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HomeMy WebLinkAbout0093 SAINT CATHERINE AVE - Health 93 ST.CATHERINE AVE., HYANNIS A= '1 a� I! i e r �L-J n Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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. A. General Information (n 1. Inspector: lSl Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by.the Local Approving Authority 5-9-11 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. Ltlm. 1/10 - - Title 5 Official Inspection Form:Subsurface Sewage Dispo I System•Page 1 of 17 S Commonwealth of Massachusetts W Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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: System is in good working order with no sign of failure. 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): Y t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval,of Board;of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ;1 f s 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 16.303(1)(b)that the system is not functioning in a manner which will protect public health_, safety and the environment: El Cesspool or privy is within 50feet of a surface water., ElCesspool or privy is within 50 feet'of a bordering vegetated wetland or a salt marsh. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David`Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: El 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: R D System Failure Criteria Applicable to All Systems:) terns: Y PP Y You must indicate "Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool J ❑ ® 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 1/ day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form _ - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M a 93 St. Catherine Ave Property Address Bank Owned (Contact David:Holt.@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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: 0 ® Any portion of the SAS,llcesspool 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 rivate water supplywell. p ❑ ® 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 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 youahave:answered:"yes7 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 f.regional•office of the Department. t5ins 11/10. - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 93 St. Catherine Ave " Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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 S on the site has rp System (SAS)) 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 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal.System Form-Not for;Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? _ ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2011 1 ,. , i. 1, Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? a ❑ Yes ❑ No Industrial waste-holding tankyresent? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: [sins-11/10. _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: N/A Source of information: Was system pumped as part of the inspection? ❑ Yes ® No E 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Towri State Zip Code Date of Inspection D. System Information (cont.) , Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): . f Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan), 18" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ,s ❑ 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 gal Sludge depth: 12" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every y H annis MA 02601 5-7-11 page. City/Town 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 20" Scum thickness 2 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): t Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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 ❑fiberglasspolyethylene other(explain): 9 ❑ ❑ Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes ❑ No Date of last pumping: Date . - Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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.): D-box in good condition with water at working level and no sign of back-up. 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Type: ❑ leaching pits number: ' ® 1 ,leaching chambers number. ' 7-Infiltrators ❑ 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.): Infiltrator leach field in good condition with no sign of back-up into d-box or surrounding stone. 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 i Dimensions of cesspool Materials of construction i✓ , Indication of.groundwater inflow ❑ Yes ❑ No t5ins•11/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 official Inspection- Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M r 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1M 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 page. City/Town 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 - o D 76 b 0- AV' Q `' •73 dT a. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection' Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - g P Y rY 93 St. Catherine Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 5-7-11 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 f + t5ins•11/10 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWNWF.BARNSTA.BLE ,OCATION �� �a ertvi e M sew;kGE # ITI:.LAGE /7���!i` _ ASSESSOR'S MAP&1L OT _ NSTALI EPUS NAME PHONE NO. ;EMC TANK CAPACrry .EACHING FACILITY: �h f" ro- size (type) ,l._._�� ;C�-� �.._.( ) _...�. 10.OF'BEDR0OMS _._ - - II,Td1.DER OR OWNER 'ERMI<TDATE: COWLIANCE DATE; separation Distance.Between the: Aaxinium Adjusted Groundwater Table to the Bottom of beaching Facility -- - ---Feet eet kivate Water Supply Well attd beaching Pacility (If any wells exist on site or within 200 feet of leaching facility) t ,Age of Wedand and L.eaclting Facility.(I£any wetlands exist.. ' within 300 feet of 1 ac6ung.fucili ) .l eet� cjaG✓rt ���/a�/ 'urnished by t - Jrn uo (� Up- too C'6 r. r s z OF�BARNSTABLE 'iOC.ATION , /, S SEWAGE # �I VII LAGE ASSESSOR'S MAP & LOT ®� INS' ALLER'S NAME&PHONE NO. 4- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: /0 /�� L� COMPLIANCE DATE: 17G� 3 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 widen 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 r\ 4y, O q ^w % lp d � 6 a t b - a �4 41%4z< No. I, .w� T Fee A90 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _} s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(p prication for Migomf bpgtem Congtruction Permit Application for a Permit to Construct( )Repair X Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 0,3 ls}, cA-V1e_r i ne!S Owner's Name,Address and Tel.No. Assessor's Map/Parcel <Sq, 4q RN'--I\S Olo to SO—) Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. mod n �:s he�c S�A�t Etl u, SACS, Q 4Lo-a600 1 �5 2A Type of Building: Dwelling No.of Bedrooms 4 Lot Size 1414 sq.ft. Garbage Grinder(Nl Other Type of Building i,�['n P No.of Persons (0 Showers( O'Cafeteria( Jj Other Fixtures L-Ay LAoow!Y_Y Design Flow 44t) gallons per day. Calculated daily flow gallons. Plan Date 91 is Jd S Number of sheets 1 Revision Date Title '1 czzr�x�- A �{ Sun em U ro_& Size of Septic Tank PAPS kStO CQ� Type of S.A.S. Iry f7t t_i _ArTtl_S Description of Soil ]�!2 QL Am OACj Nature of Repairs or Alterations(Answer when applicable) Q_!�k Am W o_r\ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of'the' Inv ironmental =ode.and to place the system in operation until a Certifi- cate of Compliance has b by thi of ealt S' ned Date Ste' Application Approved b Date PP PP Application Disapproved for the following reasons Permit No. ` ` S —We- — Date Issued— - ,I ee y No. 7 y � tr� r JF THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: AS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Mi!5po5ar *p5tem Congtruction Permit Application for a Permit to Construct( )Repair X)Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. q 3t �j�, �—�he r ne'S Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1RQv-)o,\Ao k M ta�2�a 'CLOY 5k 0\\ Onto SA t-A E. - Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Shex" 'SV\AY ErJU. S\lCS. s Type of Building: Dwelling No.of Bedrooms -4 Lot Size 14 ,4 q.ft. Garbage Grinder(tile, v. Other,, Type of Building /-�C`n p No. of Persons (0 Showers( O'Cafeteria( ✓}` Other Fixtures 1--AgA"r'-w&Y , 1 Zi roiet-\ 'ttdk LAut.-oy�-Y ` Design Flow 440 gallons per day. Calculated daily flow 443, -1-'b gallons Plan Date 9 1 I S 16 S Number of sheets I Revision Date +fir cp t c Su5 fern l)rye c-ccP Title Size of Septic Tank f'� .J� S00 C� S.A.S. 1 Iry r_t L`i e_'A'roi_;5 ' p � Ca ic��1�- Typeof Description of Soil; 2 -Q� `�o ©�c�c-1 " x j J f' Nature of Repairs�of Alterations(Answer when applicable) 2. Am Date last inspected- R Agreement: ` r 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' nvironmental Code and of to place the system in operation until a Certifi- cate of Compliance hasnA by t • r'f r Si ' o ealt _ �ned ate vor• Application Approved . Date `+Application Disapproved for the following reasons Permit No. . -5 Date Issued J. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, t at the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by o rh at 3 •�'� l��, 1� ?.� t' S has been constructed ity acc rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. 5 C-12�dated 10 L1 Installer S 1^Q '�- Designer � o. 1 The issuance of this permit shall not bt construed as a guarantee that the sy ern quctio ssigned. Date ,_? Inspector No. �-1,------------------------Fee ' ,THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Di5 o5ar *p5tem Construction Permit z Permission is hereby granted to Cons ruct( ) epair �Upgrade( )Vkbandon System located at `� �.. r r%0 �,,r S 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 cond' '-us i Provided:Con/struc/tion m t be completed within three years of tihe date of this pe i s Date:_.- l < � Approoved-by 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I y hereby certi y fy that the engineered plan signed by me dated IS a5 concernin the property located at 13 " CG _'Zv's g 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 raze is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. 0 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) So •O O B) G.W. Elevation aO +adjustment for high G.W. 10-0 DIFFERENCE BETWEEN A and B SIGNED : DATE: 15 10f NOTICE s 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. RmAv rN qAS-eptic\percexemp.doc Town,,of 1�arnsi table °FfHE rqf, Regulatory Services Thomas F. Geiler,Director + BARNSTABLE ' , t Public Health Division A'E1639. h Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & DesiLyner Certification Form Date: �S Designer: Shay Environmental Services, Inc. Installer: Address: P.O. Box 627 Address: Kett East Falmouth MA 02536 � On ®'� fir was issued a permit to install a (date) (i st filer) 1 septic system at Cam` is based on a design drawn by (address) Shay Environmental Services, Inc. dated ns (designer) VVI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MgS S o� CARMEN taller's gnature) 0 E. SHAY N " No. '1181 ��C'/STEREO SgNI TARS P� signer's Signature) (Affix De i tamp 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 r c TOWN OF BARNSTABLE LQCATIOII cJ f" C��/ SEWAGEsro ' VILLAG ASSESSOR'S MAP& LOT IISSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ��c-`-s 0 j t -,(size) NO.OF BEDROOMS t _ BUILDER OR OWNER PERMITDATE: 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 W': "4 /�� /6� (' � .. t� Y v � � 1 U:i% 1 � � ` r + I 1 � J .. _A 1 �+ `> M � ��� d •� 1\ � _ ^^ ` �[ a 1 `L(`a�-\ Vy i. t�: +. `_�l 1 / ` 2 `�/_ �'� --- -- r` ' 1 TOWN OF BARNSTABLE LOCATION SEWAGE #a VILLAGE'"n s L ASSESSOR'S MAP & LOT;7-?/' � INSTALLER'S NAME&PHONE'NO. LA sh `s i -,%, k w & ,1 i J SEPTIC TANK CAPACITY rlszead_ 5'X LEACHING.FACILITY: (type) Cesspee s (size) to NO.OF BEDROOMS .� BUILDER OR OWNER PERMITDATE: 6zffA w0 COMPLIANCE. DATE: , _ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 jrA:E� 1-v f ieuc mg -1mc. Gi rl w a a- rd zi n ryti o A 1) 4 11 (1 N rF } b M bi! N. � �� 3 7� Fee J®� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migont *pgtem Con.5tructfon Permit Application for a Permit to Construct(;/Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 93 6A/4,J CA lAkjoJCg M, Owner's Name,Address and Tel.No. #YA,741 AmrA Teci¢itri Assessor's Map/Parcel �0 _C/ / q`3 S ad 04b raoucs R4> Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TiP,V ckl cV j LUC 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 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 applicable) Ara or-p&l4� Ls` ,. .e ilc f� (:10 Alt + ' 1,e e3oer Date last inspected:0/31 2. 010a) F 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 Environment Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o e Signed % Date fn n Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. — > .. Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'Application for �Digozal *p! tem Construction Permit Application for a Permit to Construct(Rep/air( )Upggraade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 93 SAIA 7j (f j&ZNUtt /d. Owner's Name,Address and Tel.No. AMI-A FccielI C Assessor'sMap/Parcel 2d/_ 9-3Srqrrk Cx4i,ri�ts _/ l�(QHyAnnis 02ioi Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'Po.sox -7 _ r 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 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 applicable) Keo)Are QAu)9"*6, Li' .c UJI PtiC Sri U6 Nu OAS }kA noel` O'N1j, .� Date last inspected: o1ooj� IF 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 Environmen 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o e r —� f Signed Date ) p: Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired ( )Upgraded( ) Abandoned( )by 6A T at 9 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date , 9 - 1�,r Inspector i .� --------------------------------------- No. w� J J Fe SC/ Z / _ v� THE COMMONWEALTH OF MASSACHUSETTS .. Q PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5p0ar 6potem Con5truction Permit Permission is hereby granted to Construct( )Repair(ye)Upgrade( )Abandon( ) System located at 93 &,A,A (iSApjA,s t , "AAt) c nac,0 2 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 mu t be completed within three years of the date of this p t. < Date: �� �� Approved by "� TROY WILLIAMS L SEPTIC INSPECTIONS Certified i y MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COPY . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS- ,�.' -- fit - DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY CORE lti?O� ft Secretary ARGEO PAUL CELLUCCI V NI, ?DWVID B.STRUHS Governor s �Ol111 Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'A CERTIFICATION t' X, Ce,+AeP-;nc Arc Property Address: Name of Owner A r o ra g I N w N n S Address of Owner: _ +✓�✓1 4.� fj�/c Date of Inspection: �/I$ /O O Name of Inspector:(Please Print) Tray Williams /"��w ti h,� /lil a 2 C 0 I . 0 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.0001 Company Narne: Troy Wllltama So c Inaooctions Mailing Address: 19 Hummel Drfve, So. Dennis, MA 02560 Telephone Number: (508) 385-1300 . CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: "ZJ'Jzl� Date: -S//13 �6 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to 11ta system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system-on-the-D.ate of 1 Inspection noted above. T) l , 0 1 revised 9/2/98 Page I of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(con6m#ed) Property Address: Owner: Date of Inspection: . 93 St. Catherine Avenue,Hyannis,MA INSPECTION SUMMA)W9ra&{&1*, B, C, of D: May 18, 2000 A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY(PASSES: V/ One or more system components as described in the "Conditional Pass",section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination In all instances. If "not determined", explain why not. L The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of.a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. L— Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Y OtL, t�P r to a. J Q,J_N 1 s /.it4CA 0 h d V`t✓ �K/ P r/J 'e S /h $1 ok '#0 J h l t N 'b c �r f♦1 t.,�( I v U V G h V (.L L.U t'+'� Ir.G,. 1 c ��J ( pJ-13 / H3P 1.t.�o�^ W �� l 4/ 3 1 S ti so 1h) 'bc� Jr',. . 1//) h• G Varwr.�et e S 4- �Y[/�av✓o- rl� O Le-S S ra, 1 5 0.T-Tl<r r"e-,pn a.1 Y, revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Dace of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figholini C. FURTHER EVA1Wy1"&MUIRED BY THE BOARD OF HEALTH: N1/a Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 11 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER i revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 93 St. Catherine Avenue,Hyannis,MA Owner: Dace of Inspection: Aurora Figholini May 18, 2000 D. SYSTEM FAILS: Al//9 You must indicate either"Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination Is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due.-to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent.to the surface of the ground or surface waters due to an 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)• Number of times pumped_. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ = Any potion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS:At 1i9 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: The system serves a facility with a design flow of 10,000 god or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4orit I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address-. Owner: Dace of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figholini May 18, 2000 Check if the following have been done: You must indicate either "Yes" or "No" as to each.of the following: Ye; No _ Pumping information was provided by the owner, occupant,or Board of Health. _ None of the system components have been pumped•forat least two weeks and-the system has been•receiving-normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. V 114 As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. r WA The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: �V� Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) The facility owner(and occupants,if different from owner)were.provided with information on the.propermeintanance of Subsurface Disposal Systems. revised 9/2/98 Page 5oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figliolini FLOW CONDITIONS RESIDENTIAL: May 18,2000 Design flow: 116 g•p•d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow yyo Number of current residents: Garbage grinder(yes or no):_Y,4S Laundry(separate system) (yes or no):N0; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):/40 Water meter readings,if available(last two year's usage(gpd): -T? = 3 too,0 a//o., 9/ odd y a ►��ti �. Sump Pump(yes or no): Ali) -�L Last date of occupancy: 6 C cC -v J• COMMERCIAL/INDUSTRIAL: Al 14 Type of establishment: Design flow:_ qpd ( Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: �o ��/K. n. r. a i ti w v c. (c.6 l � -} 'T�r cu.-�- vr. .� -1• iP�s...System pumped as part of inspection: (yes or no) �Vo If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool 62 X, Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed Of known)and source of information: d•r', �.y h a I --Eu G + U Flo vou. Sewage odors detected when arriving at the site:(yes or no) iV4d revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(confinued) Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA BUILDING SEWER: Aurora Figholini (Locate on site plan)May 18,2000 Depth below grade:/PA Material of construction: cast iron_40 PVC other(explain) v,r y A b,.,—a Distance from privy a waters pply well or suction line /V/�-q Diameter y„ Comments:(condition of joints, venting, evidence of leakage,etc.),/ p. Floskcc,A u c S�0.)tQ—t� I� h� .5 Q4- ; "s' << �7 tnt7l Tbu.�a� Llcyi SEPTIC TANK A// p✓b (locate on site plan) (`v4 5 a� -7 Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structuraHntegrity, evidence of leakage,etc.) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7ofII i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cornira Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figholini TIGHT OR HOLDINQvJjWWW1d6(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Materiel of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity:_gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Data of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_N'1/J (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:N 14 (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised .9/2/98 Pages or II 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA SOIL ABSORPTIONAV~jgkBJi_4/_ (locate on site plan,Mfp5MlE0Wavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:— 7 ')C $` oUc✓�/o�J «S Sir,,. S Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, co dition of vegetation, etc.) 6 er /call ou tvc. 39 oh ir. c o c.�cr CESSPOOLS: oy `o4a jt,.,, (locate on site plant r,.I�r k.". �. o r�,v_,., a� �c S� � C^ /` u c�.� T i-�tJ,•'Lc_ Number and configuration: w.'a ti . t c � .�i S� : h ( c,�s h c3 / /" '^J' / d r i_�J 5�a o 1 S S fi,,,_/+✓ Depth-top of liquid to inlet invert: Depth of solids layer: (a—,A Depth of scum layer. 4 f� ) Dimensions of cesspool , t- ) /Q c_ 6 ict'r. Materials of construction:e? Indication of groundwater: it/o/V inflow(cesspool must be pumped as part of inspection) CJtje✓ T�s4c.i c,�� s oo I 1 ✓ y ode iN s �„ t pl0h Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1 ��� '`'ti kGaV7, S�✓clf� i7u�( Vyo� /�uw./^'` �� u� v..,ci�L� �c.SSrU� S i S 6C/9 Y c o of. (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figholini Mav SKETCH OF SEWA —bE IH 2000 G DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 13V- Si 7a ' Z6 � ' 6 'c 3s cis s��H i. M pia Ju C''-'�9/ate Lt-S3�O0 )• iM.a.�►� G.e�SSpve> � Cx•.c� � 0.�h��y revised 9/2/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contiran4l Property Address: Owner: Date of Inspection: 93 St. Catherine Avenue,Hyannis,MA Aurora Figholini NRCS Report namPay 18, 2000 l Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep ✓ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 1 r Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site iAbutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local.excavators,installers —zUsed USGS Data Describe how you established the High Groundwater Elevation. (Must Lbe/completed) 0 b c�lu c✓ c�t��j S� Lis 1 w c� `'l O �..�A�L•� 7 V.>� �. ��l �¢H � ' I .S- V r l�W dCI fn/c.�S 3� fj1 � O.f ;/ �-� f7 H�t. ���S S�� u � S (.aJ a,✓� .1 0 � �u L c._ 'T�� o� revised 9/2/98 . Page 11 of 11 *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (0 All OUTLET fPES Flrokt THE Least 24 inches tall) SECTION A -,4 SD11An2*NyJACIY ' Schedule PVC w/Charcoal Odor 10' min. from FNter is ExistingFoundation house to septic tank DtsTRetlTtoN Box sNALL BE : o-Box cover must be PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. ^12- ' CONCRETE COVER d7 TOP OF CEMENT PATIO = ELEV. 100.00 (Assume )Septic tank covers meet be within 6 in. of finished grade within 6 in. of finished grade �. Grade over Septic Tank - 99.50 Grade over D-Box - 99.50 ode Dues SAS - 99.50 3" of 1/3" - 1/2" Washed Peastone `• - KNOCKOUTS OUTLET a-ter'"-'..-s.•� z ,ti y-.e• '.. day 4 -�•a` A 3/4• to 1 ,1/2 Washed Crushed Stone i �\ r r r , S - 5.5• I 12• NLET :1� !ay} e Y ma;r,`� ..• ��. 0.02 3 HOLE H-10 4 PVC(CAPPED) INSPECTION PORT TO OUTLET 15• . NEW S=0.01 or Creator ST_ BOX 3• Maximum Cover INSTALLED AND TO BE MITHN 8.OF GRADE •• \�� 1 - ��- 2• ap,gn s 13 3YIR CiMlfil!/!!. Top OF System- Elev. -96.00 -~ iii - • A �"'4�'"' EXIST. PIPE n e) 1,500 GAL ,...gyp ' ¢f` T co N O 5• S- 0.01" per foot , 10"Effective Depth 15.5•-- 4" - SCH. 40 Te 1.75 ''♦ r '� 'FROM EXIST. FOUNDATION / rn SEPTIC TANK o / it 0) � s PLAN SECTION CROSS-SECTION i' Ttot+� tri 0) i Sff9 CaNCRM FULL FOUNIW y II H-10 t` N 5 = f } e .- ( ) u SYSTEM PROFILE 6 �.of 3/4--1 1/2" d 0.83'�10 inches I Mtthk311x y ai an 0 3.75' I 3 HOLE H-10 DISTRIBUTION BOXi" compacted stone i o d _ Not to Scale c c o u , rn NOT TO SCALE c '0 4' JAJ 4• Effective Length M RaiWitXFysu�e+ywyS.V0af�a__......3l_JI SOIL ABSORPTION SYSTEM (SAS) y 6 in.of 3/4"-1 1/2• 0 11 GENERAL NOTES compacted stone Q Effective vtdth INFILTATR❑R.HIGH .CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 1 m 1. Contractor is responsible for Digsafe notification, Verification of Utilities o (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. t`' Bottom of Test Pit = Elevation 88.00 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" AFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2" stone. vObs. Groundwater - Test Hole 1& 2 Elev.= None Observed 3. Backfill should be clean sand or gravel with no stones over 3" in s4e- 4. This system is subject to inspection during installation Design Calculations by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan Number of Bedrooms: 4 Equivalent to 440 Gal./Day and Local Regulations. Garbage Grinder: No 6. If, during installation the contractor encounters any Leaching Capacity Proposed: 440 Gal./Day Minimum soil conditions or site conditions that are different Septic Tank : - 2 x 440 Gal./Day = 880 USE NEW 1500 GAL. Septic Tank. from those shown on the soil log or in our design SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch installation must halt & immediate notification be Bottom Area: 0.74 gal/sq. ft. x 500 sq. ft. = 370 gallons made to Carmen E. Shay - Environmental Services, Inc. Sidewall Area: 0.74 gal,/sq. ft. x 99.6 sq. ft. = 73.7 gallons 7. No vehicle or heavy machinery shall drive over the Providing: = 443.70 gallons septic system unless noted as H-20 septic components. 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Use: (7) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3' OF WASHED STONE 10. All solid piping, tees & fittings shall be 4" diameter ON THE ENDS. NO STONE UNDER- Schedule 40 NSF PVC joints. 1 i es with water tight j PP 9 11. Municipal Water is Connected to ALL OF The Residence and Abutting i Properties Within 150 Feet. TEST HOLE #1 i THE PROPERTY LINES ARE APPROXIMATE AND PERCOLATION TEST ELEV-= 99.50 Failed J COMPILED FROM THE SURVEY PLAN GENERATED BY 1 120.00 - 4"-P _C_esspool / WHITNEY & BASSETR, RLS OF HYANNIS, MA ---------I :--- ENTITLED "SUBDIVISION PLAN OF LAND IN HYANNIS, MA", Date of Percolation Test: SEPTEMBER 12, 2005 DATED DATED JUNE 1963 PLAN 14034-H SHEET 1 Test Performed By. CARMEN E. SHAY, R.S., C.S.E. i SHED PROJECT BENCH MARK INL� 1500 GALE Vent. 0' ( # Results Witnessed By. WAIVER (per Barnstable B.O.H.) TOP OF CONCRETE PATIO Failed SEPTIC TANK AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN EXCAVATOR: Shay Env. Svcs. .'. �>w _ :;?• �; _-r :. Cesspool - �s- IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Percolation Rate: Less Than 2 MPI 0 38" ELEV. = 100.00 (Assumed) // ' •� • • • - • f , Failed THE THE SEPTIC SYSTEM INSTALLATION. Test Hole Test Hole EXISTING CESSPOOLS TO BE PUMPED OUT AND REMOVED No. 1 No. 2 ,� L I 23.5' DEPTH SOILS ELEV- DEPTH SOILS ELEV. J� �o\\ NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE o 99.50 o ss.00 =-;g\ock f c,Z CONCRETE PATIO - 2 ------ --- 100 FROM THE EXISTING CESSPOOLS TO BE DISPOSED Sandy Loam Sandy Loam OF AS PER BOARD OF HEALTH SPECIFICATIONS. <:. 10 YR 3/2 10 YR 3/2 r; THERE'ARE--NO 'WETLANDS ARE PRESENT WITHIN -200'- OF THE 'PROPERTY 0--9" A, 9825 0"-3•' A. -- 38.25 -..w_w _ 100-- I Sandy Sandy I ASSESSORS MAP 291 PARCEL 066 Loom Loam EXISTING LEGEND,o YR 5/s ' io YR s/s i 4 BEDROOM TEST HOLE #2 9"- 40" B, 96.17 9" 38" BW 95.83 I (SLAB FOUNDATION) Medium Medium I HOUSE ELEV.= 99.00 LOT #8 Sand Sand 2.5 Y 6/4 zs r 6/4 LOT #10 #98 00 104X 1 SPOT O�GRADE ROPOSED 40"- 132 C., 3s'- i32 c, i (FULL FOUNDATION) O CV X 104.46 DENOTES EXISTING '-- I SPOT GRADE 1 PL PROPERTY LINE NI I a 9r P PROPOSED CONTOUR LOT #9 - - - - -97 EXISTING CONTOUR t Perc 1 I V) w I 14,400 Square Feet +� Depth#to Perc: 48" to 66.. i w Fh I DEEP TEST HOLE & Perc Rate= 2 MPI IPERCOLATION TEST LOCATION OBSERVED H2O Elev. = None Observed 1 - 6 FOOT STOCKADE FENCE 3-24" DIAM. ACCESS MANHOLES I -1. • . to• _e. 99--- I------- ----------------------- ------------------------------ ----99 i I 120.00 PL i r m L P LOT PLAN , -INLET. - / ~1 /.�. 1 / � -• � \EQUALS INLET l` `` - ---------------` ----- - __ OF- PROPOSED SEPTIC SYSTEM UPGRADE A THE ACCESS COVERS FO , -----------------DISTRIBUTION BOX AND NT PREPARED FOR RENALDO �c MAIZA ELOY SHALL BE RAISED TO WIFINISHED GRADE. S-4 IN T CA TH�'R INS' 7A � �NU�STEEL REINFORCED PRECAST• CONCRETE INSTALL TUF-TITE GAS PLAN VIEW ON ALL OUTLET TEE EN AT 1 3-24" REMOVABLE COVERS (40 .FOOT RIGHT OF WAY) #93 SAINT CATHERINE S AVENUE _ _ HYANNIS , MA 3 min. clearance •✓ INLET 8• min_T�2• min. Mlet to outlet iY mk,. 1T INIFi NLL -10"mh. Liquid level r OUTLET C 5' -7- 5• -, A- T-i !_ JI N �Gu, REPARED BY: s 4•-0•min. CA)?HEyV E. ASfA Y 0�sew. Liquid depth i- H ENVIRONMENTAL SERVICES, INC. ;- ; 0 20 40 50 0. ; %. _;. -. �F ° P.O. BOX 627 CROSS SECTION END-SECTION SArvITAR\P EAST FALMOUTH, MA 02536 - TEL/FAX : 508-539-7966 SCALE. 1 =20 TYPICAL (H 10 LOADING) 1500 GALLON SEPTIC TANK SCALE. 1 =20 DRAWN BY: CES DATE: SEPT. .15, 2005 NOT TO SCALE PROJECT#SD799 FILENAME. SD799PP_DWG SHEET 1 OF 1