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1471 IYANNOUGH ROAD/RTE132 - Health
a5"3101g1X03 -\ COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAItS i DEPARTMENT OF ENVIRONMENTAL.PROTECT(}IO(N TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM j// PART A i l7 �� CERTIFICATION Property Address: Owner's Name: , � ' IILII ltl• &ej> ..> Owner's Addresel. 6 Date of Inspection: , , c'l tXy) 6- Name of Inspector: (please rint) Company Name37 / a.: 1+'IBvAL ' Mailing Address: Telephone Numbert,�^q-,R-- '7 7�- *'2`1-9 CERTIFICATION STATEMENT i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE.DISPOSAL_ SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address.- Owner: Date of I pection: Inspection-Summary: Check A,B,C,D or E.1 ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described_ in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria.not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N;ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank.failure is imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection.if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):. broken pipe(s)are replaced obstruction is removed distribution box is.leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 I ' Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 ..Y, a Owner:,: ..®,o r,1' Date of Inspection: V', In koo 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. I. 'System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(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: 5 _ The system has a septic tank and soil absorption system(SAS)and the'SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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: 3 �� Page 4 of 11. OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ..CERTIFICATION(continued) Property Address: , ILIA Owner• � .C�/!! —>rs Date of I • pection:v( . y a 0 60 D. System Failure Criteria applicable to all systems: You must indicate"ves"or"no"to each of the following for all inspections: E. Yes No Backup of sewage into facility.or system component due to.overloaded or clogged SAS or cesspoolA Discharge or pondmg of effluent to the surface of the ground.or surface waters.due to an overloaded or — clogged SAS or cesspool / Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface tv/ water supply. .Any portion of a cesspool or privy is within a Zone 1 of a.public well. Any portion of a cesspool or privy is within 50 feet of a.private water supply well. iV 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 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a.surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 V7 (1i'1�® /3 )^ Owner• 9. Date of I_ spection: y/ r , Q©(0 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant, or Board of Health mere any of the system components pumped out in the previous two weeks ? V tias the system received normal flows in the previous two week period? t 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? r/ _ 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? v _ 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: Ye `no /e — Existing information. For example,a plan at the Board of Health.. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR l 5.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION Property Address: l >' CAA Owner. Date of spection• r ! �d LOW CONDITIONS RESIDENTIAL,A/g Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes.or no):_ f if_yes separate inspection required] Laundry system inspected(yes.or no): Seasonal use: (yes or no):_ y Water meter readings, if available(last 2 years usage(gpd)): -�/�LA��� Sump pump(yes or no): Last date of occupancy: / COMMERCIAL/INDUSTRIAL V Type of establishment: ,r , Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/.gft,etc.): Grease trap present(yes or no):VO � ` Industrial waste holding tank present(yes or no).'V� Non-sanitary waste discharged to the Title 5 system(yes or no): c7 Water meter readings, if available: .J Last date of occupancy/use: Y, UA � c !. OTHER(describe): GENERAL INFORMATION Pumping Records/,\. Source of information: Was system pumped as part of the inspection(yes or no): /'l If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPF,OF SYSTEM _1/Septic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the.current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copyof the DEP approval Other(describe): proximat age of all components, date}'�stalled(if known) and source of information: Were sewage odors.detected when arriving at the site(yes or no):41e . 6 Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:� � .�� 1, Owner: //? Date of Ijsopection: Vl / jd BUILDING SEWER(locate on site plan)/A/6) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance fi om private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): � 1 JSEPTIC TANK: iJ (locate on site plan) ( [. L4 Depth below grade: Material of construction: g i,,concrete_metal_fiberblass_polyethylene other(explain) If tank is metal list age:_ .Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: ., X6` j /e)°� ° X SG�J Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: d7� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: /)JZ How were dimensions determined: och Q Comments(on pumping recommen ations,Inlet and outlet tee or baffle condition, structural integrity, liquid levels .as related to outlet invert, evidence of leakage, etc.): GREASE TRAP:iv(locate on site plan) - C- ' � ' �°�"s � Js 'L�'. t, L C � Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.)- IUD 7 Page 8 of I I OFFIC IAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESS MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: CACft LA Owner: Date of I spection`- . 9 r , . _1 ,Q006 TIGHT or HOLDING TANK:/` (tank.must be pumped at time of inspection)(locate on-site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain):. Dimensions:' Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): present must be o e ned locate on site plan) DISTRIBUTION BOX:�(� if en m )( p ) ( P P 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.): P CHAMBER: �. locate on site plan) PUMP � ( p ) 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.): 8 I Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IINF�O�R�MATION(continued) / Property Address.. �7Me / v1�' _, � ' ', ! =�` .'�✓li� 1 r7i ,7 i" ' Owner:v Ij P Date of Itspection: —T I f'a 0 C)C' C . SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type teaching pits,number: leaching chambers,number: leaching galleries, number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, et f iill; . a CESSPOOLS:)Y® (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): . Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY:No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: V-71 Owner: Date of Ii pection-' t d44.4 64 c :0 V � 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. 1� Lj t' a J c 11� vSoo a ��oj,) � �L �e nth C i 10 I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 71Z P ° Owner. . .g Date of I'spection 1 JW , SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water � feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: 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: 9 Mo lo 11 Permit Number: Date: -- ------ ^::v,.' Completed by: _ rT,• �'� == ` :=sn - HIGH GROUND-WATER LEVEL COMPUTATION z< f Site Location: ' ,1Z. J///Lot No. �-= l Owner: J / 14 �`��/ Address: Contractor: _ t�%���/�•�% ���1�0� Address: ���� ���J��Y'• Notes: ' STEP 1 Measure depth to water table to nearest 1/10 ft. .......................................................... 45 .................... .Date � month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: n O.Appropriate index well.............................. l.��j�.. /✓� OWater-level range zone ................................................. STEP 3 Using monthly, report "Current Water Resources Conditions" determine current depth to f water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) �` determine water-level adjustment ................................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............... . t' ,................................................... Figure 13.—Reproducible computation form. 15 1 I� uC/��..IW'10j!!/'// ,��P�� � . �� I. �, �� �✓ .m... a Town of Barnstable MMMA639. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. m ' -February 25, 2004 Mr. William Weller Weller and Associates P.O. Box 417 Centerville, MA 02632 RE: Rainbow Resort Motel, 1471 Route 132, Hyannis A= 253-014 Dear Mr. Weller, You are granted conditional variances on behalf of your client, Rosalind Gruber, to construct a temporary replacement onsite sewage disposal system at 1471 Route 132 Hyannis, Massachusetts. The variances granted are as follows: 310 CMR 15.202: To install an onsite sewage disposal system within a nitrogen sensitive area, in lieu of the Code requirement to design and include a recirculating sand filter or equivalent alternative technology where the design flow equals or exceeds 2,000 gallons per day. PART VIII SECTION 15.00: To install an onsite sewage disposal system within a nitrogen sensitive area, in lieu of the requirement to construct and utilize an onsite innovative/alternative system or shared onsite innovative/alternative system where the design flow exceeds 1650 gallons per day. 310 CMR 15.255 (2)(a): To construct a wooden retaining wall, in lieu of the Code requirement to construct the retaining wall of reinforced concrete. These variances are granted with the following conditions: (1) A septic system inspection shall.be ..conducted on the second septic system located at the;southern-side' of the property. The completed eleven, page septic system inspection report shall be submitted to the , Board :of Health` prior to the issuance of a disposal works construction permit. Wei IerRai nbowResortMotel (1) The new system shall be designed and constructed in such a manner to be easily retro-fitted to a recirculating sand filter or equivalent alternative technology in the future. (2) The buildings shall be connected to public sewer on or before February 17, 2007. If sewer does not become available to this site, the septic system shall be connected to a recirculating sand filter or equivalent alternative technology on or before April 19, 2007 (which is sixty days after February 17, 2007). (3) The applicant must obtain written approval from DEP prior to the issuance of a disposal works construction permit. (4) The septic system shall be installed in strict accordance with the engineered plans dated December 22, 2003, signed by the engineer dated February 2, 2004. (7) The designing sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the plans dated December,.,22, 2003, signed by the engineer dated February 2, 2004. The Town recently expended funds for designing sewer lines in this area. It is believed public sewer will become available to this site sometime in the future. These variances were granted because the new proposed septic system will be used on a temporary basis until such time public sewer becomes available. If town sewer does not become available, the applicant agreed to install a recirculating sand filter system or equivalent alternative technology at this site. Si cerely yo r , 'WayO Miller, M.D. Chaftnan Wei IerRainbowResortMotel 2 W� COMMONWEALTH OF MASSACHUSETTS i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION Ri±(jI&:-`i1121__3 I, Z 53 �%RCEL 0h 4 DEC 2 1 20 04 -OT `A. -= TUA TOWN OF BAnNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: t A/N a�oi /vwa/oF ��.P�STfl6Le� Owner's Name: K /dEjo41164/c / �Z�iP,�4r/yL..3 Owner's Address: 26t�2d 4fP '*Gz/ V �O O.� 33�9g3 Date of Inspection: /e / 1 4 Name of Inspector: (please print) ��1T/AR/� Ta�✓E Company Name: Mailing Address: l•�j�-6/� /,Z� Telephone Number: —2cg8 —SAl9 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: VPasses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 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. r Notes and Comments Grl/�/.QI� S� /� �}, Q�l/l/�/!j Di�OEl2 �4�vF/ca«Y.6W4 v R�cc.( �QEzO^y�,t6�� P��Fa'.✓6 0� T9��(��e �,,�.✓�.✓CE—�iRPOS�J 7`19 //24J1 .5&�IVP7111 h10A.90cCS /4/ 04eoelva toT ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: gal Owner: Date of Inspection:. Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D / A./Syste Passes: I have not found any.information which indicates that any of the failure criteria described in 310 CMR 15.303 or.in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. tem Conditionally Passes: One o ore system components as described in the"Conditional Pass"section need to be replaced or repaired.The syst upon completion of the replacement or repair,as approved by the Board of Health,will pass. I Answer yes,no or not determin (Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 2 ears old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or ex tration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. *A metal septic tank will pass inspection if it is struc ally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availa ND explain: Observation of sewage backup or break out or high static water vel in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. S em will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).Th ystem will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �� ���'I32 Owner: e/odch� Date of Inspection: O4-1 Further Evaluation is Required by the Board of Health: ditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to otect public health,safety or the environment. 1... System wi ;pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the siiWlon is no unctioning in a manner which will protect public health,safety and the environnkTai&- _ Cesspool or ivy is within 50 feet of a surface water _ Cesspool or p is within 50 feet of a bordering vegetated wetland or a salt marsh • I 2. System will Mail unless the Boa of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner tha protects the public health,safety and environment: _ The system has a septic tank and s '1 absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s e water supply. The system has a septic tank and SAS the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and t SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the S S is less than 100 feet but 50 feet or more frort]a private water supply well".Method used to determin istance *"This system passes if the well water analysis,performed a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the we is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal t or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attach to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address. 2 Owner: Date of Inspection: /Z ♦?f`M O 4L D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / _ _✓ ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding ffl of euEns• e surface of the ground or surface waters due to an overloaded or � tugged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool All, V1 .quid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow Required'pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Hof times pumped ✓Any portion.of.the SAS,cesspool or privy is below high ground water.elevation. ,1Q_�/Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface iwater supply. i/� y portion of a cesspool or privy is within a Zone 1 of a public well. — -_,/Any portion of a cesspool or privy is within 50 feet of a private water supply well. ' 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 nitrogenand 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.] .t (Yes/No)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. Large Systems: To considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must in ' to either"yes"or"no"to each of the following: (The following cri a apply to large systems in addition to the criteria above) yes no — _ the system is within 400 fee a surface drinking water supply the system is within 200 feet of a tribu . o a surface drinking water supply the system is located in a nitrogen sensitive area Q. . Wellhead Protection Area—IWPA)or a mapped Zone II of a-public water supply well Q If you have answered"yes"to any question in Section E the system is conside a significant threat, or answered "yes"in Section D above the large system has failed.The owner or operator of any a system considered a significant threat under Section E or failed under Section D shall upgrade the system in ac ance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: t2w,4444"A Owner: 4 Date of Inspection: Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the-b" occupant,or Board of Health _ V Were any of the system components pumped out in the previous two weeks? V Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to.the system recently or as part of this inspection? _✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yeo Exis ' g 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)[319 CMR 15.302(3)(b)] Q� �M«/�� ®"�y��y/��y�gu!/ �5�J Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: jel4l Owner: G Date of Inspection: /Z - !� CJ� N� LOBS ONDITIONS RESIDENTIAL ,�y/U Number of bedrooms(design): '7— Number of bedrooms(actual): Z �\ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Q Number of current residents: 2— , / v Does residence have'a garbage grinder(yes or no): D \ Is laundry on a separate sewage system(}'e' or no): / [if yes separate inspection required] "`��uundry system inspected(yeas pr no): N/� Seasonal use: (yes of no): AP Water meter readings,if avai ble(last 2 years usage(gpd)): 2019,35/—on- V),64 Sump pump(yes or no):_ ,✓ G�+=�at/ZDD¢ 9/��qc 33� Last date of occupancy: CU�PK�/ ¢?/✓ 211-17 COMMERCIAL/INDUSTRIAL Type of establishment:. t Design flow(based o d Dn 310 CMR 15.203)• �/ Ex'��i� Basis of design flow; :_©. �� Grease trap present(yes or no): ' =�D6P/f it Q?D[�'s G3 SG �f/04� �]= 78 6PP V Industrial waste holding tank esent(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): 440 ���'G 3'�' 700 Water meter readings,if available: Last date of occupancy/use: Gv/� D p ,ail/, ZZoGp - i9'/�P� - �PiJ) = 6l/ od�/6.✓� OTHER(describe), cd INFORMATION Pumping Record O iGrt/ r �Zz� —7/6Pv Source of information: dAlx 7L Al *v 2cr 7— Was system pumped as part of the inspection(yes or6y_ If yes,volume pumped: Af4 gallons--How was quantity pumped determined? 4114 Reason for pumping: �1��� �/AZP/� TYP SYSTEM � Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy`of the current operation and maintenance contract(to be obtained from system'owner) Tight tank _Attach a copy of the DEP approval V Other(describe): A proximate age of all components, date installed(if known)and source of information: �C�li►�.T- 9G-S-�3 4A7- rA C'o�� ,�y//-/-9..4 6 <W7',y�92t XJ Were sewage odors detected when arriving at the site(yes or no):�b 6 I Page 7 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: t/Fff Date of Inspection: 12- (gFL9� D¢ I BUILDING SEWER(locate on site plan) Depth below grade: v � GLt11ry dyT(S� !7,¢gpt w/�✓c ems' Materials of construction:_ ast iron ✓40 PVC_other(explain Distance from private water supply well or suction line: 9�Z,fr/l�Er Comments(on condition of joints,venting' dence of leakage,etc.): 6oa0> 45�vgcTla4/ 4-a" SEPTIC TANK:_(locate on site plan?? d/•N- Depth below grade.: Material of construction. �oncrete metal_fiberglass_polyethylene _other(explain) &f O If ?.oaf-c tank is metal list�age:V Is age confirmed by a Certificate of Compliance(yes or no)�ly (attach a copy of certificate) Dimensions:<ly-6 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: - GK Distance from top of scum to top of outlet tee or baffle: ,3 rr Distance from bottom of scum to bottom of outlet tee or baffle: !!o y How were dimensions determined: � O y'' �,✓�r J��oA/ ,BeH Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet�nvert,evidence of.leakage,etc.): , <Z) /rt26?- �CcS?4 ;/��9/5/ //.h 20 �Ba�ll4r /�c�l•�d /1/f. •c/tg(K�IJ 3�c¢"o/ / ou��e 7�i✓�G/•v�Gtaowvita/� a4ven s. icvYa-�u H•✓?�y4/ ri4c!Z /1�Sl e� k �,�U2ilk 9r o�Tc " ov O 0c �f2v c e GREASE TRAP:_(locate on site plan) �1 w r ci�306 7�6A✓K Depth below grade:2 ����0� Material of construction: 'V concrete_metal_fiberglass_polyethylene_other (explain): //?D lDOD 64L Dimensions: 411"Ureawf Eff OE,ma O" 3 Scum thickness: o v�y /'✓ L/e�u��/�i/ ' Distance from top of scum to top of outlet tee or baffle: 0,,Vzc—t ✓or Distance from bottom of scum to bottom of outlet tee or baffle: 'P'Ar T Nam' Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integn ,, liquid levels as related to outlet invert, evidence of leakage,etc.):4•T!^� `"C��� / T "�pot ' t/v 5` 12 04rFcf- iv"f%tuwt Od o/-7941t S icu Jcu�/F� ,��A»t,0FFr70,yC �QE2oM,s�.v/J Alif Oda eav f�/�/[ffT�•H- FE/lE c`�l /3Y. ire 7 f Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYST EM INFORMATION(continued) Property Address: /3Z Owner: /dd�f Date of Inspection: '/TI T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below Material of construction: oncrete metal fiberglass_polyethylene other(explain): .. ., .. .. .. m - .. .. r. .�., •may` .. Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): rVc DISTRIBUTION BOX: (" if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: r/e2rn1 � Comments(note if box is level and distri ution to outlets equa,any evidence of soliarryov,�r,,any evidence of y leakage into or out of box,etc.)WZ,4/9 �l� ef�j �7vot��2v v`✓J7�oj/dy U/.6�Za -f,3�c?-8 �•�a� a2 , ( rrYf Grits aDAL.--A—A, � PUM ER: (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 pump purtenances,etc.): u r 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: -o"e/ r Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: X�'V Z—'PG_ �Cl✓9Ct� * 4—S4 Type leaching pits,number: leaching chambers,number: leaching galleries,number: a � �ching trenches,number, length: i �i�; f� �� leaching fields,number,dimensions: EFfDAU S7o �D 7¢/ 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.): 'yTr /�/ CESS S: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or.no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,con i ' of vegetation,etc.): N1 PRIVY: to on site plan) Materials of construction: Dimensions: ' :Depth of solids: Comments(note condition of soil,signs of hydraulic failure, of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address 14,71 X /32 ygt/NrS . Owner: K Ti�YI/oUGH Date of Inspections �✓ SKETCH OF SEWAGE DISPOSAL SYSTEM S Provide a sketch of the eyy' a disposal sy tem including t' s to at least two permanent reference landmarks or benchmarks. Locate al� �within eet. Locate where public water supply enters the building. S��T/�. Ti✓�t 1--1Z0rr6)4 -Z IoS.S /�-2 4S• 7� r0�� t G a t A4-/F OT �ow � Ap w _ Vr4l 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #1/¢71 Owner: _aG+_w! Date of Inspection: / /7 f o¢ SITE EXAM Slope 4i� Surface water A� l, Dxirlf G<x�s� �� . 77' Check cellar mA-y Shallow wells AP^ ' 1,✓,g4r,,f > /5_`� Ta S-¢s �7a`✓.�/'P''� Z 7a BdicO�tiG�� Estimated depth to ground water feet� L�FG� g�y� -,r� �� ����«�a,✓ Please inddii a(check)all methods used to determine the high ground water elevation: �'O tamed from system design plans on ec �Icked,date of design plan reviewed: Y gn PO erved site(abutting property/o get of SAS) / 32o�pR�!>�/L�y��u71f Si06, Checked with local Board of Health-explain: 2=A 7-z' Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: e how ou tabli hed the hi h round water elevation: You ust de b y g i/-3o- 9-$-- 'A6 Awl �iSER �.t /yam ip) L��`r Zlab 11 I 19230 deter �je,adin,g, Review , , , , , Batcn Lvumoer From Date. Gruber Rosalind Status . . . . /S�r:ical Number. Service Address . 1M,9.6 1471 Iyannough Rd/Rte 132 Meter Position 1 Account ID . . . Work Order . . . 0 Read Mtr Meter UM R R E S Account P Date Pos Reading Consumption CS S T R T ID _ 11 22 04 1 1267 9,100 FC 1 N 1 0O15 4476 10/26/04 1 1176 10, 900 FC 1 N 1 00150476 09/28/04 1 1067 22 , 600 FC 1 N 1 00150476 _ 08/26/04 1 841 20,100 FC 1 N 1 00150476 _ 07/28/04 1 640 19,800 FC 1 N 1 00150476 06/28/04 1 442 23,400 FC 1 N 1 00150476 05/25/04 1 208 14,300 FC 1 N 1 00150476 _ 04/28/04 1 65 6,500 FC 1 0 1 00150476 04/14/04 1 0 0 FC 6 1 0 1 00150476 04/14/04 1 17865 9,500 FC 6 4 0 1 00150476 _ 03/26/04 1 17770 19,000 FC 1 N 1 00150476 02/24/04 1 17580 17 ,000 FC 1 N 1 00150476 OF,t,:, 1=,Pea4s. 6=Text, ,F,4=p,tl,s, ,F,8=D,a,te, Sect F12=Display, Toggle, F24=fore , 1 , x ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPAIrrMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 Irr 7y TRUDY COXE S -3 ® 14 H 0 a Secretary ARGEO PAUL CELLUCCI X 7 ape d DAVID B. STRURS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Iq-71 k-HE I3Z A c,zkI F Property Address: P-41f�J40100 MOtCL Name of Owner cZf4�vl< MC t)ONOU6 Address of Owner: el ph C, Date of Inspection: Jr 1 I-1 I IgQcl m t Nam e of Inspector:(Please Print) J ose le� M • I VI A-2TlNS I am a DEP proved system ins or pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: C -e iC Mailing Address: t d✓ D (l. , • ,DP el o LS /M 4 t)Z 6&D Tdephone Number: — SVf 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: V g-jrz�/4S l-�,/Passes S P e to S Conditionally Passes Needs Further Eval tion By the Local Approving Authority Se p loq le91's,bmit Inspector's Signature Date: The System Inspector 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 toll system owner.and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS Co;t f Q f.t.f d do a JUL 9 1999 6 g revised 9/2/98 Page Iof11 8 for Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel .OM1ner: McDonough Date of Inspection: 5/17/1999 INSPECTION SUMMARY: Check A, B, C, " D: A. SYSTEM PASSES: v/ I have not found any information which indicates that any of the failure conditions described in 310 CMR 155.3,03 exist. Any failure criteria not evaluated are indicated below. COMMENTS: _ Yt /` T L,Pct c G, oI Moe -PT _S&2 ViF 2 ovm s 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. 1-ndicate yes, no, or not determined(Y,N, or ND). Describe basis of determination i i�`nstances. If "not determined",explain why not. _ The septic tank is metal,unless the owner or operator has ided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was i ad within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is cracke tructurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass i action if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. h _ Sewage backup or eakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a br n,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 pumpingYnore than four times a year-due to broken or obstructed pipe(s). The system wilfpasi— i Inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 _c r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Owner: McDonough Date of Inspection: 5/17/1999 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)lb)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVJBONMEIILT: _ 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. 21 31 //// //Zl //3J 2111 1?/3,21 Y q �cbrrr s Goes 74D a /s vo J S-6o r is 7-t9 7Vk F/?fit �-Qr-e 0 x ` GRdY1 u�� old s-y �" Cd tile n/!Pc 7t Ct 3 p 1pe /•Pjqc � in ear-6 �/lY �✓Pr�lt;h•�/ S'�Pi ��s � 1�P�N�� P��P C �iGiy►') +3Pr% F2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH LAND 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 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system'has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER � y v isv 4-�_ 1 N S pez 7-70A1 -1-7-0 s o t- o ff-(cj k G 2 au n d vu Inc¢". -P i sn97vc e F01,J 9 Na 7'�"U Fo 2 i2 i Po/2 PvS r3 pnl t, . revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 1471 Rte. 132, Hyannis;Rainbow Motel Property Address: McDonough Own": 5/17/1999 Date of Inspection: D. SYSTEM FAILS: Yow m st 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 / _Y Backup of sewage into 4acili4uer system component-duelo an overloaded orclogged SAS orcesspool. 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 pipelsl• / Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. See P61146-p ! I , h Any portion of a cesspool or Orivy is within 100 feet of a surface water supply or tributary to a surface water supply. f� Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface ' ing water supply the system is-within 200 fe --a-tributary-to-a surfaoo-drinking-water supply the system is to ed in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water sup well) The owner or operat f any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Dep ment for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Owner: McDonough Date of Inspection: 5/17/1499 BUILDING SEWER: (Locate on site plan) F12o(V-r Ltd W E P Depth below grade: Material of construction:_cast iron_40 PVC_other lexplain) Distance from private water supply well or suction line Ld� Diameter ' Comments:(condition of joints, venting, evidence of leakage,-etc.) 1�OT oBS['Qued )A ;ad S 02 0yJ C{RAC SEPTIC TANK: yI (locate on site plan) ^,� n�� Depth below grade:C4,1 meM CdW6 A Material of construction: 1166ncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is[petal,list age_ Js.tge-confirmed by Certificate of Compliance_(Yes/No) Dimensions: S t L— Ap p 3o 0_ o g�e lan Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0�z r1 to Distance from top of scum to top of outlet tee or baffle: ? 11 Distance from bottom of scum to:bottom of outl t tee or baffle: / How dimensions were determined: S IUo(?Q J Up[)Q 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.) S PyL e L if U 1 Q 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 pumpi , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, revised 9/2/98 Page 7of11 . f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Owne" McDonough Date of Inspection: 5/17/1999 q �j BUILDING SEWER: �W�/` 2 T �� JSOO J (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) A,�0 06SEX12 o /Ai w411s QK j&ec.oro SEPTIC TANK:_ 4Qluc/e sM ALL 4t 3/ �J 2- / (locate on site plan) Depth below grade: �e- Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(natal,list age_ Js.age.confirmed-by Certificate of Compliance_(Yes/No) D^mensions: �!J I�' RPJ0 1 S0 o 6a Hd o Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1 /1 V.? f'✓l4:�h -7 /l Distance from top of scum to top of outlet tee or baffle: n// Distance from bottom of scum to bottom of ou et tee or baffle: `7 How dimensions were determined: lr'A S71t'I� S/UdyPJUc;/9� Comments: (recommendation for pumping,condition of inlet and outlet tee or•bafiles, depth f i uid level in relation to outlet i let, structur tegrity, evidence f lea age,etc.! r 6 U �� V 1�" U a. a a ^ GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explam Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffl Distance from bottom of scum to bottom of o ee or baffle: Date of last pumping: Comments: (recommendation for mping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of lea e,etc.) --------------------------------------------- 13 revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Ownef: McDonough Date of Inspection: 5/17/1999 BUILDING SEWER: (Locate on site plan) n Depth below grade:A10) 2'3 ' Material of construction: Vcast iron_40 PVC_other(explain) Distance from private water supply well or suction line N 10 Diameter Comments: (condition of joints,venting,evidence of ieakage,-etc.) SEPTIC TANK:_ (locate on site plan) DQW`v _ t Depth below grade: Material of construction:�oncrete_metal_Fiberglass _Polyethylene_otherlexplainl If tank is fnetal,list age_ Is.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: 3 000 6a i'vY1 �Oel2 Pia Sludge depth: h Distance from top of sI dge to bottom of outlet tee or baffle: Scum thickness: 11 Distance from top of scum to top of outlet tee or baffle:_ I 7 If Distance from bottom of scum to bottom of utle tee or baffle: —7 LvQGle Vd How dimensions were determined: f C(L/ s ,f ,�J' Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, epth of liquid level in relation to outlet invert, structural integrity, TO e©enc of eaka e,etc.) w �� t _tVl 11)7 • 4 n - Fv� Q�Q O,c Pa ccs� . L lQ�i� GREASE TRAP: 44PVQl /S 53 r•. (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 be Date of last pumping: Comments: (recommendation for pumpin ndition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,at revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Own"` McDonough Date of Inspection: 5/17/1999 BUILDING SEWER: (Locate on site plan) Depth below grade: 2-- Material of construction: ✓cast iron_40 PVC_other(explain) Distance fro 9;vote water supply well or suction line Diameter Comma ts:(condition of joints,venting,evidence of leakage,-etc.) SEPTIC TANK OF (locate on site plan) Depth below grader 2 / Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is trnetal,list age_ Is.age-confirm ed by Certificate of Compliance_(Yes/No) Dimensions: "00 I/ 1S0 0 0,42 2aejo 6a I/0-V Sludge depth: — rr ll Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness:_ it Distance from top of scum to top of outlet tee or baffle:_ 1711 Distance from bottom of scum to bottom of out[ t tee or baffle: How dimensions were determined: .0 / G s'L uoyPJ V451 Comments: (recommendation for pumping,pondition of inlet and outlet tees or•baffles, depth of liquid leve in►el ion to outlet invert, structureE ntegrity, evidence f leakage,etc.) U PCO P pVio I &Zli lnilt0o-77 GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explainl Dimensions: Scum thickness: Distance from top of s21elffleeee or baffle: Distance from bottom outlet r baffle:Date of last pumping: Comments: (recommendation for pinlet and outlet tees or baffles, depth of liquid level in relation to outletinvert,structural integrity, evidence of leakage,e revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1471 Rte. 132, HyanniSS,fdWVfj TION(continued) Property Address: McDonough Owner: 5/17/1999 Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working or as_ No_ Date of previous pumping: Comments: (condition of inlet to ndition of alarm and float switches,etc.) DISTRIBUTION BOX:_ SErZ1/C� �vrnp CI��y/n�C� (locate on site plan) 1 Depth of liquid level above outlet invert:�— O ullP1F i,oVPrA" Comments: (note-if level and distribution is equal, evidence of solids carryover, evidenc of le kage into or out of box, etc.) - + r' L/17� PP� /-e f Pe. ot, Ph<P o a C So r rr ►vPr• 7Yl/ v Tl S' vPC( /pvpil•P.-r/u PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Z17• Comments: (note condition of pump c amber,condition of pumps and rt appu nances,etc.) 19 S s m • v cf eVCl, h B •72, C C r v4 v S vP r .2P P'1 tV1,2 -- P iN 7-0r V0 V, 7 PS '&1Wb rr C CP LS—. a 40'r G60 Cc),yS o/ ,?p Vwr A, 6e C l PC 1CPq1 c,. 14:2zrcl) /rm'CA sys� �d�nPc1�' fv fhis c h��r��-n �v �x+��/� ��y nvP�- /o�.✓. revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 1471 Rte. 132, Hyannis;Rainbow Motel Date of Inspection: McDonough 5/17/1999 SOIL ABSORPTION SYSTEM(SAS): ✓ DL c o 1,u&—X IT (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: � leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ 3, leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition o soil, signs of hydraulic failure level of ponding, damp soil c nd'tion of vegetat')n, etc.) ,� P tout/ D E �c E/v C-3 GGl/vV G,+?�r� it — C. bJ a ,I dA- 14 VP✓ d s P /haX h�S h �,pv✓r,�wafPv, CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cessp Materials of con ction: Indication o roundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,.condition of•vegetation, etc.) PRIVY:_ (locate on site plan) Materjals of construction_ : Dimensions: Depth of solids: Comments: (note condition of oil,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: 1471 Rte. 132, Hyannis;Rainbow Motel Owner: Date of Inspection: McDonough 5/17/1999 SOIL,ABSORPTION SYSTEM(SAS):— (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type � /�pP ©� 7 X 6 leaching pits, number: leaching chambers,number:_leaching galleries,number:_ tf - C/f osev- 71V /pd r //�� /i I leaching trenches,number,length: Cf e b e /P 8,,Tj� _ lJ� or( •� leaching fields, number, dimensions: CJ overflow cesspool,number:_ Z e/ e �2 (W L� ,�o 1o" Alternative system: �' 0 Name of Technology: — 9 f 2 3 /0 ;� �i J Comments: Inote c ndition of soil, signs of hydraulic failur ,level of pondm damp soil, condition of vegetation, etc.) / aNp_�r� o, C/ 6'ler /_Pv' c S /� L Jhc v K• AM in 13 4WI(mPel /02�joPry G1ile'�. /ci'vi CESSPOOLS: 79Ir 6 " &60,V //)%1� �/�Q Sd�'1P �rlcrtr (locate on site plan) Sf►'1.PS I"�Sc�� nGr O� T C IPq'-, pf t�wP VP/ SO Ic /; 6 d✓{ JJdG�� �o/ sNumber and configuration: �l�gv1 . S/ dY , wj," 1 Depth-top of liquid to inlet invert: mUG lud LIP Ro r Yl al j3/-ICk, Depth of solids layer:Depth of scum layer: 60 T# LPCxCA / 9 r5 rf2-e / /'' Dimensions of cesspool: Materials of construction: t4SJ/IifGP��G� htsh 5'/7i(/,i1�Gf/y ✓- Indication of groundwater: car inflow (cesspool must be pumped as part of inspection) S� / ��. �� �� -��� o Comments: (note condition of soil, signs of hydraulic failure,.level of ponding,condition of•vegetation, etc.) PRIVY.•_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) V revised 9/2/98 Page 9ofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Owner: Date of Inspection: McDonough 5/17/1999 SOIL ABSORPTION SYSTEM ISAS1— (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:-471�--69 leaching trenches,number,length: _ leaching fields, number, dimensions: P overflow cesspool,number:_ Lj//'0r/ _ LLB S h J Alternative system: 1 V� 1Name of Technology: V -o / 6 Q , ,&770'X4 Comments: (note condition ppf soil, signs of hydraulic failur r level f ponding, damp soil, condition of vegetation, etc.) Ala y� Cc V 7�' ✓ S lJ /� Cy /✓ S CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be ped as part of inspection) 4 Comments: (note con ' on of soil,.signs of hydraulic failure,level of ponding,condition of-vegetation, etc.) PRIVY:_ (locate on site plan) Materjals 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 9of11 I - , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: OWE: 1471 Rte. 132, Hyannis;Rainbow Motel Date of Inspection: McDonough 5/17/1999 SOIL ABSORPTION SYSTEM(SAS):_ /7 N J (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type � y /X (� leaching pits, number: leaching chambers,number:_ leaching galleries,number:_ I/ �` / �7� leaching trenches,number, length: 2e G(P / CJ (� .6.6 r I leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Q/t Name of Technology: Comments: Inoye condition A soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc ) / Cv�81� GSEgoFlD. aAI c ,EAU- IV 42aEic1� 2-dT G�'�(�' CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Mlaterials of construction: Indication of groundwater: inflow (cesspool must pumped as part of inspection) - o Comments (note condition of soil,signs of hydraulic failure,level of ponding, condition of.vegetation, etc.) PRIVY:._ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level o ndi�conitionof vegetation;etc.) revised 9/2/98 Page 9 ortl I1�lJ)i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1471 Rte. 132, Hyannis;Rainbow Motel Owner: McDonough Date of Inspection` 5/17/1999 SKETCH OF SEWAGE 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) �LL Dt�fi�� +N FEFT' A 17 C(OMA'WED N� cA-KIf a�sl D t2�•� .15 R =.P.3 c4f lmlu" ,o ' �oM G N o .RDonr /V 5` RqL= yl NL-= 63 �0 _� NM= 6� Mc. :r OP s k= it, b Po tj b U x = 36t Wx _. 37 REM idi►v6 L revised 9/2/98 Page 10of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1471 Rte. 132, Hyannis$K§UM FOMATION(continued) Pi.op"Y Address: McDonough Owner: 5/17/1999 Date of Inspection: NRCS Report name 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 = /A/ PO)ZLW7 A2 ff/G1 ��'d�NOfN/l 1L Estimated Depth to Groundwater_Feet L jd � � GPI 3 9 /"V Please indicate all the methods used to determine High Groundwater Groundwater Elevation: f/Obtained from Design Plans on record X'o e,-p/)C'2 LI Observed Site JAbutting property, observation hole, basement sump etc.) /417N J jO R!N 6 MJ67(- /Determined from local conditions T S 7-67 y Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data G 15 A4 S -TOLL)J D 66(&S746(C Describe how you established the High Groundwater Elevation. (Must be completed) 3, RIFT E-.tEv&?-1 Aj z p vs 7Tff -/9 9 &W d'l? ENE C A G9CfWe r� -s- a .rrs S. ��.s l p J -�y , .s- p _ 3. 9 revised 9/2/98 Page 11 of 11 i II Permit Number: Date: Computed w: HIGH GROUND-WATER LEVEL CObIPUTATION Liz No. 0...- I?UVS Address: Contractor: m �/Lr/�S Address: Nctes: STEP 1 Measure depth to water table � a ; tonearest 1/10 ft. .............................................................................. Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: W OAppropriate index well.................................................... �o�y Water-level range zone ..................................................... I II i STEP 3 Using monthly report "Current I Water Resources Conditions" 7 determine current depth to water level for index well ........................... mon h/year I I, STEP 4 Using Table of Water-level Adjustments I for index well (STEP 2A), current depth to water level for index well (STEP 3), j and water-level zone (STEP 2B) determine water-level adjustment ....................................................:..................................... ' 3 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. =lQ- Figure 13.—Reproducible computation form. 1�. T �oo0 0 41 9' ycj t � � � rox TOWN OF BAWnTABLE LOCATION ��" >4� � �" SEW 1E # w VU-LAGER ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 17,712S 6/iZ ��fYG SEPTIC TANK CAPACITY L /. O a / G,P2xdSc %g�l� LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUU-DER OR OWNER �,/Z/� /I/(�(� � ,� 46 PERMITDATE: COMPLIANCE DATE: ! Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 pf tMF> DATE: FEE: lARNSPABLR � 1dA89. � 1679• `0� REC. BY ArED fAA't e, Town of Barnstable �SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R-S. FAX 508-790-6304 Sumner Kaufman,Iv1.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 1+7 I -Woy'l: (3'7i OyAt-)tJ I S 1 -kAr Assessor's Map and Parcel Number: 'Z 3 01 Wetlands Within 300 Ft. Yes X Business Name: V A)P 13o O Resc,2T No Subdivision Name: APPLICANT'S NAME: i20GA•L t3Q LiRLLBrz(L Phone C4o1) 44+- 63� Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: 90SAL,100 Z�90621Z? Name:"TI?I s 0,cu_en - O�U-e2 r A;5-m • ' I 3z74i� Address: 77q GIzkcl( ,E l 1op,_-2 "rEY�. ,N Tt�Roll.�L Address: 41,7 aq-r�-�/i U.E, PA Oz(o3?/ Phone: C 4 7) 44¢-(:;3 L Phone: &saS)T73- 07 35 VARIANCE FROM REGULATION oast Reg.) REASON FOR VARIANCE(May attach if more space needed) owl �t2AS'rR•glG - (�R#"_1�1 fSEG 1�,� . 14 SIZIF- L�e 310 cMR i5,zs� z Cad ram ATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System 1 hecklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's.expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same bwner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED - Sumner Kaufman,M.S.P.1L REASON FOR DISAPPROVAL Wayne A Miller,MD. ° Q:\HEALTH\Application Forms\VARZREQ-DOC i Weller & Associates Bayberry Square -- Suite 4C 1645 Falmouth Rd. -- P.O. Box 417 Centerville, MA 02632-0417 Town of Barnstable Board of Health 200 Main St. Hyannis, MA 02601 Re: Rainbow Resort Motel, 1471 Route 132, Hyannis, MA Assessors Map 253 Parcel 014 Dear Board Members: We are seeking two (2) variances, one from 310 CMR 15.255(2)(a) and one from Town of Barnstable Health Regulations — Part VIII, Section 15.00. This property is located within Area of Concern CE-4. There is presently being designed an extension to the town sewer system that would be made available to this property, therefore a full upgrade of this site to meet current regulations would be unjust as the system would be abandoned within the next few years. Very truly yours, Tristram M. Weller Fax: (508)775-0754 Phone(508)775-0735 Town of Barnstable ' Department of Public Works ,�xer,►us, � P Engineering Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4088 Fax: 508-862-4711 Robert A. Burgmann Town Engineer Mr. William G. Weller Weller& Associates P O Box 417 Centerville, MA 02632 RE: Rainbow Motel, 1471 Iyannough Road, Route 132 Hyannis, MA Map 253 Parcel 14HY Dear Mr. Weller: This letter is being written in response to your question of connection the above referenced property to town sewer. There presently is no sewer in the vicinity of the property. The closest gravity sewer is located at the intersection of Bearses Way and Route 132. The Rainbow Motel property was identified as one of the properties abutting the lake that needed to be sewered. It is designated as being in Area of Concern CE-4. The preliminary design of the sewers to serve CE-4 is presently underway. It is anticipated that construction will be beginning on those sewers within the next several years. Rather than look at a very involved and expensive pumping system to connect the property to the gravity sewer at Bearses Way, which will have to be abandoned when the sewer system around the lake is completed, I strongly suggest that you seek some less expensive interim repairs to the existing on-site system. Unfortunately, I cannot provide you with a more definitive schedule for the availability of town sewer at the property. Feel free to contact me from time to time for schedule updates. Very truly yours, R e A. Bur , P.E. 0 Enginee i L OGU$ LtSS�sS cS�S �{ -753 fq A,F ?kaccl. 18-3 gig IS (fir-`- ZePr--T-( 112Js-F e�43 rl,v Z�3 4— DR-. HA uN � G2-1 -�jrrj 4000q, FL- MAP 33� 8 3 9,153 V`PfV-W--L, 13 817 oc 0 s(tz F u_ s 021.32-- C4E�,LLIE�� 0Z�3v 113 0-2, 3�- Pi k 5z5 o s. ozJiuLZi �1 UzcSS TZO FSA �3t , Nl� 07k 3 o wook p N) ''t OZS G� f "DAJ LY2 CAS SRPO-LOLO �� Ca4�0 I A l'� �-► s p� w ban t JJL -- e,40 +� :Lug TAM AK LL 00 81 Co N'oOT7� INS L— ��� 'FAU NI�I.ISSf� � 1--7 88 Ce*P-16fLO►L-k-�, C`q(Gex.E A*V3p�2Sv.�S CA `(�q,2so�s o&� sew U- V�? 81? ow (o+3 1 F, ��T�21,���� � ►M� 02� 3�— Cam'T�2�►w�, �l,P�- O�.to��-- l l M bps o M o� CA URIC �,v�Zl-►�ti T a�, r�� ���0 3 CT- 06 0 33 G��eCzJtU.-� , M.� OZlo3Z ���I�CtG ; s-(�4�o►J �t�� ZA4 P2C�, r-H 6AL)UT w 000 U.A pry 61(. 0L.K2 s aO-V-7 Chu, PO moo ► , c- UfsIT g �- rwiL.A c/ rAk oZb3 Z sA � TLCssa.t� '� Cow b 8(� 61.V) (+IIJ._ tut 01r environmental � moo* operating mammals Monosson *Iut@oif s 5®asaa00a June 15,2004 Mr.Paul Drake Rainbow Motel 1471 Route 132 14yannis,MA 02601 HAM SASTNK System Agreement Client site Rainbow Motel 1471 Route 132 Hyannis,MA 02601 BAM SASTN System Description EOS agrees to install one BAM SASTM(Bacterial Augmentation Mechanism for Soil Absorption System)at the above location in the configuration outlined below. Treatment Location Controller configuration 2 Leaching Pit Sub-surface basin Septic Tank 2 Surface container The BAM SASTM installation is intended to improve the functionality of the client's failing soil absorption system through the addition of air and a specific suite of bacteria, introduced directly to the soil absorption system. The system will consist of two components;a BAM unit and the EOS Controller. The BAM unit will be placed within the treatment location specified above via the addition of a cylindrical riser. The EOS controller,which delivers air and bacteria to the BAM unit will be placed in the either in a sub-surface basis or in a surface container(as described above). The EOS Controller will be locked shut and is only to be serviced by a certified technician. The installed price for this system is$8,000 We recommend redirecting the flow from the existing 1,500 gallon septic tank to the pump chamber. The soil absorption system near the shallow pond will be eliminated through this flow redirection, The BAM SASTM can be installed immediately and flow from the 1,500 gallon tank can be redirected at any time. 15 Carlson Lane,Falmouth,MA 02540 • Phone: 508-495-3300 • Fax 508495-3353 Initial Installation Environmental Operating Solutions(EOS)will be responsible for the following items related to the initial installation of the BAM-SASTM system: 1. A representative from EOS will meet with the client,if required,at the installation location to review the layout of the system and scope of the work"involved, including the proposed physical placement of BAM unit and EOS Controller. 2. Client will be required to supply a I I OV power source from which installer can run power the EOS Controller. A dedicated,outdoor,GFI outlet will be sufficient. 3. EOS representatives will install all system components and perform initial `system startup. 2.5 gallons of bacteria will be supplied at the initial installation(approximately 3- 4 month supply). 4. EOS representatives will review the functioning system with the client either directly following the initial installation.or at another time convenient to the client and EOS. At the time of this meeting,operating procedures for the BAM-SASTM unit(s) will be explained to the client. 5. EOS representatives will return to the site and provide a two-week and/or one-month system check. Continued Operation Environmental Operating Solutions will maintain the BAM-SASTM unit by returning to the site periodically(approximately every quarter)for the duration of the rejuvenation effort and afterwards to be determined by EOS or.the customer's discretion and perform the following activities: 1. Check all system components to ensure proper system operation 2. Observe system performance and take samples/measurements 3. Replenish bacteria as needed(bacteria replenishment charged at$1.50 per gallon) Continued operation service will be performed by Environmental Operating Solutions. Payment Terms The services listed above will be billed to the client in one payment upon delivery. Once installation is complete,a payment of$8,000 will be made to Environmental Operating Solutions. The cost of bacteria replenishment will be billed as delivery takes place. This Agreement will be null and void if a signed response is not received within thirty(30) days. r t - ' Frequently Asked Questions (continued) Gnvironmental ,: environmental � 0o - � Now is this system better than other Operating 000600 peratin.g 00 ® � � treatments available today? ®0 a a a Other treatments, including pressure cleaning Solutions ® � come oluogs ` ° and additives,provide temporary relief. BAM ' SAST"' provides long-term system rejuvenation For more information,contact: and extends the life of the system. A f Does the biological process produce any Environmental Operating Solutions,Inc. ' • natural pCOCeSS 1 OC harmful residual products? 15 Carlson Lane I'e J uvf i n ati n your #ai[1 i n i The residual products of the biological Falmouth.MA 02540 degradation process are harmless carbon Phone:(509)495.3300 septic system dioxide expelled into the atmosphere and Website: www.easenvironment:tl.eom water which leaches out into the surrounding i sails. 4 i What will f see in my backyard? Alt system components can be subsurface. EOS Company Overview a Access covers are visible,but are designed in fi ' natural colors to blend wish the outdoor Environmental Operating Solutions,Inc.is a � environment.- Falmouth, Massachusetts-based company that develops bio-au mentation technologies to How long does`lnsialiation take? P g System installation can be completed by EOS remove-targeted contaminants from various certified technicians in approximately two to six water sources. EOS products can remove hours,depending on site conditions. nitrogen,fats,oil and grease and other contaminants from various water sources Can the unit:be removed once the system including residential and commercial septic i is rejuvenated? systems,ponds, lakes and estuaries. Once the system is rejuvenated,the BAM http:/twww.eosenvironmental.com SAS'"'continues to operate in a preventive mode to prolong the life of the soil absorption system. BAM SASTO,BAM''A and EOS Controliertm are What are the ongoing maintenance trademarks of Environmental Operating requirements? Solutions, Inc. - BAIIA SASTIM EOS certified technicians will visit quarterly to I BAM SAST14 is a patent-pending system replenish bacteria and check system developed by Environmental Operating Solutions, components. Homeowner will only be Inc. responsible for calling technician when indicator Bacterial Augmentation light is illuminated. mechanism for Soil 1 Will this system disturb my landscaping? AbS01'pt10n SyStei1TT$ I Components are small and unobtrusive and installation technicians take care to preserve you lawn, bushes and gardens. - IMF ..< ... - The Problem The Solution Customer Testimonials The most common reason for the failure of a Environmental Operating Solutions has "Our leaching pit was failing and is underneati septic system is a failing soil absorption system, developed BAM SAS'"to cost-effectively our parking lot. We would have had to dig up often known as the leaching pit or leaching field. provide long-term rejuvenation to a faiing soil the parking lot in order to replace the system, absorption system. but now we don't have to.- Failure of the soil absorption system to property Office r, Small Bus., Falmouth,M discharge water into the surrounding soils can BAM SAS*"'(Bacterial Augmentation 8,Agana e cause the septic system to back up and Mechanism for Soil Absorption System) overflow. continuously circulates the contents of the 'The level of water in my leaching pit has leaching component over an engineered media dropped dramatically." A failing soil absorption system is generally while injecting oxygen and the optimal selection Homeowner,Bourne, It caused by excessive build up of a clogging of naturally occurring bacteria specifically layer of organic material that prevents water formulated to digest the organic compounds that from leaching properly. typically clog teaching components. Advantages Homeowner alternatives to restore the system As the clogging biomal layer is broken down . Provides long-term rejuvenation for failing range from the application of chemicals,which through this natural process,water is absorbed soil absorption systems may provide some short-term relief, to by the soils surrounding the leaching component complete excavation and replacement of the and normal functioning of the system is restored. • Circumvents costly excavation and system failing system. replacement Once the failing soil absorption system has been restored,BAM SASTm continues to operate in Limited/no disturbance of existing order to extend the system's tile. landscaping L • Hassle-free operation for homeowner How BAM SASTm Works BAM SASTM in a leaching pit` The BAM SAS TAOhas two components,the Frequently Asked Questioi EOS Controller and the BAM Tv unit. Now fast will!see results? The BAMT1" unit is installed in the leaching The organic material clogging the system has component and distributes oxygen and developed over a period of years. Significant bacteria to degrade the organic material results can be expected within three to six clogging the system. months and many systems have shown resul The EOS Controller regulates the delivery of within the first week of operation. air and bacteria and houses all of the What is the cost of this system? electronic components. The cost of the BAM SASTM is significantly To install the BAM SAS'"',a cylindrical column Continuous Injection of less than the alternative of replacing the is added to gam access to the leaching oxygen and bacteria system. component. The EOS controller can either be biologically degrades the Should!be worried that bacteria Is beln located sub-surface(as pictured)or above the _- clogging biomal layer added to my system? surface in a discreet location. and restores the system No. EOS enhances the natural process ihs '. to normal perlomnanoe takes place in the septic system by adding naturally occurring bacteria. :: , -.i � fM f f i k 4 S# ae ei t aC ♦. i It. •`k {. S� 2 s; ,' .e syste is nten ed``tti saxes nine 14ntel. iuii t� at tiro R rsc ns a ,ar -aid 3 s,desk anted to• a Lilo 900 �a1�:a per day. � T- hlse system p .. t ,£ . 'Will c ►risis�' fly':4 1 '500 ,9a1.on precast reinforced oonaret� poptic .tank; .a .str butt Qn b4x . an d a s r g .a each n fed ah prc vidas P10 .#q-ale fee$ of avail able .l �ahing x +- yy Th5 Division ,of Sanitar Eueoriag .s 4 th�3aapi t j that' the'plan is Jji,aCGardanea th good, ex�ttesring practice and sippriaes`it the • i Z. 3�i ms .:aCld are 1imi•ted t s o a,flov .of 50 g#44 per'day and 5 2 /p•a]lbno per,day xesps Gtive y t, = s•t t�dl:i vi east iron- i :nand c�,rer:at. �_ .11 ov ded pr d f fin.• i ,ovar'th6 inlet"end,,o' .'each.'septic' to 31 �'he R ntii unit motel addition , no eoccupiedUthe-now • _ i a t b tldt sour • �� K u {o grater' s 1 has beer_ approved bl+-.this 0epa�nt. • r +; °' . 30 other changes.•will,be made in.,th® pl,an id thdut'trio. prior, written appr6*A of this' Capartaaent. a s' " '• � •� ;' ', ,i - � ,' � '"'^' •=' �. � � • tE .` + 0nrstru tign, ll, bea in strict accordance �t5.th :the approved.pl 3 4. °sec' ..�• .. ._ �„_ , Y , : ', . •. - :' ". .#:_• ,�,- .,. - �¢ riaGGordanco with .the, provisions of Artials XI of ,thg`Stag Sanitary Cods 2 •i�u ;"a it vM ess'�be r ary is bbtaia a'�Disposal.•Works 'Const•uction Parmik�. from.the i a - - as E- }`, }local Hoard-of Hsaithf }ppg Vhen the $auraa of.water �ipplyris operational and the sposil faci.liiies = 3 - d i, have have .been.ccom .p backfi3lin .this office mot be notified: so'°that� , pofasfjofd Y�ab on pan-be made wa4 4w ' i .L • -k s� r .. i ,z Er►Glosed is s $ a ►pad appr oven cople Qf thQ � . �4 ei�py of a stamped . w approved plan must tie kce�pt`sin tie 'sit, and must be used .for',`aoAstruction '`1Y' ' _ L I *.. .� `1 �k y. ) • 1•'r• 1. ,. purposes ,pgrY truly,iourii �:�! �y "-f4,•r"•"' . d ,� r..'a s... � 'y '� -.. r y`1= h• °'}-as ..-. R .. - ., s• :� ' ,�' k 5'v 7(r',y:E ''' _s , For t he Director-... s� +_ .tt� .a t ..,. ., .•, _ �]wa: k. .a+ s ..r �' `-a� _ .^ {,y �Fssr• t. `• 'a ♦. f.• y1' ''4 } `. t i _ x t .e +' ,''t. �i s isj 'Si• c ~_ 1Y i `'• -}r Y ass'' -i ..( • *i .-. .." k R. 4�./• {'. ✓r ,. # i T "F+" _ a... # . ,,,,, ,i •.". ?, '"•, aUi . ndersom Pf9f.p # ,, f s ( :, n '. 'District Sanitary,ng no-or southp4ot.6rn Health District. ' HOspi.ti&L. (t $ Kiddlsboro3. 2�Bt3$RCh�.lsett8 2346 t s ti + Coxeccc��e ���cce a�C�n�cixanmen�ir����rixa `'c ' ��irzx�men� �C�n�aixanimen�cc� �a�� (�n neexi 41M Sve DAVID STANDLEY 1OOwilm elT/M AJ&W 02202 COMMISSIONER December 6, 1976 Mr. Charles D. . Spohr RE: BARNSTABLE--Subsurface Sewage Consulting Engineer Disposal--Proposed 10 Unit Addition to 45 Fells Road Rainbow Motel, Route 132, Hyannis Falmouth, Massachusetts 02540 Job No. SE 76-095 Gentlemen: The Department of Environmental Quality Engineering, in response to your request, has had one of its engineers examine the soil at the above-noted site and has reviewed a set of plans in two sheets, the first of which is titled: SEWAGE DISPOSAL SYSTEMS ;) FOR PROPOSED 10 UNIT ADDITION RAINBOW MOTEL RTE. 4 132 OLD STRAWBERRY HILL RD. HYANNIS MASS. OWNER MR. FRANK MCDONOUGH DESIGNED: C.D. SPOHR DRAWN: J. B. CHECKED: C. D. S. DATE: 14 JUNE '76 SCALE: AS SHOWN DRAWING NO. 1466 SHEET 1 OF 2 "B" 19 NC•V '76 REVISED PER DEQE TELECON 18 NOV. 176 "A" 5 OC.T '76 REVISED PER DEQE LETTER & PRINTS 27 SEPT.. '76 REVISION DATE DESCRIPTION " Soil examinations conducted at the subject site on May 13, 1976 in the areas proposed for subsurface sewage disposal indicate that the natural soil, beneath loam and subsoil, consists of medium sand and gravel which has a percolation rate of less than two minutes perlinch. Ground water was encountered at an elevation of 100. 9 feet. a -2- .5 The plans propose to dispose of 1400 gallons per day of sewage from the subject project by means of a 2500 gallon concrete septic tank, a 1000 gallon concrete pump chamber equipped with two 50 gallon per minute submersible pumps and two leaching pits with a total available leaching area of 730 square feet. The Department of Environmental Quality Engineering hereby approves the plans with the following provisions: 10 Construction shall be in strict accordance with the approved plans and Title 5 of the Environmental Code and no further changes will be made in the approved plans without the prior written approval of this Department. 20 A Disposal Works Construction Permit must be obtained from the Barnstable Board of Health prior to the start of any construction. 30 Written certification that the disposal facilities have been constructed in accordance with the approved plans and Title 5 of the Environmental Code must be submitted to the Barnstable Board of Health with a copy to this office by your engineering company prior to the system bein'k backfilled. Nothing in this provision is intended to interfere with the right of the Board " of Health to inspect the disposal facilities at.any time during construction. The building shall not be occupied until a Certificate of Compliance is issued by the Barnstable Board of'Health. No environmental assessment form is required to be submitted for this project since it is exempt under the Environmental Protection Regulations of the Executive Office of Environmental Affairs, and the project has therefore been determined to cause no significant damage to -the environment. Enclosed herewith are stamped approved copies of the plans, a copy of which Trust be kept on the site and be used for construction purposes. 1 Very truly yours, I. For the Commissi er L Paul T. Anderson, P. E. Regional Environmental Engineer Southeast Region Lakeville Hospital Lakeville, Massachusetts 02346 • A,/lf/JXC cc: Board of Health Barnstable, Mass Barnstable County Health Department Barnstable County Court House Barnstable, Mass. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.....�� ID L— ........................................................................ Tatifiratr of Tomphaurr I or Repaired TW IS TO CERTIFY, That the Individual Sewage L4posal System. constructed �Lfl Z.5.z.......... ...0�nvt x .................... b,y.................... I aller at.......................................... .......... i..........MID-S .... ...... ................................................... ----------- has been installed in accordance with the provisions of A I c e XI of The State Sanitary Code.as described in the 79 application for Disposal Works Construction Permit No... .. ..... ................... dated -e.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ...................................... Inspector.... ............... ----------- -—---------—----------------- ---------M----------- CHARLES D. SPOHR, PE CONSULTING ENGINEER TEL. 548-0623 REG. PROFESSIONAL ENGINEER_ 45 FELLS ROAD MASS. No. 7468 q FALMOUTH, MASS. 02540 R. I. No. 2146 26 May 1977 ASHRAE Barnstable Board of Health Town Hall Hyannis, Mass. 02601 Attn: Mr. John Kelly Re: Sewage Disposal System Rainbow Motel Rt. #132, Hyannis, Mass. Job #SE 76-095 Dear Mr. Kelly: I have supervised the installation of a new sewage disposal system at the above referenced site. I wish to certify that said system has been installed as shown on our drawings #1466, sheets 1 and 2, revision "C" as approved by D.E.Q.E. and signed by Paul T. Anderson on 3/30/77. Very truly yours, 4, 2+44'� 1 Charles D. S pohr, P.E. CDS:ms cc: Mr. Paul T. Anderson, P.E. Southeastern Health Region Lakeville Hospital Lakeville, Mass. 02346 Mr. Frank McDonough Rainbow Motel Rt. #132 Hyannis, Mass. 02601 • It 4, .4; v& Ij� 17��IT OT 1-M -4 "14T) to OG JEST j 0,� " , ; SYSTEM 42- X MUM 2% SLOPE REQUIREd CYVER ENGINEER: DOUBLE RUN'110"we LEVEL WED, WITNESS: :2# DATE.. TO.-.5/0', ��pnc. RA I E,, 711 WIDE LONG"At q, LOP .005i�s - CRUSHED,-STOW, --2 , 02� �' -1: 1 CLAS SWIL-S 1§0 comp D'a x 1 DOUM WASI. z To I iv, TM '31Z SLOPE) su)FE "'o :r -44, W�,v 17" N7� �Nt:: or �-e-�Ao%0- Of , UNDATION4:--�':� Box -7 FACILITY 6-p- 6011-, W4, 241 4 1 LEACHING' -SSORS ASSF MAO -1-0 0 0 �Z 0 N E:, IL ANG':'ZOO 1��44 1 �.q" �41 Vt.:.;I Al, _�S .7 EMAC Ks Al BOTTOW'OF REAR 3 t,H PLAN REFERENCE: (LA. A7 x PIC 7, :6 fi ':V: I '4 4 V�J 4',M 11 16 14�a e. 4,AiN"NA"'jo- �0 "g,�j'j --2"-MU ICIP� W. 7 AQVATEF� S:: 'U M P GAUL, ITCH, T s f P At' F 'O� A�L E D E!�Id 1`4 bjNG��' PL ECAST!"`U N IT. HO"H J,- " is IVI�";st 7 IF ),t;t�It, 7z PTi .',*rAN K "."ZL��; PIP E,�`JOINTS,`,T AT TP RDA CE, 6 .'CONSTRUCTION: TA4S 4'�To7i - X' I -N��", A. -I i4,�, -,N n, �J I L?L-J. !Xt ,V�%;4,-%�i,, 15 EMARONMENTAL`��,QOE-`.-T It L: -THIS RLM ROPOSED' WORK7,"p Y- TO G BOTtOh*i VAKING �J GP wl-,-�n) CAW— 5. 1; TOI y'sy A �5 vq ENTS��'NOT. BACKFILLED ITHO,UTY--i APO;& )BTAINED --,BY'�BOARC H EALT- H t�,`AN b P INSPEOTIOW j 1". gg PROM BOARD-'�OF,�,`tHEALT!44*.`�,' �jo: I 0 k, !14 -y� 70 R" ".1 `m'o�'T, 6 g T o 'A t Aw 9.1 2'r-p Gf:Np 41 :'W� -�74 I 91 e �i� ? � X 34, 01 iy% -PROPOSED SPOT 'ELEVATION q 'i'A Ni e I'dw/A-t� 0 5�t 9-11-4 01'e EXISTING SPOT. ELEVASION, g�! JI, NA; -vm, 1�4 Y,; -I,'a I,'E-XIS I ING -7r 711. "�&OSED' CONTOUR, t'WWA P1 il "T W, I�Itf 7, 6 M, ��j'S�J-,r J, , . As, La CONTOUR '4. 79� .:���,, �j I'A . 9 T tv 0 4;2, 1k ;4"f, T 7Y IN" BOARD*'OF lilt S� 4, N -MVRovo V DATE PREPAREb x �wI "i io., 'I D) '41 cap. e, enoineer �1 VA.% rig Jn 7 jt NEERS Mr 7. 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J � T PLAN VI L/\I`k , LO AT G ION 1471 RQU-E In II HYANNIS, MA � I' B\ PREPARED FOR: RAIN OW MOTEL I SGA E: DRAWN 15Y: r /C AS NOTED _ TNW i c J0� t�vif�ER: DATE: 5t1�T: �- 03-083 2-Z -- i I , II VVLLi� A�50G I ATD i REGISTERED LAND SURVEYOR DATE 5T - ` REGI ERI D ENGINEER DATE 645 FALMOUT H RP SUITE 40 GENTERVILLE, MA TEL.. (505) 75-0735 FAX (508) 77507 i FILL f = FIRE SLTY SAW 2.5Y8 2 62 = MEDILM TO COARSE SAW 7.5YA/5 WATEL.,