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HomeMy WebLinkAbout46, 48 FRESH HOLES ROAD - Health 46,48, FRESH HOLES. RD. , HYANNIS A= 1 fit. I I r ` Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary AssessmentsK' C'' 10 46-48 Fresh Holes Road vl Property Address Margorie Bourgeois rill Owner Owner's Name information is required for every Hyannis 1/ Ma 02601 1-8-2019 page. City/Town State Zip Code Date of Inspection .J;t Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Brett Hickey key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 w Company Address Sandwich Ma' 02563 City/Town State Zip Code rsru (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails yt 1-8-2019 Inspector s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: r The system was in working order at the time of inspection. 2) 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�jrears old is available. ❑ Y ❑ N ❑ ND(Explain below):''. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (I' 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.726/2018 Title 5 Official Inspection Fortn:Subsurface Sewage Disposal System•Page 3 of 18 t Commonwealth of Massachusetts r Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Q Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form gal Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4648 Fresh Holes Road V Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Q Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ M Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ E 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? 0 ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ O 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: 0 ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4648 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 2+2 (4 total) Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 442/gpd Description: I 8 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection. ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes No Seasonaluse? ❑ Yes No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: ***2018-19,700gallons 2017-22,600gallons*** Sump pump? ❑ Yes 0 No current Last date of occupancy: Date t5insp.doc-rev.7/26C2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r- iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �> 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 .Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Owner- pumped yearly Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owners Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any). ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New SAS added to existing tank in 2005 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 39 Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments (on condition of joints, venting, evidence of leakage, etc.): t5ins .doc•rev.7/26/2018 p Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 c Commonwealth of Massachusetts ` Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road v Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ❑E 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 1000gallons Dimensions: 10if Sludge depth: 26" Distance from top of sludge to bottom of outlet tee or baffle 611 Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 11of Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road V Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes No" Alarms in working order: ❑ Yes No" Comments(note condition of pump chamber, condition of pumps and appurtenances, :, etc. P PP ) NA " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: (4) 3050's n leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments 46-48 Fresh Holes Road V Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D.,System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching was in passing condition at time of inspection. Leaching was 1/2 full when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ` Title 5 Official Inspection Form - li� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately Driveway Driveway Front F E A B AC-49'6" BC-19' FD-37' BD-18' FE-16' C a BE-24'6" t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�. L � 46-48 Fresh Holes Road v Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope M Surface water ❑■ Check cellar ■❑ Shallow wells Estimated depth to high ground water: No GW @ 135"feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record 10-17-05 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: A plan on file with the Board of Health was used. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46-48 Fresh Holes Road Property Address Margorie Bourgeois Owner Owner's Name information is Hyannis Ma 02601 1-8-2019 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. QQ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑E D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For,15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOa A dJN e��/$' �6L t s' I`4-s 11e S SEWAGE #�'a�—S�`rl� VII` AGE �/ ' ASSESSOR'S MAP&LOT+ � /77 INSTALLER'S NAME&PHONE NO. A Z e-NI SEPTIC TANK CAPACITY l 6 C�C� � x �✓ LEACHING FACIL=: (type) /t ra--,qsize) 3 e7l X 13 X NO.OF BEDROOMS j BUILDER OR OWNER PERMITDATE: /6��s= �—COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 � c � n a - ii Q N No. L� Fee ©� / r, b' TH� COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS . Z(pprication for Miopool *potem,(,Cott!6truct on`'Vermit Application for a Permit to Construct( . )Repair( �)� Upgrade( )Abandon( ) O-Complete System_ O Individual Components Location Add ss or Lot No. Owner's Name,Address and Tel.No. Aj Assesses s Map/Parcel �l 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( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 7�► 6 gallons. 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 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 toplaee the system in operation until a Certifi- cate of Compliance has been i y this and of Health. Sig Date/d d Application Approved y ' Date ®Al/O Application Disapproved for the following reasons Q Permit No.r�� 5 .593 Date Issued �Co J !� pis. 6 No. O'—`cam 5 ��7a � 3�-._� �; �� Fee THrtbO bNWEALTH OF MASSACHUSETTS Entered in computer: 00000 Yes ,•,PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE}MASSACHUSETTS 2pplication for Mitpool *p!tem Conotruction Permit Application for a Permit to Construct( )Repair( . Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. _I ,Owner's Name,Address and Tel.No. 6 `�fzz F s l yF� s d� )-,9rcrr� y. Assesso;js Map/Parcel � / 7 ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �i /LL H �,�. 5,1 /.5 Q /Z l3 � � Type of Building: Dwelling No.of Bedrooms �� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow LAID gallons per day. Calculated daily flow 9Q, 67; gallons. 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 a i ler— r r f , " Date'last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system r 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 Board of Health. " Sign d' r -" —C_ .- — -- =------ Date ,1C7 Application Approved by Date I gQle Application Disapproved for the following reasons t ) Permit No. Date Issued O THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded.( ) Abandoned )by e at �S' .� /""G2 Z has been constructed in accordance with the provisionsions of Title 5 and the for Disposal System Construction Permit No. S S y dated_TI ,f6�� Installer Designer The issuance of this permit shall not be onstrued as a guarantee that the s�stem wi un�3n as designed. Date ,d! /� Inspector No. A400-5 5 9 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5ar *pgtem (Construction Permit Permission is hereby granted to Construct( _)_Repair( )Upgrade( )Aban�� System located at l/f/�� 1422 Z 5-41 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 of this erm Date: /. , Approved by Town of Barnstable pFIHE} Regulatory Services Thomas F.Geiler,Director • ............ • 9 + BARMSF.. E. MAM�b .m�q Public Health Division ArE p � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 161-2 Designer: D41 Yh�I�I � Installer: A C-« Address: F0 - % �(� Address: Dox OZra57 `� A7A On � �-�/� �� 02-� �' � was issued a permit to install a (date) (installer) septic system at gj &Ljs .based on a design drawn by I (address) 4_67h VA4M Al Oq,i1 dated (designer) ' f X Y certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Re Plan revision or certified as-built by designer to follow. �zN oF,ttls , (Installe s Signatu e) o. 1140 "ISTIE SgNITARk (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM Ialf 11 r"t` "" ,hereby certify that the engineered plan signed by me dated �� �S ,concerning the property located at 46 /+Y�S meets all of the r — following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • 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. • 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-be located no less than five 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) B) G.W. Elevation 4-ui +adjustment for high G.W. . DIFFE BETWEEN A and B N P SIGNED :� DATE: �� 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 ASeptic\percexemp.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' v DEPARTMENT OF ENVIRONMENTAL PROTECTION v a d F Y Ve Y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 46+48 FRESH HOLE RD.HYANNIS,MA 02601 Owner's Name: FELIX MIETLA Owner's Address: 60 COOLIDGE RD.WORCESTER MA 01602 Date of Inspection: 11/19/01 LOW ENE® Name of Inspector: (please print) JOHN GRACI a Company Name: SEPTIC INSPECTIONS 6 Z001Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Tele hone Number: 508-564-6813 FAX 508-564-7270 THDEPTABLE P 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: ' #' 4 X Passesy s ` + k _ Conditional1 Passes _ Needs Furt Evaluation by the Local Approving Authority Fails ., , a Inspector's Signature: Date: 11/19/01 The system inspector shall subm' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspe tion. 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. Notes and Comments 3 THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. r r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) U Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 'V 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 criteria described in 310 CMR 15.303 or in 310 3 • i'H.: CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: ' THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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. n/a The septic tank is metal and ove`'r 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: n/a n/a 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 k Health): x. _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a ;< n/a The system required pumping more than 4 times a year due to broken or obstructedpipe(s).The s stem will ass Y 9 P P g Y Y P inspection if(with approval of the Board of Health): 't _broken pipe(s)are replaced *t _obstruction is removed jj ND explain: n/a " ; Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh >' 2. System will fail unless the Board 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: l' _ The system has a septic Itank 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. r _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. .4 _ 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 n/a "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: n/a 2 _ j } Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46+48 FRESH HOLE RD.HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 D. System Failure Criteria applicable to all systems: You must indicate"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 less than ''/z 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 nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of 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 I 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. (This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 q' 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 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) .o s yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a`ni6ogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. w ' w r) Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM K PART B CHECKLIST Property Address: 46+48 FRESH HOLE RD.HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 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? F. X _ Has the system received normal flows in the previous 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? 1. . X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS,located on site? X _ 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? t t F 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(SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] a t: Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 FLOW CONDITIONS .'-' RESIDENTIAL , Number of bedrooms(design): 4 Number of bedrooms(actual): 4 ;r- DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 6 Does residence have a garbage gri'rider(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): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO x Last date of occupancy: n/a COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203):n/agpd t Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a ; } OTHER(describe): n/a `GENERAL INFORMATION Pumping Records ;' Source of information: n/a Was system pumped as part of the-inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil'absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) a l _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval r Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1990 FROM AS BUILT ?' Were sewage odors detected when arriving at the site(yes or no): NO t } Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 BUILDING SEWER(locate on site plan) i Depth below grade:36" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:30" Material of construction: Xconcrete metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8"" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 1" : Distance from top of scum to top of outlet tee or baffle: 6" T Distance from bottom of scum to bottom'of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. Y> RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade:n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a ' Dimensions: n/a ` Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a `•+• Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a li { t; 7 Page 8 of 11 F OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a .' Capacity: n/a gallons g Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): ?g " n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) t Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into s r or out of box,etc.): AN,' n/a t, � rl PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no)`. NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a < <Y Y. it i1 .. 1• Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46+48 FRESH HOLE RD.HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: nla n/a leaching chambers, number: nla 4'X4' H 3'3" leaching galleries, number: 3 n/a leaching trenches, number, length: n/a f' n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system x, 1 Type/name of technology: nla 4 Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACHING GALLIES ARE STRUCTURALLY SOUND AND FUNCITIONING PROPERLY. HAS 2 FT.OF ,: LIQUID IN IT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): fi=' n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46+48 FRESH HOLE RD.HYANNIS,MA 02601 , Owner: FELIX MIETLA Date of Inspection: 11/19/01 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. f . O � t x =J. in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM N PART C SYSTEM INFORMATION(continued) Property Address: 46+48 FRESH HOLE RD. HYANNIS,MA 02601 Owner: FELIX MIETLA Date of Inspection: 11/19/01 SITE EXAM Slope _Surface water ;;. _Check cellar ':;; Shallow wells Estimated depth to ground water 10+feet {' Please indicate(check)all methods used to determine the high ground water elevation: NO. Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of 1-lealth-explain: n/a ` NO Checked with local excavators,,installers-(attach documentation) NO Accessed USGSdatahase-explain: n/a y 3 You must describe how you established the high ground water elevation: GROUNDWATER DETERMINE BY AUGER-NO WATER AT 10'--BOTTOM OF FIELD AT 7' ryt N t f 1. te' 4ry,: ty X� s�j j rr , 4 ��• ""°" s� BARNSTABLE COUNTY z DEPARTMENT OF HEALTH AND THE ENVIRONMENT 0 O - - ` "- SUPERIOR COURT HOUSE , J POST OFFICE BOX 427 • '' ' • BARNSTABLE, MASSACHUSETTS 02630 q 5 EJ Phone:(508)362-2511 Ext.330 Public Health Administration 333 Environmental Health 383 Water.Quality Analysis 337 TDD 362.5885 LETTER OF LEAD ABATEMENT COMPLIANCE DATE: 4/1.4/94 Dear Mr. & Mrs. Mietla This letter is--to--certify--that—I inspected your property located at 46,48 and 52.Fr_esh Holes=Road , apartment no. , and relevant oc mmon areas, in the City or Town of Hyannis"- , for lead abatement compliance on 4/14/94 off on that date those surfaces cited in the initial inspection report of 3/13/89 - were found to be in compliance with Massachusetts .General Laws, Chapter _111, .Section 197, and 165 CMR 460. 000 Regulations . for Lead Poisoning Prevention and Control. Massachusetts law does not require the abatement . of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance .only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials and as long as coverings forming an effective barrier over such - paint or other leaded materials remain in place. See the reverse side of this letter for the locations) of surfaces which were covered as an abatement method to achieve compliance, if applicable. Sincerely, . Ix VVector DPH License umber Jane Crowley C2829 INSPECTION AND ABATEMENT HISTORY David Green 88158 Name & License Number of Inspector Who Performed Initial Inspection Jane Crowley C2829 Date of Reoccupancy/Reinspection Name and License Number of (if applicable) Inspector Who Performed Reoccupancy/Reinspection Name (s) and License Number (s) of Department of Labor and Industry Authorized Deleading Contractors) Who Performed Abatement: Steve Barnatt DC000616 LOLAC 03/30/93 AREAS WHERE LEAD PAINT OR OTHER LEADED MATERIAL HAS BEEN COVERED AS A LEAD ABATEMENT METHOD. INTERIOR Room No. (As Indicated on Initial Inspection Report) Side Surface or Fixture Type of Covering j i EXTERIOR Side Surface or Fixture Type of Covering r 97z& O &=a&oeu ,&YMIS/A. WZd d &MtY cam: William F.Weld 02»> Governor Charles D. Baker Secretary David H. Mulligan Commissioner CEASE WORK ORDER Pursuant to Massachusetts General Laws, Chapter 111, Section 197B (f) (3) , you, C -e'�7 �r (Name and/or Business Name) are hereby .ordered immediately to cease and desist -all de/lpading work at (AddresW for the reason that your work is in violation of G/V& a , o (D / C/ 7 (Cite violation: Chapter 111, Section 197 or 197B or specific regulation or order or terms or condition of license, registration or certificate) and such violation will enda ger or materially- impair the health or well- being of n /. „l o�, c« 'C2" '-4 v 'n -P)/J (Occupant of premises or lead inspector or deleader or person employed in performing renovation to premises) . This order is effective immediately. Should you fail to comply with this order, you will be subject to legal proceedings. DATE: Sign e Time: -��� Title c F 6Cc.,e/>s J�G�- �� �U 17 T/ Received a Copy (Signature) Childhood Lead Poisoning Prevention Program Department of Public Health y 305 South Street Jamaica Plain, MA 02130 ' L-^-'C A F ION SEW E P RMI No. "46 �-48 � HaA-E`-ft l �! YCrfLLAG € "AV.A.4��5, INST L. LER'S NAME 6 ADDRESS d U 1 L D E R OR OWNER O U d,I -a VI L-LAC--Ot 4P I S 14Y.A,� &.LtS M4S s DATE PERMIT 1 SUED 3Dh DATE COMPLIANCE ISSUED-� / o C� azi n 1 =l i"� 1 l _ - FHz THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH 724.....fir .........OF......... .. .............................................................. Appliration for Dispnsttl Works Cgnns#rudion Prrutd Application is hereby made for a Permit to Construct ( ) or Repair (Y) an Individual Sewage Disposal System ............. — -----• -I,ocaii•n..Ad•r'g....._.............�..—.— ..............--....--._....•.........or t N......_...... .--- ----• r ...........QGG�ZuJ l/ f/ ...� -Adore ......._........ ---•------....(� ........... ....................f.... •- - •- Installer Address/- Type of Building Size Lot............................Sq. feet ►, Dwelling—No.'of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .._.__._... No. of a YP g•..--•-•-•-----•-- persons:........................... Showers ( . ) — Cafeteria ( ) a' Other fixtures d .......... ___--_--•-------- -----•-----------__............... •••.......... W Design Flow............................................gallons per person,per day. Total daily flow._.....--_..:.........._____-----_-----.__--gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth_............ .. Disposal Trench—No..................... Width....................Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..................... Diameter................_... Depth below inlet.................... Total_leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by________________ ...................................... Date...........I............................ Test Pit No. 1................minutes per inch Depth of Test Pit._.................. Depth to ground water........................ f=, Test Pit No. 2.......:........minutes per inch. Depth of Test Pit.................... Depth to ground water........................ pP, ...........•..............................•••-•--.....-----..........---................_----•-•-----••-...................................................... Descriptionof Soil........... - .............................................-.........................._............................................................... -=- UNatgte of Repairs or Altera ns saver when applicable.. .... ............................ _. ......_......... ep .......--•----- .� ,�r1.1 ................................� •........ ......... .••-----•-•--....................__...... Agreement: The undersigned agrees to install the afor de ibed Individual Se a Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary de—The undersign f he agrees not to place the system in operation until a Certificate of Compliance has ssued by boar gned ................. ---••---- .........................•---.....-----_---• 8 Date ApplicationApproved By.................. ....... .................................-----=-----•--•-.._............. .._..-------....---•••---............... Date Application Disapproved for the f olloun g reasons:............................................_.......:..................................•..................--- ...........................•••-------------•.._....__________.--•-----••-....--------..._-------•....._............................... .-------........ - -- Date PermitNo...... ..._.' . .... Issued.-...........................................---•---- Daft .� 1 - -- 4. :u ...," . tt - -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .-.......0 F.....:. ............-..........-------•----....................._................. , .Vpliratiun for Bisposal Works Tonstrurtion jImAit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System�v-�1�8 ��• /�- %� � ......»..... _ _, _.. .Locati.n�Ad-T;•5•--•...............�.._.» .-.................-•—•--................or�Lot•No+�----•-•--- --- ...... � C.� � � Ow-:••-• -Address4 . -----•---•--._.._.�J:. :... 1 ........... .. ' - -- --- ---- ---------------------......-- Installer Address I Type of Building Size Lot............................Sq.'feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria p' Other fixtures Q •-••-••-•-••..................•----.............-----•.---•••-••••.........._.................. ... W Design Flow........................................._.gallons per person per day. Total daily'flow......................._................._..gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by..............................•---•--=---•-••-•--••--.......--•----•------ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2............:..minutes per inch. Depth of Test Pit.................... Depth to ground water........................ fia --•--•-----•--------•--•-------------•-•----------.----- ................................ ............... ODescription of Soil................................................................ + --•--•-••..............-- ••................................ .............. .....h^ -.._....... ...-`_.. �...........• _. .._ ..... - :... ----- ----- U Na .e of Repairs or Alterations Answer when applicable ..�.. � .. �-'� -'i�*-� t : ................... ..............�.......--.-----...------------... ��.x ..... ••--�v�'---•-�..-------•-••--•--.......0..._.._........._.......-•--- Agreement: The undersigned agrees to install the aforede�seribed Individual Sew, Disposal System in accordance with the provisions of TITLE 5 of the State Sanitaryo�de—The undersigned�u.her agrees not to place the system in operation until a Certificate of Compliance has been issued by the board f health. gl / Date ........................ ApplicationApproved By.............................' -....................... - - ---•-•--.._.............. ........................................ Date Application Disapproved for.the folloun g reasons:...............................................•..........._.•._...._.._._.__....: s ........................................................................................_............._._.........................................................................................ate No......b ....f:?. .._........... Issued........__._ ..:_.....'....D ..... Daft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .......OF............/../Z........................ .................. TPxtif iratr of Toutphanrr THIS IS TO CERTIFY;That the Ind•;vidual Sewage Disposal System constructed ( ) or Repaired (/-Z,) by--....._•-•--- -... -=--• '`- _..._. '.!.Z..C, ..................•--- -•---•--------=--•-•----..... .. .. ��� Installer' ---... --------•--- --------- -........................ has been installed in accordance with the provisions of TITLE 59f The State Sanitary Code as escribed in the application for Disposal Works Construction Permit No..... . .'__k.7.,r{....•...... dated........, ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS'A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................1 :` . ...........H I ! ti Inspector.....................0.......... •--•--•---•-............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF %H,;;LTH M O F.. /C� No:..... ..:....... j ........... . ......................... ........-•-•-----•----............................................................. FEE.. :..-... ..... �.�ts}tiis� ����br��iu!�Guttt Permission Is hereby granted.... -•---•. T......................... --.....-•..... at Construes( )� Repair ((✓ ndivi�age I,�is sal System p PP PD ... street �3•�,� . as shown on>the:application for Disposal Works Construction Permit No..................... Dated........��'.`�{..��-� w.... t: .................................................... ... ---...G__..............- Board of Health DATE...... •-'--�-�---�-�-•---•-r...................•-•---•------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS • TOWN-OF BARNSTABLE Loci},kTIoN WP4 -q0 s SEWAGE # VILLAGE I ASSESSOR'S MAP Cz LOT INSTALLER'S ME 6� PHONE NZ 'ars.NAr SEPTIC TANK CAPACITY LEACHING FACILITYc(type) ` (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER i�(;/ 8 DATE PERMIT ISSUED: S ),0 DATE COZiPLLANCE ISSUED: ,' ' - IG -�0 VARIANCE GRANTED: Yes No d 7 Fss...... .Q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratinn for Uispnsttl Works Tonstrudinn f rand Application is hereby made for a Permit to Construct ( ) or Repair (,, an Individual Sewage Disposal System at: - w ovation-Address �or Lot No. .............. . _. .a .r�..: -� -.....------•.....-.....-- -•----•-•-------..... ..1! �...... .._.,....................._...-•---......... •..� Owner Addres ,W1 Af s t ts` X �.....s :�aa,c. .... �.��.. � � .r.............•-•-•----•--........---•---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......j...................... .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -----•------•-----------------------------------------.......... --WW Design Flow.;....�_ _.......................gallons per person per day. Total daily flow.........-�--..._.a_......................_gallons. C� Septic Tank-L Liquid capacity.VS/):.1gallons Length...t l�___... Width._ r....... Diameter................ Depth................ Disposal Trench—No. .......$........... Total Length.....,/_k1....... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1"4 Percolation Test Results Performed by.......................................................................... Date..............................-......... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. ti. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------•---------------------.......--------------- ......•-•-•------------ ...... .---...... ............................................................. ODescription of Soil..........................................................•---.....--------.....-----------------•.----••--•--...---•-------•-----...--•---................._--_... U ------ ••-•----------------------------- •----------- ..---------------------------- -------- -...... .. ---- ----•---.....------.-•------------------•-----•--•- •----------- •............. .... W .....------•-------------•---•--•..- .............................................................................. •-•---••. .. .................................. UNature of Repairs or Alterations—Answer when applicable.._. JVZ7 1.S7t' �Lk....�-��............: A:4� . ..�......._ :.t ._._'.6�1 �� .t:.._..a M_ ..c? .```��/`.e ....._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of hea th. Signed. ---------- --•--�------- Date Application Approved By.............. .-•-�. - ---as-----------•-•..................... ...............5-., -3� _./Qd.. Date Application Disapproved for the following reasons-...........................-.................................................................................. ..................•-•--•---....................-.......-•--•--••---...............................-••----------••-.........••----.............-••-••••--••-•--•-.....•---••.. ......-••-...--- Date PermitNo........ Cf..._._. �L..................._ Issued..........-..............................-............. Date No_,.e)...���.... � � Fizz......3.2....... THE COMMONWEALTH OF MASSACHUSETTS, ` r' BOARD OF HEALTH . 1 .........OF tN 0V*SI.&SAe_•....................................... A0Vftra inn ,f pt,UisVvsal 19orks Tons c#tun 4pamtt Application is hereby made for a Permit to Construct ( ) or Repair' (�,).ean Individual Sewage Disposal System at. .• , i ---..... ?� .` �...... t i� ..............•._..... Y.rA r wa��.- -- .:.. -... : :...........•---- Location-Address or Lot No. ............. --------- --------- ..................... a ................................................ Owner Address u ......LIub.-••--•••••••......•••••-•..............- ... M Installer Address Type of Building Size Lot..........' ...............Sq. feet aDwelling—No. of Bedrooms...... ...............:...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria ( ) i = P Other fixtures ...............................•--•-• ................................... •••••-•----•-------------------•-•-----------------....................... W Design Flow......oc ......................... gallons per person per day. Total daily flow.......� ......................gallons. WSeptic Tank-1-Liquid capacity.1.:?.,gallon Length..:E 2..._:_ Width..:`,_.._... Diameter................ Depth................ .. x Disposal Trench—No..-,o G.OMet -Width......_`.`�.__........ Total Length.....//�W�...... Total leaching area....................sq. ft. Seepage.Pit No:3....................Diameter.................... Depth below inlet--.................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) I, a Percolation Test Results Performed b.Y......................................................................... Date........................................ Test Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ h w Test Pit No. 2................minutes per inch Depth, of Test Pit............._._:... Depth to ground water........................ x .....................................................................------------- f ; 0 Description,.of Soil--------------------------- • -.............................................................................. ........................ ....................•......................................................................... a x ............. ........--........ .................._ ....... ................_.............. ..... ..._ .................................. U Nature of Repairs or Alterations Answer when.applicable � r� � /fly S r "t—a t1 ------- - .. '._�/ . t� _ i!1�lr► �C.....0 f .-� k. �S............................................ Agreement: f 1 I The undersigned~agrees to:install'the'aforedescribed Individual Sewage Disposal System in+accordance with the provisions of:ITL 5 of the. State Sanitary Code,—�..The.undenigned,furtl:er agrees riot'to place the system in operation until'a Certificate-,of-C6rilpliL ance-has been, issued by the board of health. Signed ' .�'7.,e..- -: Application Approved By.............. .---�--t -._-� ----- ---- -------....:-• ... ..... Date', - ----- D Date Application Disapproved for• the following reasons:..................... ................................................. ` --•............................................::..•-•-------..... -------=--•---•----••.._..............------••----............................-•••--------•-----•--••----- .�_ Date Permit=No..•.... ... .. ......-••-••_.._. Issued-......----•--- --- ........................- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .................................. CIrrfifirate of Tumpliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �-) by.............................. ,. C yisi. ?' ..... ..........•••...........•-•••--•-•--. .. -----•--....................•--••••......- -�`' ' '* t InstallT: er at............................................. 1. o.~f .......�'t� '_ �!w:. .o...`.......... ------............-•--------------......---.....--------- Y has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the applicatiori'for Disposal Works Construction Permit No......................................... dated...............-................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE l SYSTEM WILL FUNCTION SATISFACTORY. b DATE.... ..........__ - - - �lr .............. Inspector---•••......•.:`a -. 1 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �fY 4�11Q1VSt �.,. . �- /� ..............................OF .. FEE._.. No..7. ... .. ... .......'. Dispsal Works Tlattstrudi an f amit L04(-D S,- r e Permission is hereby granted.------.. _ . : ----------------------.. to Construct ( ) or Repair ( L);�-an-Individual Sewage Dispo System atNo.: C-�1^ .- y ..... E'C_ _} 0 ..---� -•------•- ----•-. .......-••-•••••--•---•••-----•-•------....--••...... _ - Street .//,! �./if ' . as shown on the application for Disposal Works Construction Permit No . _................ Dated ...................................... . G -----------------------------��` F J `-•---•---.--------•----------- •------••- Board of Health DATE------- -------------------- -- i -•- -----------------•- j 9 ASSESSORS MAP : NOTES: TEST HOLE LOGS NOTES: r71 oo -7 PARCEL: ` � 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH r j1 Zpp = o FLOOD ZONE: I�� AZ SOIL EVALUATOR :- MEW �� (�j� THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF WITNESS NOT U)(�En J i t (rA F, BOARD OF HEALTH REGULATIONS. 8 w+u.tT Ro€a REFERENCE: LC.P l(03%15 DATE: � 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, r Nonni a PERCOLATION RATE: v M 1 wc�k q SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO SO iI.S LTA-(t 0, N `1 INSTALLATION. E TH- I _p ,� c� TH-2 C. 3 THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION o f l�f►" � C.1. Q.-Ad`I .S r ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE a lip y 1'� r I t..-. 4 Z.. �u I C.(i �.o DETERMINATION. u ' f31N F Arm A (Q 3 _ LA � � 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS S d y A�d � Y s S z 9 / 4� (� 4-9-67 SPECIFIED OTHERWISE) LOC'AT I ON MAP(N` t•�, I/�f1 S f�J� 10��5`� j�q,lq L N1 (���`""�a /R�I' 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A -T C ���I U� �/ 14A I IO'. M�� � `C� GARBAGE DISPOSAL. S'I�f�p2' S�� 2'q� 'b 't7 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) 791 Q�3.b 74 44.31 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON CZ M4V Z,S 7 � ABASE OF 6"OF CRUSHED STONE. SPr*Iv Y l�( 4 71 t s11 NCt. C. ftt, f_ P/T- __?�__B �t�weo;, 132 ��� 13�5 3q •LS Na w ►,Io w a :� Fr ui Pam.- T lTLE V. - h�+��d1 8 _l�lo ,� ✓�_P v�-ice t t.Ls_t i�u 15010F OWB e�ch� SEPT.I C .SYSTEM DESIGN ._-------- --- _ -t! 6� ^l 6 F FLOW ESTIMATE i1 1 12 BEDROOMS AT 110 GAL/DAY/BEDROOM - `-40 GAL/DAY h 51 SEPTIC. TANK Z `� GAL'IDAY x 2 DAYS - GAL - toh ti USE Gq GALLON SEPTIC TANK-E1C/Sr7AA- WLACZ wl I> �10 \ �` t- �k I F Flq'11.En, VAMeg6P dt LmVU,'S1Z9V 50 ` / �� 2 SOIL ABSORPTION SYSTEM PAV9D �4� t=it Tt-ATO UN1� v�lg ,ni c�v StpES 1 \ r:_ 341 '� S I i)E AREA: 2 + I2.16� Q x Z x 0,74 13 6 43 SURD CE BO+TOM AREA: �{ X IZ.tb )c O.74 = 305.q� BENCH MARK G TOP OF WATER GATE / ��\ ' �_ / Q42.S'? GPQ ELEVATION = 60.02 J\cJ .01 ��� rert ok USGS DATUM ASSUMED / l� Q\ O� ; SEPT I C SYSTEM SECT I ON JLog A �/ i5L. 50. GA TER CJ�O M W vGJC.Sj W`)1'V `� M)h ATV 14 S Nt 1 e c 1 "1 a� p J t�" (0 6� i�7 Yl 1 �1 fQ9 LOT l4 \ 50 it.t 2 "S 33 D_ �7 f1REfi = 1/598 sf +- t�pC10 GAL �7.� W `i q7.° 4S ° SEPTIC TANK -� -� � ({v✓t'�cIKlNess EX�STIN4 �-- 34 L Y t 2.14 - 4 S 0 0 aF VAS,gc SITE AND SEWAGE PLAN 02� DA EN ►1 G �CI MAL �/w t a LOCAT I ON : 4 48 FkgSH 41es A�W r No. 40 � l� -C Z � -DvAuk PREPARED FOR : C� IE `'rr�Yfi c 12.1b� C /�40 _ * _ SCALE: ! ZD DARREN M. MEYER, R.S. ° DATE: �� d P.O. BOX 981 J EAST SANDWICH, MA 02537 3 DATE HEALTH AGENT Ph: (508) 362-2922 Z