 1087 Falmouth Road Property Address Alice Fardy Owner Owner's Name information is required for every Hyannis Ma 02601 5/19/2018 page. City/Town . State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 y„ TOWN OF BARNSTAB. LOCATION rq(h&0QJ'V1 SEWAGE # V VILLAGEy -ni 5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �r� SEPTIC TANK CAPACITY 1 1I36X CX\S- [''�Xlt"tc r; LEACHING FACILITY v jam, �6S a� a X • (type) �� C 'll�.��--- size) NO.OF BEDROOMS Mao BUILDER OR OWNER.;�V d�� ����y / � Y 2® K PERMIT DATE: IV O •-COMPLIANCE DATE: [ NJ v-- Separation Distance Between the- Feet,Adjusted Groundwater Table to the Bottom of Leaching Face Feet Private Water Supply Well and Leaching Facility (If any wells exi D on site or within 200 feet of leaching facility). ``t(N\ Feet Edge of Wetland and Leaching Facility(If any wetlands exist) /r n �� Feet within 300 feet of leaching facility) !� y �� Furnished_by i i a Uzi y 13��JrUc�r�. j (poor` l6FfJ A 4b 6� �� o b r'°0.Xr A V0 Cv � y Ntw ��- 3 b Q�o 3a - c�t}C; h , Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: forms on the computer,use (C)S\ — \C) e)�1 only the tab key Property Address to move your cursor-do not Owner's Name use the return key. 9 t rr o( . Q_Q.-fit (O�w�ner's Address "�b� l�'tJ�2V�V l��e 9�1�t• ��3 City/Town State Zip Code Date of Inspection: Date 2. Inspector: Name of Inspector cbkmk Company ame �t 0•`'�o x Company Address �y City/Town State Zip Code Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance Hof;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: - 1(' Passes ❑ Conditional) Passes '' \ y ❑ Fails:: Needs Fur er E atio th ocaI Approving Authority l i^ -- r� In pectoris Signature Date :.% -'l 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. t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) ((501 Dam r r� (rv►�o Pr erty Address ' Citi wn State Zip Code Owner's Name Date 61 Inspe ion 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. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal S stem p Y Page 2 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) Property Address 9-6 IT �l � State Zip Code Owner's Na& r Date of In pe i n 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 ❑ 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: 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 t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M B. Certification (cont.) 025(— I007 f=yttwo URX W4 1 Pr perty Address t u MOSS citvrro,wn State Zip Code Owner's NaTmel Datd of Inspecti 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. ` ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t5insp.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4of16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cost.) 9 1 -- (OB7 T73nj Mo J roperty Address cl cl own State Zip Code Z l �i / wner's Na a Date a of fnispWiin�(o 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. t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Certification (cont.) Pro erty Address �S Cityrroivn State ZipCode Owner's Name Dat�fInspecttOnn�a D)System Failure Criteria Applicable to All Systems: j 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 -K Static liquid level in the distribution box above outlet invert due to an overloaded ❑ or clogged SAS or cesspool ❑ f Liquid depth in cesspool is less than 6" below invert or available volume is less 1� than day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ,h( Any portion of cesspool or privy is within 100 feet of a surface water supply or yam' 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. Yes No ❑ r The system fails. I have determined that one or more of the above failure j� criteria exist as described in.310 CM 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. t5insp.doc•03/2006 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 C. Checklist Z ty Address wmnhS oown State Zip Code it VAIIAN - Owner's ITamel Date_ofllnsi ection Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YES NO ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (62,( r I 0 n EA(wu,`��� Property Address 1 yw\C__1 City wn State Zip Code 3)i 1 7 2 i Owner's Name Date-of nsp�tion Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): �CoO Number of current residents: 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 a No Water meter readings, if available(last 2 years usage(gpd)): d, Sump pump? ❑ Yes No Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) Property Address C, 1 /T State Zip Code Owner s N , e Date of nspe tiort General Information Pumping Records: Source of information: -- 1 " IgU5 stop Was system pumped as part of the inspection? ❑ Yes No If yes,volume pumped: gaubrSs How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DE approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No t5insp.doc•03/2006 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 Subsurface Sewage Disposal System Form D. System Information (cont.) 107 51 - 1 o s 7 Pr perty Address V1Wyot C' itv own State Zip Code 77/9-1. p . Owner's Name I Date of Inspe tion Building Sewer(locate on site plan): Depth below grade: A-T �72641�2_ feet Material of construction: El.cast iron 440 PVC Elother(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting; evidence of leakage, etc,)- to - t �t CHt Septic Tank(locate on site plan): �tG Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) -------------- --------------------------------------------------------------------- ------------ ------------------ Dimensions: tt Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3 c r rr Scum thickness Distance from top of scum to top of outlet tee or baffle 1 � I1 Distance from bottom of scum to bottom of outlet tee or baffle y How were dimensions determined? t5ins .doc•03/2006 Title p t e 5 Official Inspection Form;.Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) Property Address ity wn State Zip Code ��U a _ Owner's Name I Date 41nspec ion Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels s related to outlet invert, evidence of leakage, etc.): Il�eec� D "Fey_t 5 L- LE Grease Trap (locate on site plan): Depth below grade: feet Material of construction'. ❑.concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) f 0 e( _ 1© 00" -f t-t ,�z�k) � Prop rty Address Ciao State Zip Code Owner's Name Date bf 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.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert �s �� T Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of kox, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) Property Address City own State Zip Code Owner's Name IDate of In ection 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 condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•03/2006 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 D. System Information (cont.) Property Address Ci /T n State Zip Code Owner's Name D to a of In ection 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: ❑ 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.): t� C— t5insp.doc•03/2006 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 D. System Information (cont.) �®9, 0P-I Property Address �14/T wn State Zip Code +-UW ( G9 Z(.;?,(1 b Owner's r4am4 Date of Ynspectio 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. LZ \0S1 9 � g 3 .V—A�\ S R2-.2d 0Z-3\ B?- 3 ) �`f 32- 3 .-32 t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 v Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (coot.) roperty Address Ni�I 0 )*j k C, , City/Tdwn State Zip Code �\fQ b a 7 it, 6� Owner's Name I Date of Inspec ion Site Exam: Slope des Surface water *.�O Check cellar Qr� Shallow wells tJ Estimated depth to ground water: 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: PyeS_T'. r4c>D19 yS 662 ttA t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 YOU WISH TO OPEN A BUSINESS? For Your Information: 'Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st F1., 367 Main St., Hyannis,MA 02601 (Town Hall) and get the Business Certificate that is required by law. trv.... DATE:L4 5<- Fill in please: : a F APPLICANT'S YOUR NAME/S: - In ��r Sly` null BUSINESS YOUR HOME ADDRESS: ryy " TELEPHONE # Home Telephone Number NAME �tAT pF CORPOION; IUAIVI OF N�VV BUSINESS PE OF BUSINESS c IS TWIS A EJDME OCCUPATION YE5 ADDRESS OE F3U51N5S� NiApJPARCEI NUM®ER a : .�Q �0. (gssessing)' When starting a new business there are several things you must do in order to be in compliance with-the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has beBn rimeof th e permit requirements that pertain to this type of business. MUST ISO(/1 !i�; ARDGi1S MPLY WITH ALL Authorized Signature** MATERIALS S REG(,ILA TL')r,�c COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE Date: H TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: I''/Z I yYn nLt.j, TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: -�Ay� EMERGENCY CONTACT TELEPHONE NUMBER: SO r -3� O s (J S 3 0 MSDS ON SITE? TYPE OF BUSINESS: S INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW-. ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant Signature Staff's Initials r .rye YOU WISH TO OPEN A BUSINESS? [For Your Information: Business certificates (cost$30.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME in town which you must do by M.G.L.-it does hot give you ermissio op )9 Y P e.ra Business Certificates are available at the Town Clerk's Office, 1°` FL., 367 Main Street, Hyannis, Mq 02601 (Town Halt) Fill in oo,E y please: . e ° APPLIGANT-S YOUR NAME:: YOUR HOME ADDRESS: O(f 9 14/ U TELEPHONE # Home Tele hone Number �;S 0- 0 j30 N NAME OF NEW.BUu Nt5*3 1S THIS A HOME OCCUPATION?. YES NO-.: � .0 © SINES 1 el 1 TYPt�OF 15U S: I� r� 10 Have you been ' iveii a r.'oyal • -' 9 pn fr :r NO ADDRESS.OF BUSIfVESS , 1 �" MAP/PARCEL-NUMBER When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you {nay need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street). to make sure you have the appropriate permits and licenses-required to legally operdte your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informd e of any permit requirements that pertain to,this type of business. Authorized Signature** OMMENTS: 2. BOARD OF HEALTH This indjvidual has e for e _ f e requirements that pertain to this type of business. r Aut ized Signature** MUST COMPLY WITH ALL COMMENTS: . / �(�- ��G��p�naj, HAZARDOUS MATERIALS REGULATIONS 3 CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual di id.ual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.. COMMENTS: 777 Date: y / t / •08 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: r BUSINESS LOCATION: `b INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: ® 6 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: cJ C INFORMATION/RECOMMENDATIONS: oce, „Pd-20d s 7T-el Fire District: -l'- � G/fLLOAJIS or 1��iKt�Z In/ BA-St_WCA,�r, ILL EXC&3S Lf0"4,'.¢JOT /S L67=7- uW,,rR iYe ewSTDP- gEe. A COMSrX yC_70Aj f_ S C' D C f Waste Transportation: —�� Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: A11A Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) V Misc. Corrosive NEW USED d Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas U Photochemicals (Fixers) 0 Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink B Degreasers for driveways & garages Wood preservatives (creosote) B Caulk/Grout Swimming pool chlorine ® Battery acid (electrolyte)/Batteries Lye or caustic soda d Rustproofers Misc. Combustible U Car wash detergents d Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW .-USED Any other-products-with "poison" labels- - Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents 0 Bug and tar removers v Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS No. Pool ^4k 7U a C Fee Vs THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatton for Zigpogar *pgtem Congtruction Permit Application for a Permit to Construct( j Repair( )Upgrade 44bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and(Tel�No. as-0 — 8 Assessor's Map/Parcel ` V `� (- ",. A. s kil Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder C ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow (( gallons per day. Calculated daily flow i, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank � b Type of S.A.S. C.v Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ad d a C U I R C 4Z ?L_X5 IS4M Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar Sign Date Application Approv Date ? 10 Application Disapproved for the following reasons Permit No. c�llod y �- Date Issued g 3 r `l --1 ry c No. 7 p� ai. �• o i6 Fee V C7 ! THE COMMONWEALTH=OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN`OF BARNSTABLE., MASSACHUSETTS 2pprication for Mfo'� gld *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade 004bandon( ) O Complete System ❑Individual Components r Location Address or Lot No. �]1p—�a- Owner's Name,Address and(TelNo. Assessor's Map/Parcel a� _. `l 1 ` L�V C)� 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Scoff c-� � Type of Building: ` Dwelling No.of Bedrooms In Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ �� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank fS 0 Type of S.A.S. C CJ kt f Description of Soil, r 't -t Nature of Repairs or Alterations(Answer when applicable) HJ o .� C U -4f t_ S U C-Ft�n0 -�U P X 4�-�_ 4��r irr_,�S�dc�c ,•.� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar C l Signe f ' Date / 4 /��.� Application Approve�d'by Date �. 1 Application Disapproved for the following reasons Permit No. 9,00 " { �) cam, Date Issued 9 1g G "� --------------------------------------- THE COMMONWEALTH OF•MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance l THIS IS TO CERTIFY, that the On-site Sewag Disposal System Constructed( )Repaired (V Upgraded( ) Abandoned( )by W& Z � at b M U 1,1 2d sic t. atn 1 as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi o. ZOO S-`A/Z dated 9— ,?`o 3 Installer CCU lh r", Designer FG ci The issuance of th'k pe4nit shall not be construed as a guarantee that the system wil nc>0 1de 'Qe' , Date-9 I// Inspector (! t --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ]Bigogal bpgtem Con0truction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at �nflrl05( ? and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date f�this p it. Date: Q /g Approved by f 5/25/01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, 1+c-� A t-�A Shereby certify that the engineered plan signed by me dated 9 g 3 , concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface Elevation (using GIs information) Sco B) G.W. Elevation F&,< + adjustment for high G.W.7•S = 77 DIFFERENCE BETWEEN A and B 71 \ SIGNED DATE: 9 P 03 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp Z . 273 -502 576 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sen Met&Nu,717 r/ t Off tate,&ZIP-CA&IN Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee u� rn Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ M Postmark or Date LL tL Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached,'and present the article at a post office service window or hand it to your rural carrier(no extra charge). a� 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address °) rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. ¢ 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. coo ch 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. L`oL 6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 a .� ,.� Town of Barnstable HnxNsrnBi.E, Department of Health, Safety, and Environmental Services KAM t679059 Public Health Division �� P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health January 3, 2000 David Pietro, Trs. D P Realty Trust 37 Mechanic Street Worcester, MA 01608 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BbARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 1086 Falmouth Road, Centerville was inspected on December 28, 1999, by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.602: Unregistered pick up truck filled with garbage; rubbish also on rear deck and side yard covered with garbage, rubbish and unregistered vehicles. You are directed to correct this violations within three (3) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. OF THE BOARD OF HEALTH homas A. McKean Director of Public Health pietro/wp/q/ls ��A P �.ct - �2s V P � '- 3-7 M s`t NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00. STATE SANITARY CODE II. MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION' AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE 'CONTROL REGULATION NUMBER ONE The property owned by you located at , Ma was inspected on /')--I If. ` 1997, by I Health Inspector for the Town of Barnstab e, b ause of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: You are directed to correct violations within of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than S500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and S 15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health J r ..f��i f.4>;�'✓,.2s`, L '.f #.. %7s: ..:•4";f t.?f.:#>;:#;;: £rr,'s fix' , .;5." ',n6» fau, �: ::^" '.s„t,^» .:./ 'bfi .>k.Y,..�SF2>;?.;, 9., #'v�.:�'sf�".9:.SY C:. r.}.n :Y`£KNs:frrrw.`St;?k:»J' ;.. t;,.». .. . . ram... :�?�a.. a+ :skY.���<_.'>. :F to , / ,:,R.t nf^,�'�/ ��`''�:r°r'< y'iifxckr :r ^" +�s,a •,ask"^: ..�:, . . ..x5.: ...�3.t..:. '.G',?rY) Ci;+, �Y.YYY ::£#FF."u.`.;....: ..t..n:..,m''� .:,..{.;::v:"';;�..rr".�.".ro: '£"%T:�>it „"' .4 .»: #zk� £i:b^�.,:,,f ,. ... , t. ;.:E,: ,ss r,:^�€: ,,.. ",.�»:n.�w».,,a::.:jF.:�: .>/•:,f .;»:.: ;. ::'y:,;,..:.q.zh�n„n.b.)+ "3Y �o�an "A:r>:;.>#i• %<:il�%#%% �{`tYY" �•;,„:tart;��,tm:::£N#S.s.:, f"g„ ,� #�j^`# 'm°dio° °4c.. #f: 250027t00 ;.,:'�`;✓:. i..,.D�:.;,..i»..,;:.;a-- ,! ,rszsl. ..r,# ::ar3.w: ..{ '�� ::Ys .rs,o>r" .zzsrrar 'a:�rs:»br.. ...f:>•::::.;.�:,;:;; ., s z#:..'::a '£?a'.,^ v: .E;£ �,•:�n'z'x:: z.+,F.�.b'>:.13r :;y' ;�',Ys ..:�.». ��.,:r .r.;,...�,r'`?'t#3�: �:r+ 250027T00 #� ���fitl.r:.+ 0000000 .: �!"%7� �Rbr �`' f/.'. n.,," ��'%r:'s£KRrt;Y;f':: .:.,»-..,? *; .+Y.» /:#4#.: d..•t+: ; ...r.,,:/., »..�"N4 »,:�:.. ,.r. »,...y <:3rr.,2..ay f;#s` +.,' � �4 r:# ,•,;.�. ',:a,.• ;#Yisi`."rn;�ar .»+;., :.+b 50AC R��Y»:+Y.: X::abLz +ak:fsR "«sr Ary aY'»os .�. . »... ,."y.A2r2ttf Y::� •,Sv", �C.b,./.•r... ....rFr�i :. f:E2'2:'. ,... x.n ..V" `::Ss. � Y':�': at$t?w, �,+�:r, :.�� .. :^..•s;;�?:.+..>:rr�.;.,h. ;;,.. rz:C'� ayi Y>" ..3r:a» ,'fYa.'& #? '<' d;i:: :>' r { "F 3Y'y., a1: ?3•.^L'": tKb` Su"�`'i'i,. `rjry``' ,p':£.r, .f.s: t'#Sr' i.. ".L.... a) tY ^"Gc '' ,3.t'l:Eir: PIETRO DAVID G TRSt ry: ., .^ 101 I Ymrn .,i'Y> rikis'f �;.u., D_P REALTY TRUST 37 MECHANIC ST�... 00 r k.k .,Y.. + ........: n;.��.Rat? ..?:%•'`� �.. ... li¢lio�SY •.:{> n,.Y.�•`.a ^iri ;rl:f :..e.. WORCESTER MA 01608 #<�:{�r '::� �' r;.`.�.,,....�. ' ,f ., £ ,.t / ! :��/., .vYa�..,C+?f. ,v R:+.....E. .. v<:., ,....,re.:^Y:'..k,:n:•.Y, f�.,:.�,`i»t '>:\� a:s'i' :.:\`: :.l;.f.. :£\.w r;JYr..� I,r »iGf, /1' Ari. r.�s ...;x. .� :.ru7'ri:y..,�.•mf. .':\: :Y. .An n:.v 9Y�},:r. ..c:.^. �::.n �,: .:} ,.4'�^ :r,•::r< :x.�:#; /l�Y' %€z#.. »x.. #.. :. f MSR u ....n.::n;:..;a,,;t,+;::.t �n.,�a:/..:n,»» .wa�.a::f„a +y.,<.......:........:::::.a:....n.r...++t. ,<.r :. »r:;:.«. r.+.• ;:.3;:. :. .l,} ..C». :,l x> ... .. ,..f:::. ....5:... .. , » �h\. , ... A.........w....n...�f ... .. : :» ..fin 010187 #.. t»,, 5541026 +... �'` � :y R: riR. :, .. .. �...�: J.:. r,.,..Y �.R' ,4:.r�': ':'::.W: 'C,.rrx ..5.^ .»g F'•',c:/..::#Y.ki`�i.L�Z.? ..£� .... .. �.+.: .,S .flti:Fx: '": :,)». :. 33?rfi+;,:"��::,:�r;£si'S3: .a,,.,.,?''.vt .:}ft.,.Yn 'i:.'�...'•S:n o:3:: 3,e ..Y^.. :a#izs;:.?Y.. ..,b::�' ...£x.+7}.�....F�b`#$`•t::r*Fr"<.. 8i �,fscr tt:,.t�.:.rRrr :..<;:. :#£"' .a:£r1k�.;8'� ;;C.. PIETRO DAVID G TRS 5541/026;# SYaf�,�;a.::<,;;r,'F..a., .� .,. .......w:»»::.:..:::. ::.: F%£:`#£: '.'ab,'M. 'lyr; •::ems.: »Nf`3a3��l H;. .:f'R�r: .� rr•#,$.1., S i 91 SOO .:i �y..?�•,: ;..#.i." :3�... 76000 #'L;.i::'•rsSs;+sss'>; `4�`y{RRsY FALMOUTH ROAD(ROUTE 28) ``>:; 0522 £{, 0190 ..��......: .:t;.,.r .;t.;�ry,.;':., .:.):: YR:IY h u..k,;oli6a�:##.i""r�.dy./' `f:r;r>.k?'sy"YY. .5r::».�i•!r;),{;'; �Rj4�;?:x�..: STRAWBERRY HILL ROAD 1546 <> "` 0183 „+ t 6 �, i»i is^•""" ,+:#duo � i.k�:k x{i?ia3q;�;ti::., S�' �+,�......�.'»�3...� a'r. ,lr"`"'r�tU�..��'r:,`+,.,..''.+'<�e�,..s.':.?Fr,..�,„'.•:€"�•µ'.»t��' �� �, 3r. ..> .� "`;`.+�n»•i""' � €x .,x.:; ',tYz�;..7't+�`": �„ , M :.o`Ky //"� '.. 's:Y: :' �...:r f/' ..,.. ».#'». ,,. '�.h{; `'fitf•..+3iiffaf• �::i", ".s#'^ "r�,,..:.��:r:Y�Ysa = Y�#;Rk.: 7��,d,3ii;'Y:vr,.».;:y:l:'r �rr �'c »:s£.«:r�. R.ss''�'<.'r� '/ ;s ''"."^'s$ii Y:YH; .t. +•�€£`� �"fa'`"f#: s'E`' aL.'� ;..�:£. :so{#:{£r.'csi£"k r;, i,,t#{is#'p.t:a v�' ..r•.a .`�'`' �ls:zbr�� ii .x5:s;.;rr 'Rir.?ss :s*r ^c, q / iz'..%b.'° r•.%:: ..y. /�, i� ^{. a5 t$g'# �`:✓:�\#� F�:+s+;.: <`f:;:x.: ,..0:.+3 i?;'?;:i=f#R'o. c.c,; '4'�., <+i„?7y�.;' �;)f,'•�'' 'j >i:ftik �3�W. <<#. .A+Y trr% i� fr. /.;t'»r ar:a y ; i ;:Ygr a : r i'. xx. srr�#b Ss'+ �`R?F c,:... ..,.....».. � ,n...,.,.: ,.»x::. .+. :.+..:.r.f..:.v....:.�.:».r. .: ..:.''r.:a>� acit ••�<# r„£:`>o ..f.r.F»f:�. ...............:,r''t..0+..�..,... .�3•. ....... A,. .,,.......: ..... ...Y�.... f ,... .:::r::� ...i"' m fiyC'R, ..........: .......A.. ..... .......:3`.A. .. ..F. n.:�,nk..n,.. .....:..+....+r..,..1.;:£'n:.»...f:......... .....:< R'{..:`?`.,: n. ..R<K»; .z »�i:. ..... .. ./ ..... i w.. : ....+.:.. ;."....'• .. ..n...+..,f...n........... ... .f lv.4b5.+.. ,...f ff Ef.: .fl:f.. .i..rar;tar,Ray::».. ... ....:.r ., ; ... .nr f!..:....S,..n.+�..fi. ..n.+...R r............ .:..+...r...:..,.».., r..,,. ..:r ...s...,. jarF?hz:f n.,. r .ra,. :,..,.r ."i'oi f..k aa... A ..... ..,�.�zn.... :.»�Y ..f....:. . .z:...rr.:.+,+rx::::r::. .z.. w•L<,,...r.fY w:o,r;�:;k•:::.:.2s::>a.�.,, :E:�.c!;; 2:iR::2:9».»f. :x ac.��.,u��<';,£.. v s :£Y£. ti:�. �',i{,» nry::•2::s rrl��;',"i;i'"3:f^,') ^"?xii.' r k. � r•:E::ss::;» ,.#';£`.f`.: >`:%N2ir:f.3" s�"J.r.. '.\;S p��:;s<.C't'#tf z o� :,Yt» .. .;.». : ,�..:..f..0 r,is?n::.,.;C r.rf:Y..,:�. :fta",.R`.b Y.i:..:.T3, •.; T;x .3's?'. ._ - .. .,r ,.r R...a.+. a .. .,.:.. X.»:. K.v'..,. .n... '.s.n.. '='�s#:Q: ,u5sk�� 'd„ t;t�•�,.� :Y x,? .:.•Y., 3.,: »;`S.r 't�:,. ,;O•,. r..t�r'.x;ftiC3 »a»+..:_?':nb`�»::..:.- �:f::r:�.+rnfr" ';..�. .:.>•. ..4. Y:a�,:;+'..y�' .., +.,ki;r• v»•4#, �,»;:t:h' !2:`' #1:^ :»�� �R::k#nf�{.s�` ...::;,.a:ror>r-a>-3ig' .,;';ir+r<'r;' "zr.,,;»:..;: �#'?k5i' »::f�f+r?a.. :a9.?•� ..�,Y:.i£:o»». ,n:,:...r, ,....�. .. < y :; ,�Y;:iY `'#t'�'i'. s kC•. Y:{?. .+.R:' ."ate..�s;' r'e�.t$:CL#..'zi:�»4".s';z�ff':$%`''t�.�: "<" 2'''t�F?:..��"�r..r...<�`L&�a"w"Yf,ra`3�ifi:�ts'.�:f;�.�,#�,Cr<�;i��'.'`,3.ka=AF>i:<`:�;tkr. %.•�','fXrfi=n'�x..»z`�»;?H:�3l�surxa;.. .......:,�»: .#�r`.�. .. COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date f Delivery item 4 if Restricted Delivery is desired. / — —00 ■ Print your name and address on the reverse I so that we can return the card to you. C. Signature ■ Attach this card to the back of the mailpiece, X ,r am C _c ❑Agent r or on the front if space permits. ❑Addressee D. Is delivery address different from item 1? ❑Yes 1. Addressed to: If YES,enter delivery address below: ❑ No 3. Service Type ED Certified Mail El Express Mail ""B-Regjg � ❑ Return Re handise ❑C.O.D. •y�- estri every?(Extra [YYe 2.-Article Number(Popy ft Wd PS Form 3811,July 1999 Domestic Return Receipt ,y 6-M-1789 h UNITED STATES POSTAL SERVICE First-Class Mail f Postage&Fees Paid LISPS 'I Permit No.G-10 I � • Sender: Please print your name, address, and ZIP+4 in this box • I I I Public Health DiviSiop l own of Barnstable PO.Box 534 I 'pan >is,Massachusetts 02601 _ E :III IIIIIldJIIIII, tw; �IIIIIII'!-XI'IIE;Il1"I,1I1if ` _tTOWN OF BARNSTABLIE', LOCATION ^� O CC�I�U� �ZA XSEWAGE # a ' VILLAGE" Ce n�E:S2 INSTALLER'S NAME&PHONE NO. G� SEPTIC TANK CAPACITY LSCM c%�Z LEACHING FACELITY`:( ) 'C',l (size) U rc/�� { NO.OF BEDROOMS BUELDER OR OWNER - PERMTFDATE: �� r� 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 fee of leaching facili /�7Un1L_ Feet Furnished by A , 711 WITHIN . ACCESS COVERS MUST BE I - UM GENERAL ' NOTES :,, . g MINIMUM.' �/ NVER`T EL EI�A T_I ONS . DES I GN CR l TER 1 A 6- OF FINISH GRADE 3 MAXIMUM COVER T C TANK: 97 0FLOW: I LAVER T OUT SEP l : DES!GN . ; N ,UCT O C LAST 1 TO FOR THE DE SIGN AND 0 R :FIRST 2 I. THIS 7S INVERT IN DIST. ` BOX • 96.87 `6 BEDROOMS AT I IO G.P.D. PER B LEVEL P ASTONE OF THE SEWAGE DISPOSAL SY STEM TEM NL Y. E L MIN 2 OF f ROM EQUALS S60 G.P.D. -`INVERT OUT DIST. BOX: 46. 7 BEDROOM INVERT IN LEACH CHAMBER. 95. 4 DIAM Pl 3/4 - 1 112 DIA. 2. VERTICAL DATUM IS ASSUMED, FOR BENCH MARKS • NO GARBAGE GRINDER • BOTTOM°OF LEACH CHAMBER. 93.0 oDOUBLE WASHED STONE _ SET. `SEE SITE PLAN. 9 7 � T2. `6° ° HIGH :GROUND WATER. 72.0 ' p'g6 .0 .9 93.0 _.8 SEPTIC TANK REQUIRED; S AND - A 3. ;At L CONSTRUCTION METHO DS AND,`MATERIAL A CULTEC RECHARGER 330 S 6 60 G.P.D. , X 200x J 320 GAL.. 3 OUTLET 3 HE SEPTIC`SYSTEM SHAt L , EXISTING SEPTIC TANK PROVIDED. 1500 GAL. EXISTING MAINTENANCE OFT _" W/4 - STONE AROUND: l2 r x 24 ! x 2 d D BOX 1500 GAL CONFORM TO MASS. D f P. TITLE. 5 AND LOCAL ' ' SEPTIC TANK TONE OR ABSORPTION SYSTEM REQUIRED: BO ARD OF HEAL TH REGULATI ONS. 6 CRUSHED S � SOIL COMPACTED BASE DES/GN PERC,RATE l 5 M/N/I NCH SOIL TEXTURAL CLASS 'S l 4. ALL SEPTIC SYSTEM XOMPONEN TS LOCATED UNDER PROFILE • NOT TO SCALE EFL ,' - F UENT LOADING RATE - 0.74 GPD/SF AREAS SUBJEC T TO VEHICULAR TRAFFIC OR GREATER 0. 692 S.F.' REQUIRED THAN 3' 'I N DEPTH SHALL 8E CAPABLE OF 'W1 TH 4 GPD/SF 660 GPD / 7 STANDING H-20 WHEEL LOADS. F A L M O LLT.hj R 0A,ID R O UT.E 2 - PROVIDED: 3 MAXIMIZER INFILTRATORS W/4• STONE ARO UND. A- 528 S.F. EXISTING 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR 3 CULTEC RECHARGER 330 S W/4 STONE AROUND "APPROVED EQUAL. A-432 S.F. PROPOSED. TOTAL A-960 S.F. 960 S.F. x 0.74 - 7/0 GPD 6. SEPTIC ,TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE AND WATERTIGHT. 0-BOX SHALL BE WATER TESTED TO CHECK FOR LEVEL WHEN THERE ". � UP 5 I S MORE THAN ONE OUTLET.r� � ; — $jO�KADE fEN \\ 7. BEFORE CONSTRUCTION CALL -D I G-SAFE'. ` 1-888-DIG-SAFE'AND THE LOCAL WATER DEPT. 89°OS 40 E " FOR LOCATION OF UNDERGROUND UT I L I TIES, \ i 150.00 r y 12'CEDAR ti / r --— _ . ———' . i 8. SEPTIC SYSTEM INSTALLER 'SHALL NOTIFY THE DESIGN ENGINEER TWO DAYS PRIOR ;TO CONSTRUCTION. \ 1 DIRT DRIVE � OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE CONSTRUCTION INSPECTIONS. ', `- -- ------ f , 9. EXISTING CESSPOOL TO BE PUMPED DRY AND Llv1NQ Roots 1 , BACKFILLED. CONCRETE 1 � ? t PATIO i M CORNER STEP , ' B co �________,� r � 10. ALL UNSUITABLE MATERIAL (A A B HORIZONS) BATH KITCHEN Et-105.6s t ENCOUNTERED BELOW THE INVERT OF THE LEACHING { FACILITY TO BE REMOVED FOR A DISTANCE OF 5' DINING � ` L/V/NG ROOM BEDROOM a AROUND AND REPLACED WITH SAND IN,ACC ORDANCE WITH Tl TLE 5. DECK y Y ' EDROOM BEDR00 BEDROOM _ BEDROOM r ✓ BEDROOM .` BATH KITCHEN a BATH O O _ rr 0 — • r LA BM CTR SL R S l C -_ o `� �, \ . .,n •` EL-99.3e w f SECOND FLOOR PLAN EXISTING AL a 1500 GAL 1 }a -'1 t NE SEPTIC TANK' � i � ' 2. n r'' D-BOX S �' y hj O },a PROPOSED 3 CUL TEC REFHA�CIERS� G W14• STONE AROUND \ \` R 1x O 1!(,/a \ 3-I, -f10Ct 1 \ \ \ 10-HOLL��: ` y \ O Ln EXISTING 3 MAXIMIZER y: m INFILTRATORS #14 STONE `,` / / ! 5 / �J / E ! V! L� / ��/ / V .i / GO8 / c3� I '087 F- AL MOUTH ROAD "A P 2-50 . PC_L 5 / PREP,4 REl.7 BUR = f SOAL E : / 20 SE"P TEMBER LOCUS l �, o TOTAL AREA 33 . 798 f S . F . REVISED: SEPTEMBER 1 / . 2003 FS ' ,-? j FAGI_ F SUF:RVEY 1 NG I NC R o u t es 6 A 923 • ``-� � f _ ^-. Y a r mo u t h p r� r t , MA . 02675 t ( 508 ) 362--8 1 32 r - {_j r �' / 508 432-5333 � 150.00 ►/ N89OS40W 1 0 ',.:. , 40 ' :'i SAH o /O. 2 CFW > ORN CAC SAH�CFw CHECx ,. 03 OS7 FIELD CFW/DAB.. L . a vs MA P JOB NO t Lc r , , r r t ^. , ° , , a.. i