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HomeMy WebLinkAbout0455 PHINNEY'S LANE - Health (2) 455 Phinney's Lane r• Centerville A = 230 100 llll �REcvca� 0 UPC 12534 No.2� 153LOR HASTINGS. MN TOWN OF BARNSTABLE LOCATION ��� J ��� SEWAGE # VILLAGE C Q 11�Pe„�lCe ASSESSOR'S MAP & LOT )-3d-00 INSTALLER'S NAME&PHONE NO. /'/ SEPTIC TANK CAPACITY rerJ tM W (J OV4r f 'w W/eovz LEACHING FACILITY: (type) �3 (size) NO. OF BEDROOMS BUILDER OR OWNER o PERMITDATE: /VJ,4 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by c30` .�7 e 3 ' SEC K eZ. Z SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART A. CERTIFICATION 455 Phirmeys Lane RECEIVE® Property Address:Centerville,Ma Address of Owner: (if dtfferer t) F E B 14 20 02 - Date of Inspection: 7 May 2001 TOWN OF BARNSTABLE Inspected by: James Holler HEALTH DEPT. I am a DEP approved system inspector pursuant to Section 1-5_.340 of Title 5(310 CMR 15.000) Company Name: Holler& Son Construction LLC Mailing Address: P.O. Box 702,Marstons Mills,Ma 02648 Telephone: (508)420-0280 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 syste W. e system: 4Z ' 'IT11117""1i N Passes --- PARCEL , ElConditionally Passes LOT []Needs Further Evaluation by the Local Approving Authority Fails �y Inspectors Signature Date: The system inspector shall su t a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to'the system owner and copies sent to the buyer,if applicable,and the approving authority. INSPECTION SUMMARY: Check A, •B, C, orD: A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: Comments: B) SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board-of Health, will.pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. ❑The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a -Certificate-of Compliance-(attached)indicating that the tank was installed within twenty(20)years prior to tie date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection ifthe existing septic tank is replaced with a confomung septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 B) SYSTEM CONDITIONALLY-PASSES.{.continued) ❑Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes)ordue to a broken,settled or unevendistribution box. The system-will pass inspection if (with approval of the Board of Health). Describe observations: ❑"broken pipe(s)are replaced ❑ obstruction is removed [�distribution box is leveled or replaced ❑The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ❑Cesspool or privy is within 50 feet of 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 APPROPRIATE-)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 to 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 with 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 thatfacility 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 w SUBSURFACE SEWAGE_DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑-I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or Cesspool. ❑ Z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. El 0 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''/z day flow. ❑ ® Required pumping more than 4 times in the last year not due to clogged or obstructed pipe(s). Number of times pumped ❑ ® Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ ® Any portion of a cesspool or privy is with 100 feet of a surface water supply or tributary to a surface -water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Z Any portion of a cesspool or privy is with 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 colifonn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes"or"No" as 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 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 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No ❑ Pumping information was provided by the owner,occupant,or Board of Health. ® ❑ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ® ❑ As built plans have been obtained and examined. Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. I� ❑ The system does not receive non-sanitary or industrial waste flow. ❑ The site was inspected for signs of breakout. IRI ❑ All system components,excluding the Soil Absorption System,have been located on the site. ® ❑ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location or the Soil Absorption System on the site has been determined based on: ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing information,Ex.Plan at BOH. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 5 Numbcr of currcnt residcnts:I Garbage Grinder:Yes Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):N/A Sump pump:No Last date of occupancy:Current COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER:(describe) GENERAL INFORMATION PUMPING RECORDS and source Owner System pumped as part of inspection No Volume pumped: Reason for pumping: TYPE OF SYSTEM Ej Septic tank/distribution box/soil absorption system ❑Single cesspool Z'Overflow cesspool 11 Privy El'Shared system(y/n)(if yes,attach previous inspection records,if any) ❑I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information:Owner,Approx.70 years Sewer odors detected when arriving at the site:No SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of inspection:7 May 2001 BUILDING SEWER (Locate on site plan) Depth below grade 18 inches Material of construction❑Cast Iron❑40 PVC®other Distance from private water supply well or suction linenone Diameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: Sludge depth: Distance from top of sludge to bottom of tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Comments: GREASE TRAP (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leak,etc.) i SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455-Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 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: GPD Alarm level: Alarm working?❑yes❑no Date of previous pumping Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:❑ (locate on site plan) Depth of liquid level above outlet invert: Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,etc.) PUMP CHAMBER:❑ (locate on site plan) Pumps in working order: (yes or no) Alarms in working order:(yes or no) Comments:(note condition of pump chamber,pumps,and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 SOIL ABSORPTION SYSTEM:(SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) if not determined to be present,explain: Type; leaching pits,number leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number:two,approx.650 gallons each Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration:2,primary and overflow Depth-top of liquid to inlet invert:4 inches Depth of solids layer:6 inches Depth of scum layer 2 inches Dimensions of cesspool approx.650 gal Material of construction stacked block Indication of ground water inflow(must be pumped as part of inspection)no Comments:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) bottom of system is greater than 12 feet above lake elevation in rear of property,and high bank to cesspool dimension exceeds 125 feet,soil conditions are excellent for drainage,no hydraulic failures or breakout. PRIVY❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) SUBSURFACE SEWAGKD.LSPOSAI.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. © N I > o�S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 Depth to Groundwater 12+feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ observed from design plans on record ® observation of site(abutting property,observation hole,basement sump) ❑ determine it from local conditions ❑ check with local Board of Health ❑ check FEMA maps ❑ check pumping records ❑ check local excavators,installers ❑ use USGS data Describe in your own works how you established the High Groundwater Elevation..(Must be completed) �pt�1'e� use ` ID CO(1.1-PN-Zlr �01TO11A 1: ''mil® fZ l� (-�16 kJ RTC I� ivL tk►21� C i v ®F 'E AM Vl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. T � 1 ) > > 1 2m� HP OfficeJet Fax Log Report for Personal Printer/Fax/Copier BARNSTABLE HEALTH DEPT 5087906304 Nov-28-01 13:40 Identification Result Paees T Mg Date Time Duration Dia,Mstic 916179268280 OK 02 Sent Nov-28 13:38 00:01:54 002185430020 1.2.0 2.8 I'I I December 12,2001 Bill Copacino 455 Phinneys Lane Centerville,MA 02632 Dear Sir: I recently received a call from David Hajian about possible renovations at your residence,and wanted to inquire about the septic system,and if it could handle the renovations on the property. I was told the property was recently transferred,which would require a septic inspection. We don't have a record of the septic inspection here at the town hall. Inspectors are required to get them into us within 30 days of the inspection. Mr.Hajian faxed me a copy of what he had for the inspection,and it appears from the diagram I received that there may be two single cesspools on the property without septic tanks or distribution boxes,and they are not connected to one another. If this were the case,it would not meet the requirements of Title V,and the Town of Barnstable regulations for subsurface disposal. Do you have the inspector's name that inspected the septic system for the property transfer? Do you have any other information/diagrams regarding the septic system? Any information would be helpful,because as it appears to me,this would be considered a failed system according to my interpretation of the septic system diagram/inspection I received. Thank you for your help. Sincerely, David W.Stanton Health Inspector,Town of Barnstable 200 Main St. Hyannis,Ma 02601 r ' CO0IONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRO.VL RENTAL AFFAI:tS DEPARTMENT OF ENviRoNMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 TRUDY CO' Secret: ARGEO PAUL CELLUCCI DA'VID B.STRU1 Governor Commissim SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION /� p,�� Property Address: °i�S /la�NNfV&LAo-E Name of Owr__KATo L.E r-N M. 9Lft -LzA 21lWLE,M A Address of Owner- Onto of Inspection: • Name of hspector:(Posse ) i am a DEP approvgd ern inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) a5 Company Name: 1 i� Mailing Address: .-A(=>fEAN IS MWJ b "PVP.a-I +a, MIR Telephone Number.•7Z I - 1_ZA SOT 59t ri- °Mc 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 h�.sed on my training and experience in tha proper function and maintenance of on-s-iteessewage disposal systems. The system: V Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspectors Signature: Date: The System Inspector eHall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)with)n 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 owne shall submit the report to the appropriate regional office of the Department of'Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. w, NOTES AND COMMENTS 33 1 revised 9/2/98 Paget orll a~ 4+Printed on Recyded Papa SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIICATION(continuedi Property Address: f/, ' /iiisd s LA�Ii�� �.r/f�.ICL�GL L� AV4 . Owner: Data of Inspection: 9/Q�d9d INSPECTION SUMMARY. Check A, B, C, or a. A. SYSTEM PASSES: r�I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or�nore system components as described in the'Conditional Pass"section need to be replaced or repaired. The system,upon` completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N.or ND). Describe basis of determination in all instances. If'not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken,settled or uneven distribution box. The system will pass inspectior if twith approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipets)are replaced obstruction is removed t revised 9;2/98 Page 2ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ys'S' fiyif�.vEYs��2tlE CE.v .���G�' � Owner. X�7Wze-V-V 13,2,p�c y Date of Inspection: �Q 0� C. FURTHER EVALU�iTg1O 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. �} SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEIii IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. i 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANYI 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 sal absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soa absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply wen.unless a wen water analysis for conform bacteria and volatile organic compounds Indicates that it welt is free from ponution 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). 31 OTHER 1 revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coatirwed) Pr YAddes: � A.1A1A/n � � ,w, E �lflGria' Owner: /�.�r.�►c�e�w 8.A.�� � Date of Inspection: 9�1/0® D. SYSTEM FAILS: You must indicate either"Yes"or"No" to each of the following: i have determined that pne or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility-or system component-due-to an overloaded or clogged SAS or-cesspool. - Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box aboire 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 lass than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pips(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any 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 —conform 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 drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply -- - --- t the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA).or a mapped Zone it of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. revised 9/2/98 P2ge4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST property Addess: 'T c� �/�����J'sy� �f /�/ToI��l � Da a of inspecu M: Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes , No Pumping information was provided by the owner,occupant.or Board of Health. None of the system components have been pumped foratleast two weeks arid-the system hasbeea•receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this Inspection. WAF As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. ✓/ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orr the site has been determined based on: Existing information. For example,Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptablel / (i 5.302(3)(b)) V- _ The facility owner land occupants.if different from.owner)were provided.with infounation.on tha propar maintonaoc"f SubSurface Disposal Systems. revised 9/2/98 Page sofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 94FORMATION Property address: owner: Date of hupection: qq FLOW CONDITIONS RESIDENTIAL: _ Design flow: y`�50 g.p.d.fbedr•_t. Number of bedrooms(design): .S Number of bedrooms(actual):J Total DESIGN flotiyc�a Number of current residents: _..1.� Garbage grinder(yes or no):.gf Laundry(separate system) (yes or nr,^p If yes,separate inspection required _ Laundry system inspected (yes or no Seasonal use(yes or nol r, Water meter readings.if available(last two year's usage(gpd): Sump Pump(yes or no): A10 ' Last date of occupancy: �LGL7�/� COMMERCtALANDUSTRIAL: Type of establishment: Design flow: gad (Based on 15.2031 Basis of design flow . Grease trap present:(yes or no)_ Industrial Wasto Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informa+l;on: System pumped a:part of inspection:(yes or no)j;,*-' If yes.volume pumped: Ze>G gallons Reason for puinping: ooh 20o CAf&,&_ 410r a, TYPE rte;SYSTEM Septic tank/distribution bisokl absorption system ' ZSingle cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tanks Copy of DEP Approval Other APPROXIMATE AGE of all components,date instilled{if kno%yn)•and source of information: (>*?J Sewage odors detected when arriving at the site:(yes or no)A/O revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(conti)nued) Property Address: W,!r -yS ,�)�, Z f FA )r'&,e(/l Ue W7y Owner: w r � � ! Date of 9/g foQ BUILDING SEWER: (Locate on site plan) Depth below grade: Z40 Material of construction:^ZC,,.,C,,on_40 PVC_other(explain) Distance from private water supply wen or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) SEPTIC TANK_�{�.t/ (locate on site plan) Depth below grade: Material of construction: .*...Oncrete„_metal_Fiberglass _Polyethylene—other(explain) If tank Is metal,list age_ ls.age.confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: -' Scum thickness- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: i Comments: ' (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert,structur4;ntegrity, evidence of leakage,etc.) _ GREASE TRAP_ A244 (locate on site plan) Depth below grads:_ Material of construction:_concrete`metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) ---- revised 9,12/98 Page7oflt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Prop"Address: y�� / own : �il�� �yr �yg er ���-�d�!!/Gr✓�1 /��► Date of hvgxction: XAr1y��ac� ,8/���G �� 7/1 d /j TIGHT OR HOLDING TANKFank 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 order:Yes_ No_ Date of previous pumping. Comments: (condition of inlet tee,condition of alarm and float switches,etc.) J DISTRIBUTION B01K__,j"6 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) — - — PUMP CHAMBER-.. Q/1/(9 (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) i revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIO N(continued) Property Address: �f i)Me of SOIL ABSORPTION Ilocate 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:_ leaching trenches,number,length: leaching fields,number,dimensions; overflow cesspool,number:+ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil.condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration: /Pyvu9 I 7.r6 /POUND e-17ueX17'ej- - Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: �^ Dimensions of cesspool: 41.2 7--Ae O ,t/l� Z 7x6 .ov&42) Materials of construction:fer/G�,ET'� Indication of groundwater: A w r,tiFirZ Inflow(cesspool must be pumped as part of inspection) 1 Comments: (note condition of soil,signs of hydraulic failure,level of ponding,c nditi n of ve tation, c.) sa./ �l AJ11 g� ,s o L � .a fun+r PRIVY-A?041QF (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: y (note condition of soil,signs of hydraulic failure,level of ponhing,condition of vegetation,etc.) revised 9/2/98 P2gt9Of11 SUBSURFACE SEWAGE OMPOSAL SYSTDA*SPEC7)ON FOR)rt PART C EYST AR 24FORUAIM deandr:»d) y Addrsas: J'-�.�' �T�III/�€/t�y� �.11.»!/F �tr'•!�TE,�t/jLG'G` �i,�+ _. • . Report name Soil Type_ Typical depth to groundwater Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep :AM Slope Surface water Check Cellar t. Shallow welts ad Depth to Groundwaterm set ndicate all the methods used to detarmine High Groundwater Elevation: btained from Design Plans on record bserved Site(Abutting property,observation hole, basement sump atc.) stermined from local conditions hacked with local Board of health hacked FEMA Maps hacked pumping records hacked local excavators,installers . sed USGS Data e how you established the High Groundwater Eiev 'aIIon. Must be completed)Y g 4 ®�� � 'f400� pWitI6AS t�L Gv D SUBSURFACE SEWAGE 0ISPOSAL SYSTEM WSPECTION FOAM PART C SYSTEM NFORUATM(contlmx4 Q 1 - Property Address: Owner: ,�i.�CgEti •� �GEY Oate of inspection: SKETCH OF SEWAGE DISPOSAL SYSTFIUI: iulude t is to at bast two permanent reference landmarks or benchmarks locate _ ate an wens within 100'(Locate where public water supply comes iyto house} SATE 2. ' N-5 icy LL. N G- C. ` c �rx tv,` cssspool 0 lzrlty IjZf A-C - �1. / i sg '1�� revised 9/2/98 hge 10of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 455 Phinneys Lane Property Address:Centerville,Ma Address of Owner: (if different) Date of Inspection: 7 May 2001 Inspected by: .James Holler I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Holler& Son Construction LLC Mailing Address:P.O. Box 702,Marston Mills,Ma 02648 Telephone: (508)420-0280 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ®Passes ❑Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑Fails Inspectors Signature Date: The system inspector shall su ' a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system,owner and copies sent to the buyer,if applicable,and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: Comments: B) SYSTEM CONDITIONALLY PASSES: ❑One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. ❑The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exiiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 B) SYSTEM CONDITIONALLY PASSES (continued) ❑Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑distribution box is leveled or replaced ❑The system required pumping more than four times a year due to broken or obstructed pipe(s). The system 1' will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ❑Cesspool or privy is within 50 feet of 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 APPROPRIATE)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 to 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 with 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. Yes No ❑ M Backup of sewage into facility or system component due to overloaded or clogged SAS or Cesspool. ❑ M Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. ❑ M Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. ❑ M Liquid 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 of times pumped ❑ M Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ M Any portion of a cesspool or privy is with 100 feet of a surface water supply or tributary to a surface water supply. ❑ M Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ M Any portion of a cesspool or privy is with 50 feet of a private water supply well. ❑ M 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" as 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 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 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health. ® ❑ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ® ❑ As built plans have been obtained and examined Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. ® ❑ The stem does not receive non-saint or industrial waste flow. system ary ® ❑ The site was inspected for signs of breakout. ® ❑ All system components,excluding the Soil Absorption System,have been located on the site. ® ❑ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location or the Soil Absorption System on the site has been determined based on: ® ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing information,Ex.Plan at BOH. ® ❑ Determined m the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 3 Number of current residents:1 Garbage Grinder:Yes Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):N/A Sump pump:No Last date of occupancy:Current COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER:(describe) GENERAL INFORMATION PUMPING RECORDS and source Owner System pumped as part of inspection No Volume pumped: Reason for pumping: TYPE OF SYSTEM ❑Septic tank/distribution box/soil absorption system ❑Single cesspool ®Overflow cesspool ❑Privy ❑Shared system(y/n)(if yes,attach previous inspection records,if any) ❑UA Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information:Owner,Approx.70 years Sewer odors detected when arriving at the site:No Gf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of inspection:7 May 2001 BUILDING SEWER (Locate on site plan) Depth below grade 18 inches Material of construction❑Cast Iron❑40 PVC®other Distance from private water supply well or suction linenone Diameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: Sludge depth: Distance from top of sludge to bottom of tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Comments: GREASE TRAP (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leak,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 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: GPD Alarm level: Alarm working?❑yes❑no Date of previous pumping Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:❑ (locate on site plan) Depth of liquid level above outlet invert: Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,etc.) PUMP CHAMBER:❑ (locate on site plan) Pumps in working order: (yes or no) Alarms in working order:(yes or no) Comments:(note condition of pump chamber,pumps,and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 SOIL ABSORPTION SYSTEM:(SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) if not determined to be present,explain: Type; leaching pits,number leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number:two,approx.650 gallons each Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration:2,primary and overflow Depth-top of liquid to inlet invert:4 inches Depth of solids layer:6 inches Depth of scum layer 2 inches Dimensions of cesspool approx.650 gal Material of construction stacked block Indication of ground water inflow(must be pumped as part of inspection)no Comments:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) bottom of system is greater than 12 feet above lake elevation in rear of property,and high bank to cesspool dimension ' exceeds 125 feet,soil conditions are excellent for drainage,no hydraulic failures or breakout. PRIVY❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. 21 k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:455 Phinneys Lane,Centerville Owner:K M.Bradley Date of Inspection:7 May 2001 Depth to Groundwater 12+feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ observed from design plans on record ® observation of site(abutting property,observation hole,basement sump) ❑ determine it from local conditions ❑ check with local Board of Health ❑ check FEMA maps ❑ check pumping records ❑ check local excavators,installers ❑ use USGS data Describe in your own works how you established the High Groundwater Elevation. (Must be completed) i Ir r - r It _ - 1 - { tl - I 'I r .i ® �j ,/Z;fi�.G✓.� 'Y2.�c�/�G!/ Li' —' /�2-1'��`�.�/ L�/Y`�" �� ALP r� t I 1 y + 1 ' cjo i Lid✓!�'� L%�� . 1 i FROM Hajian ArchitectS Inc. FAX NO. : 617 926 8280 Nov. 16 2001 02:17PM P3 fe'.3:vv:•�:Cc�Ys/ifiE 00-o L SYS7�*�T' y-,C-. M0 F m °Daft f! /f�, -alb �'•�.r� o�Ey • s o� �sus.srst�: = . dad.tt�to ae vast spa s�.�ssta�.aioa Lt�n.•r4y a b.a�s '� Ian m www wwa la0'&ACKA U*W*g--&A-fa watx-goo pr a—"��= -• . fie .'e c • . Its LC LL p Cs- : rr Y. UT#N 91"A revised 9/2j98 11 FROM Hajian Architects Inc. FAX NO. 617 926 8280 Nov. 16 2001 02:16PM P1 FAX TRANSMITTAL Mr.David Stanton Barnstable Board of Health 508-790-6304 ,3 PAGES INCLUDING This COVER SHEET Dear David, As requested,please find the following two pages regarding the existing system at 455 Phinney's Lane. This is the only information we have, as received from the owner. As mentioned earlier,we are in a very preliminary stage regarding Asp _Bible renovations. At this point,the owner is interested in finding out what the regulations are,in order to assess the scope of what he might wish to do. From our latest conversation,it sounds as if any work affecting the bedroom count. would impact the system. Any additional information you can provide would be helpful. Sincerely, David Hajian • - File 11/16/01 3 55 Dexterwatenown, MA 02472 Telephone 617-926.8282 Facsimile 61.7.920.8280 i