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SEWAGE INSPECTIONS,
LOCATION '3'7 Arrowhead 'Drive DATE 11 /7/02--
I�VILLAGE 'Hvannis,Mass. ASSESSOR'S MAP & LOT271 -061
-INSPkTORJoseph P.Mac�mber. Jr.
SEPTIC TANK CAPACITY 1 500 gallons + Box
LEACHING FACILITY: (type) 3-Cultec recharger(size)
NO. OF BEDROOMS 3
BUILDER OR OWNER Dr. Peter Eckel
OWNER•x MAILING-ADDRESS
• 511 Calhoun Street
West Point,MS• 39773
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TOWN OF BARNSTABLE
T,OCP_PION f R�pU iv C.4A .r/A409: SEWAGE #9/0
VILIaAGE Y Z &� ASSESSOR'S MAP&LOT 27/-06/
INSTALLER'S NAME&PHONE NO. VN 6, eA $/&S-o- JV"7 7S- rr;!7 6
SEPTIC TANK CAPACrry Z��
LEACHING FACILITY: (type) �� �O•L� 'I� (size)
NO.OF BEDROOMS It
BUILDER OR OWNER C
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
Fuiniihed by'�""""!
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V TOWN JOF B�nARNSTABLE
SEWAGE #
VILLAGE 1—l_ .K,�, ASSESSOR'S MAP & LOT 0 7 L o 6
24STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Cc-,\ti vG K (size)
NO. OF BEDROOMS vac
BUILDER OR OWNER�.c
PERMIT DATE:_ o COMPLIANCE DATE: 9 6
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 ,e �
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important:
When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
r� P.O.Box 763
Company Address
Centerville Ma. 02632 ..
°D City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification.
I certify that el 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 in Lgction. Tfie inspection
was performed based on my training and experience in the proper function and maiptenanc of on-site
sewage disposal systems. I am a DEP approved system inspector pursuant tom' ction 15340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails w
❑ Needs Further Evaluation by the Local Approving Authority
6/13/2008
Insp is Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic system is in proper working order at the present time.
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
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2
' 1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
ww 37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND.Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in.accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
37 Arrowhead Dr.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601. 6/13/2008
�
every page. City/Town State Zip Code Date of Inspection
1
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ .The system has a septic tank and.SAS and the SAS is les's than 100 feet but 50 feet or
more from a private water supply well". ,
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
El ® Static liquid level.in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
❑ . ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
37 Arrowhead Dr.•03108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza .
Owner Owner's Name
information is required for Hyannis + Ma. 02601 6/13/2008 .
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All.Systems (cont.):
Yes No ,
[_1 Z 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
a❑. ` ® well.
;❑ ® : Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
{ r system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
- _ and chain of custody must be attached to this form.] ,
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
• 0 ® The system fails. l 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.
c
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet'of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ; ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection''
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
o�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..
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c�M 37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for H annis Ma. 02601 6/13/2008
y
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been.done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
El ® 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?
I .
® ❑ Was the site inspected for signs of break out?
I
® ❑ Were all system components, excluding the SAS, located on site?
I
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ❑ Existing information. For example, a plan at the Board of Health.
El ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
I
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is Hyannis Ma. 02601 6/13/2008
required for H Y .
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions. {
Number of bedrooms (design): 3 Number of bedrooms (actual). 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder? . ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage (gpd)): 2006:17,000
9 ( Y 9 2007:79,000
Sump pump?' ❑ Yes ® No
Last date of occupancy: 6/13/2008
Date
r
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft.,etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
37 Arrowhead Dr.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7
Commonwealth of Massachusetts.
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address f
Ricardo DeSouza
Owner -Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
y General Information
Pumping Records: .
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
'❑ Single cesspool
❑ Overflow cesspool
F
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
system installed 1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;N 37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is Hyannis Ma. 02601 6/13/2008
required for y
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 20feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line. feet
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
1'
Depth below grader feet
Material of construction:
® concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain)'
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes ❑ No
.--------- -----------------------------------------------------------------------------------------------------------
Dimensions: 1500 gallon
Sludge depth: 4
Distance from top of sludge to bottom of outlet tee or baffle 28
Scum thickness 1
7
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
13"
How were dimensions determined? Measured
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. Ciiy/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears to be structurally sound.
.Grease Trap (locate on site plan):
Depth below grade: feet.
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other.(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 37 Arrowhead Drive
Property Address _.
Ricardo DeSouza i
Owner Owner's Name
information is required for Hyannis > Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity:.
• gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if-present must be opened) (locate on site plan):
Depth of.liquid level above outlet invert No
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.):
Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or
out of box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
37 Arrowhead Dr.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11
_ Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for Hyannis Ma. 02601 6/13/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):.
If SAS not located, explain why:
Type: _
❑ leaching pits number:
• cultecultec
® leaching chambers number: 3 3 c s
El leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation;etc.):
Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12
Commonwealth of Massachusetts
F-oTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address ,
Ricardo DeSouza -
Owner Owner's Name r -
information is Hyannis - Ma. 02601 6/13/2008
required for H Y '
every page. City/Town State Zip Code Date of Inspection -
D. System Information (cont.)
Cesspools (cesspool,must be pumped as part of inspection) (locate on site plan):
Number'and configuration
Depth—top of liquid to inlet invert
Depth of solids layer.
Depth of scum layer ,
Dimensions of cesspool .
Materials of construction
Indication of groundwater inflow, ❑ Yes ❑ No
CommentS`(note'condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
t
etc.):
r
Privy (locate on site plan):
'Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil_, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.): -
. + J
c
37 Arrowhead Dr.•03/08 TiBe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13
Map Page 1 of 2
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
37 Arrowhead Drive
Property Address
Ricardo DeSouza
Owner Owner's Name
information is required for H annis Ma. 02601 6/13/2008
y
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of leaching 40'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within.150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of
groundwater elevations.
37 Arrowhead Dr.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
of I;I.
t>t r . . .
Regulatory Services
RARNSYABLE, s' Thomas F. Geiler, Director
y MASS,
�ArF039. � Public.Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
i
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town. of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving .this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number of
bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit"..
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
Q:ISEPTIODisclaimer Private Septic Inspections.DOC
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION .
Property Address: 37 Arrowhead Drive
Hyannis ;
Owner's Name: Richard&Mamey Lema
Owner's Address: A
e Zi
Date of Inspection: 6/24/2005 c� r`--
:y.
Name of Inspector: (please print) Patrick T. Sullivan
Company Name: Ready Rooter o
Mailing Address: P.O.Box 371 w
Sandwich,MA 02563 crJ
Telephone Number: (508)888-6055 rn
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 Authority
Fails
Inspector's Signature: _ � i1 Date: 05
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.
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Mamey Lema
Date of Inspection: 6/24/2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
C. System Passes:
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 Pas ' section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as a roved by the Board of Health,will pass.
Answer yes,no or not determined (Y,N,ND)in the for the ]lowing statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or th septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank a approved by the Board of Health.
*A metal septic tank will pass inspection if it is ly sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is a ']able.
ND explain:
Observation of sewage backup or br out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,se 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 requir pumping more than 4 times a year due to broken or obstructed pipe(s).The system.will
pass inspection if(with proval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
C. Further Evaluation is Required by the Board of He
Conditions exist which require further evaluatio y the Board of Health in order to determine if the system
is failing to protect public health,safety or the enviro ent.
1. System will pass unless Board of Healt determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manne which will protect public health,safety and the environment:
_Cesspool or privy is within 5 eet of a surface water
Cesspool or privy is wi 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Suppl' r,if any)determines that the
system is functioning in a manner that protects the public health,safety d environment:
_The system has a septic tank and soil absorption system(SAS and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_The system has a septic tank and SAS and the SAS is 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 S S is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to dete ' e distance
**This system passes if the well water analysi performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicat t the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate ni ogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the sis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE"SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to.each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
,f Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or
cesspool
_ _SZ Liquid depth in cesspool is less than 6'below invert or available volume is less than'h 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
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 50 feet of a private water supply.well.
_ (Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for 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 criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to deternune what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility 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 criteria above)
yes no
_the system is within 400 feet of a surface g water supply
the system is within 200 feet of a tribu to a surface drinking water supply
the system is located in a nitrogen se • itive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply w
If you have answered"yes"to any que ' n in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large sys in has failed.The owner or operator of any large system considered a
significant threat under Section E or ' ed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should ntact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
Check if the following have.been done. You must indicate`yes"or"no"as to each of the following:
Yes No
Pumping information was provided by the owner,occupant,or Board of Health
_ Were any.of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
_ Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
i
_ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
i
_,Zr_ 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 bales or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if different than owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
— Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation'of distance
is unacceptable)[310 CMR 15.302(3)(b)]
i
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): Q
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3 3<n (:Z, -fl .
Number of current residents:
Does residence have a garbage grinder(yes or no):h'Xz,
Is laundry on a separate sewage system(yes or no):.t�Nif yes separate inspection required]
Laundry system inspected(yes or no):= r�
Seasonal use: (yes or no): "!�j
Water meter readings,if available(last 2 years usage(gpd)): Q'*QrD'i
Sump Pump(yes or no): �
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sgfl,e .):
Grease trap present(yes or no):—
Industrial waste holding tank present es or no):_
Non-sanitary waste discharged to th itle 5 system(yes or no):—
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information.'�;)_-�_-.,=�-,, e,
Was system pumped as part of the iApection(yes or
If yes,volume pumped:_gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
—ivy
_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
I obtained from system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
2
Were sewage odors detected when arriving at the site(yes or no): J
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
BUILDING SEWER(locate on site plan)
Depth below grade: l ;?11 /�
Materials of construction:_cast iron ,/40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on 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(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)Dimensions: _
// --le ,r X � `5
Sludge depth: a"
Distance from the top of sludge to bottom of outlet tee or baffle: 3 a v
Scum thickness: t I Q�`
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 were dimensions determined: ,..n c�.� YV-\ a
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
� L .sa v
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 t or baffle:
Distance from bottom of scum to bottom o outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendati ,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of eakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
TIGHT or HOLDING TANK: (tank must be umped 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: gallon day '
Alarm present(yes or no):
Alarm level: Alarm in wor g order(yes or no):
Date of last pumping:
Comments(condition of alarm float switches,etc.):
DISTRIBUTION BOX:_Z(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
v
Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUN P 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 condition of pumps and appurtenances,etc.):
M
r
Page 9 of 1.1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
_\Lleaching galleries,number: ---3, -- CA-'t'
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): (�
V
CESSPOOLS: (cesspool must be pumped as 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 es or no):
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan) r'
Materials of construction:
Dimensions: a, h
Depth of solids:
Comments(note condition of soil,signs of h Lc failure,level of ponding,condition of vegetation,etc.):
I
i
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
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.
I
L-? I
1. 0
ID
�3 - 33 '
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: 37 Arrowhead Drive
Hyannis
Owner: Richard&Marney Lema
Date of Inspection: 6/24/2005
SITE EXAM
Slope
Surface water
Check cellar f
Shallow wells
Estimated depth to ground water �-55 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: /,d4 4-
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with the 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:
i
f�
DATE : 11 /7/02
PROPERTY ADDRESS :37 Arrowhead Drive
— Hyannis,Mass— ----
------
02601
------------------------
EIVED
On the above date, I inspected the septic system at the abov a6d' -Fesss. '
This system consists of the following:
1 . 1 -1 500 gallon septic tank. NOV 1 2 2002
2. 1 -Distribution box. TOWN OF BARNSTABLE
3. 3-37OCultec rechargers. HEALTHDEPT.
Based on my inspection, I certify the following conditions:
4. This is- -a title five se tics stem. (78 Coe) MAP
p _Y _ _..
,5. The septic system is in proper working order
- PARCEL.
at the present time. - -
6. The cultec rechargers are presently dry. LOT
SIGNATU /R
Name : J . P . Macomber Jr .
C0 Rip any : Josgph _P._ Macomber 8 Son, Inc .
Addrdss :__BQx _tz ............
Phone:--508- 775- 3338
-------------------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
son — ,ONE
via
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools•Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775.6412
COMMONWEALTH OF IP3SACHUSETTS
• EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL, PROTECTION
TITLE 5
OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS-
' SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ,
PART A
.CERTIFICATION
Property Address:37 .Arrowhead Drive
I-E�ra_nni G MaGG _ _
Owner's Name: n.r Petpr Eckel `
Owner's Address:51 7 Calhoun Street
W a.c.t P n i n t __M.S 39 7_7_3—
Date of Inspection: 1 1 /7/02 '
Name of Inspector: (please print) Joseph P. Macomber Jr,. . '
Company Name: J.P. Macomber & Sons Inc
Mailing Address: Box 66
(''AntP_ryJ 1'1 P Ma 02632
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
I certtf) that I have personally inspected the sewage disposal system at this address and that the information reposed
below is rrue. accurate and complete as of the time of the inspection. The inspection was performed based on my
,Tatnwe and experience in the proper function and maintenance of on site sewage disposal systems. I'am a DEP
app(oved system inspector pursuant to Section 15140 of Title 5 (310 CMR 15.000). The system:
/Y Passe_
'•" Conditionally Passes
_ Needs Funher Evaluation by the Local Approving Authority
Fail '
Inspector's Signature?bm
Date:
The system inspector shall 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 now 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
authorir).
Notes and Comments,
•77This repon_only describes conditions at the time of inspection and under the coaditions,of use at chat �.' �, 4.
time'Ttiis.inspection does not address how the,system will.perform in the future under the same or different ? {"
conditions of,use.
3> ' k
Title 5 Inspection Form 6/15/2000 page I
_ r•
4
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 37 Arrowhead Drive
Hyannis,Mass.
Owner: Dr. Peter Eckel
Date of Inspection: 11 /7/0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D '
A` Sysm Passes: -
have not found any information hich indicates that any of the failure criteria described in 310 CMR ,
15.303 or in 310 exist. ny failure criteria not evaluated are indicated below.
Comments:
�iThP %en S�7Stem"�i`s``in 'proper workinq�order ---F'-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.
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 ; ' , ;� s.ks `•'
obstruction is removed
C
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: 37 Arrowhead Drive.
Hyannic,Masc
Owoernr PeteY F.rkisl
Date of lospection: j j ;i /n2
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
i is failing to protect public health,.safety or the environment.
i. S,s•stem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner wbich will protect public health,safety and the environment:
aCesspool or privy is within 50 feet of a surface water
Cesspool or privy is witbin 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:
/1Z The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or rributaryao a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple.
. !vim 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 tartk and SAS and the SAS is less than 100 feet but 5 feet or more from a
private water supple yell". Method used to determine distance J/
'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliforn
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 ocher
failure criteria are rriggered. A copy of the analysis must be anached to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 37 Arrowhead Drive
Hyannis,Mass.
Owner: Dr. Peter Eckel
Date of Inspection:11 /7/0 2
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
j Yes No
_ Backup of sewage into faciliry or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
/ clogged SAS or cesspool
Static liquid level in-the-distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h•day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped 'Q .
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
— water supply.
_IX portion of a cesspool or privy is within a Zone 1 of a public well.
y portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. ]This system passes if the well water analysis,
performed at a DEP certified laboratory, for 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.]
—11i 0 (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
i the system is within 200 feet of a tributary to a surface drinking water supply
i i 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 S of ;
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Properr) Address: '47 ArrnwhPad Drive
Owner: Dr Pe el
Date of lospectioo: 11 /7 1102
Check t(the following have been done You trust indicate 'yes" or"no" as to each of the following:
Yet 'II0
// Pumping information was provided by the owner, occupant. or Board of Health
�N'cre an%.of the system components pumped out 0 the previous two weeks
_ /Has the system received norTnal flows in the previous two week period?
ZHas-c large volumes of water been inrroduced to the system recently or as pan of this inspection ^
Were as built plans o(the system obtained and examined? (If they were not available note as Nr.A)
_ was the facility or dwelling inspected (or signs of sewage back up?
Was the site inspected for signs of break out ^
!/ wcrc all system componenis.x-Ycluding the SAS. located on site '
Wcrc the septic tank manholes uncovered• opened, and the interior of the tank inspected for the cencl::or.
^e baffles or tees. material of consuvction, dimensions, depth of liquid, depth of sludge and depth of scum ^
_ Was the faciliry owner (and occupants if different from owner)provided with information on the proper
naintenance of subsurface seµ age disposal systems '
The size and location of the Soil Absorption System (SAS) on the site has been determined based on
Yes no
Existing information. For example, a plan at the Board of Health.
Determined in,the field (if any of the failure criteria related to Pan C is at issue approximation of diY--n:c
CMR 15.J02(7)(b))
:s ;nacccplablc) 1310
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5
Page 6 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 37 Arrowhead' Drive
Hyanni c; Mass_
Owner: Dr- PPter Fekel
Date of Inspection: 1 1 f 7.1n 2
FLOW CONDITIONS
RESIDENTIAL ,
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: 0 _
Does residence have a garbage grinder(yes or no): lb
Is laundry on a separate sewage system ( es or no):&k (if yes separate inspection required)
Laundry system inspected (yes or no): 76�
Seasonal use: (yes or no): A16
Water meter readings, if available (last 2 years usage(gpd)):2000-1 9, 500 gal lons=53. 43 GPD
Sump pump(yes or no):,Ou&* 2001 —49, 500 gallons=1 35. 62 GPD
Last date of occupancy:
COMMERCLAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CM 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no): ,
Industrial waste holding tank present(yes or no): 4h4
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available: 111W
Last date of occupancy/use: 'Ve
OTHER (describe): 410
GENERAL INFORMATION
Pumping Records
Source of information: 11Ji9
Was system pumped as part of the inspection(yes or no): I
If yes, volume pumped: 0 gallons -- How was quantity pumped determined? 109
Reason for pumping:
TYP OF SYSTEM
Septic tank, distribution box, soil absorption system
,IL5 Single cesspool
Overflow cesspool
Privy
Zd,Sha.red system(yes or no)(if yes, attach previous inspection records, if any)
,lei technology. Attach a copy of the current operation and maintenance contract(to be
/obt fined from syste owner)
Tight tank Attach a copy of the DEP approval
Other(describe):
A roximate aee of all comp ne s date i tallep(if known) and sou ce of information:
Were sewage odors detected when arriving at the site(yes or no): 4
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6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:37 Arrowhead Drive
Hyannis,Mass.
Owner: Dr. Peter Eckel
Date of Inspection: 1 1 /7/0 2
BUILDING SEWER(locate on site plan)
�!
Depth below grade: I
Materials of construction: cast iron /40PVC Afd other(explain): .0,4
Distance from private water supply welFor suction line: /dit
Comments(on condition of joints, venting, evidence of leakage,etc.):
mints appear tight -No Pvirlence of leakage ThP system is
,vented through the house vents.
SEPTIC TANK: Zoocate on site plan) 1600 j*'10 K
Depth below grade: Id J
Material of construction: dconcrete tfd metaW�fiberglass& olyethylene
,!�Oother(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):i1/6 (attach a copy of
certificate) ��� I
Dimensions: 0'4'6��A ST"AL,>1
Sludge depth:�0�
Distance from top of sludge to bottom of outlet tee or baffle:;7—�.c�,Z
Scum thickness:
r
Distance from top of scum to top of outlet tee or baffle:
Distanee from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid level's
as related to outlet invert,evidence of.leakage, etc.):
Pump the se=ti c tank every 2rd3 zPars '"Thl et & nutlet tees
arP i np l arse The tank i c c4-rUCJ-.mall y sounds and Shl1wS nri
evidence of leakage.
GREASE TRA (Iocate on site plan)
Depth below grade:
Material of construction:,eAconerete go metaLle frberglass�olyethylenWAother
(explain): e1�
Dimensions: Z14
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:_ ld'�'
Distance from bottom of scum to bottom of outlet tee or baffle:_ kg
Date of last pumping:—d --
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structwal integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Grease trap is not present-
7
f
Page 8 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37 Arrowhead Drive
Owner:Dr, Peter Ecke
Date of Inspection: 1 1 f 7 02
TIGHT or HOLDING TANK,&(tank must be pumped at time of inspect ion)(locate on site plan)
Depth below grade:CIA
Material of construction: concrete Ametal dZ&_fiberglass v,!9polyethylene,4& other(explain):
dlr4 `
Dimensions:_AR
Capacity: AA gallons
Design Flow: AM gallons/day
Alarm present(yes or no):��
Alarm level: A)h Alarm in working order(yes or no):
Date of last pumping: AA
Comments(condition of alarm and float switches,etc.):
r .
Tight or holding tanks are not present.
DISTRIBUTION BOX: y (if present must be opened)(locate on site plan)
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.):
Dic; -rihLtion hox has one lateral No evidence of solids
carrz_ nvPr _Nn -vjdPncP -Qf leakage into or out of the box
PUMP CHAMBERQjfy,(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.):
Pump chambere is not present
f
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 37 Arrowhead Drive
-Hyaanis,Mass.
Owner: Dr. Peter Ecke
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): �/ (locate on site plan,excavation not required) ,
1-cultec rechargers
If SAS not located explain why:
Located; See page 10
Type
VQ leaching pits, number: O
leaching chambers,number:j=C,(T&c 1&40'90-5
,4?,� leaching galleries,number:
leaching trenches,number, length: _d
leaching fields, number,dimensions: Q
AV overflow cesspool, number:D
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.):
Loamy sand to boney medium sand to fine sand.No. signs of
hydraulic failure or pon ing of 1s are
is normal.
CESSPOOLS(cesspool must be pumped as pan of inspection)(locate on site plan)
Number and configuration: n
Depth-%top of liquid to inlet invert: 4J4
Depth of solids layer:
Depth of scum laver:
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.):
r'Pccnnn1s are not present
PRIVY
4�(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
r
oljr IOo(li
OFFICI,�i rNSPeCTION FORAf- NOT FOR V.OLVNTARY ASSESSI, C, _SU8SU'RZFACE SEWACE DISPOS.oL SYSTEM INSPECTION FpFZ/�
PART %'
SYSTEM INPOR,/vl^TION (conilnvco)
37 Arrowhead Drive
Peter �,cK Mass
�i�� orin�p�c��oo:11 f7 /l7�
SCTCH Of SCwACC DISPOSAL SYSTCM
Ao--o" ILmh Of'^I ""If 000111 iymm Inclvo(n; lI(, I0 111(m rwo ptrrfltntnl rt(trtncr itn
., v►I ..�ui „n,n 100 (M Lot III
wh(" pvblit wllcl IV I
C/n t i
PP 7 tnitri inc Oviloin(
5
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0 k/(�\
�Fy i
1 �
10
Page I 1 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 37 Arrowhead Drive
Hyannis,Mass.
Owner: Dr. Peter Eckel
Date of lospection: 1 1 /7/0 2
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:
&Ob
O�wi d �aburntimnpro
on record • If checked, date of design plan reviewed: 1 1 /7/0 2
s sitservation hole within 150 feet of SAS)
YPC ecked wit -explain:Copy of as built
YES Checked with local excavators, installers-(anach documentation)
YES Accessed USGS database-explainhttp: //town.barnstable.ma.us.
You must describe how you established the high ground water elevation: '
Used: Gahrety & Miller Model. 12/16/94 Ground water elevations above
sea level . _
Used: USG t June 1992
Used: USG tin 92-000-1 Plate #2 January 1992 Annualranges
I up or Ur n of ground water elevations.
3-330 Cultec
rechargers
Dry 6"1 :eet
6l9 T
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per
p Fnmptcr Method
' Therefore, the vertical separation distance between the bonom
,h
Of the leaching pit and the adjusted groundwater table is � G4
feet.
11 I
I
�.•r-,>, n rrT'r,r +1-• r-r�.rne•rr:•.�,- Tv.r:-sr-r-r+,r>•r.-,z:*+-s-or+er.rrt-
TOWN OF Barnstable
BOARD OF HEALTH 1
SulfsulcFnCF aEHn(lE ►>(SNsnL sYSTFM IN9hECTION FORM - PART D •- CERTIFICATION I
•••�•1 �••.'::,—!.11•�-.T.T..�.•n:fTI TZ T.TTl.Tn1'T1•.��•.•1���i.—.TTII— I m-clmse.w-lvr� ,Ann'�nr+.r+r,R.�•r+:m+r.•.�r•r.- r•�• —. AAA
-TYPZ OR PRINT CI•CARLY-
PIIOPERT Y INSPECTED
STREET ADDRESS 37 Arrowhead Drive Hyannis,Mass.
ASSESSORS MAP , BLOCK AND PARCEL # 271 -061
OWNER ' s NAME Dr. Peter Eckel
PAPT U - CERTIFICATION
NAME OF INSPECTOR Joseph P . Macomber Jr
COMPANY NAME Joseph P. Macomber &"ion Inc
COMPANY ADDRESS Box 66 Centerville Mass 02632
Street Tovn or City State LIP
COMPANY TELEPHONE ( 508 ) 775-333-8 FAX ( 508 ) 790-1-578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
omplete as of the time of .- inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
Chec one :
]� 'Systeui' _PAISSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLil or Lhe. environment as defined in 310 CMR 16 - 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The. inspection wilicll I h, )ve conducted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspec � ion f rm .
Inspector Signature J Date �� ✓�
Onecopy of thi c t.ification must be provided to the OWNER, the BUYER
where appl Lcabl and the DOAftD OF HEAL1'll.
* If the inspection FAILED , thL owner or operator ehall upgrade ' the eyetem
within one year of the date of the inspection , unless allowed or required
otherwise as provided - in 3.10 CPIR 15 . 305
partd . doc
Fee $50 . 00
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • '
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS
~ 2pplication for Mtopogar *potem Construction Vermtt
Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) . ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,-Address and Tel.No. 4 2 8-5 5 6 3
37 Arrowhead Drive., Hyannis , MA Bob Gonnella/Argon Properties
Assessor's Map/Parcel
PO Box 772 Osterville, MA 02655
Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic. Service
PO Box 1089, Centerville, MA 0263
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(nd
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
` Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Installation of Title 5 Septic
system consisting of 1500 gallon tank, D-box.; and thrp- #130
high capacity, stonepacked, cultex infiltrators-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by thi B d of Hea h.
Signed A A Date�-9 4
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
ii "4^f �„•- +` 'n'S.1 f\.'7'r'i '�:3G...n.•'.N.� F ".. .t•r s�.r.' 3:-'v,•rk'.?'p`...,,�"^-'a.,. F..:� .'.+ �" ..: `-..
No. xt :,ca $50.00
w Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH-DIVISION TOWN OF BARNSTABLES MASSACHUSETTS
App
Yicati"Afor ]Digpogal 6'pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) O Complete System ❑Individual Components " t
Location Address or Lot No. Owner's Name,Address and Tel.No. 4 2 8—5 5 6 3
37 Arrowhead Drive, Hyannis, MA Bob Goneella/Argon Properties
Assessor's Map/Parce
t PO Box 772 Osterville M9` 02655
Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic-Service
PO Box 1089, Centerville, MA 0263
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plari Rafe Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
a y Nature of Repairs or Alterations(Answer when applicable) Installation of Title 5 Septic
system consisting of 1500 gallon tank, n box, and - three 0330
high capacity, stonepacked, cultex infiltra
3� ~
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the*system in operation until a Certifi-
cate of Compliance has been issued by this Bo d of H4ah.
Signed A.A Date./;—I 7- 9 Z
Application Approved by Date
Apptication Disapproved f r the following reasons s.
Permit No. 62!5 17Date Issued'
THE COMMONWEALTH OF MASSACHUSETTS
Argon BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( x )Upgraded( )
Abandoned( )by Wm E Robinson Sr Septic Service
at s7 Arrowhead Drive, Hyannis has ben constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Wm E Robinson Sr Septic Sry. Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector_
T
. ;
No. Fee$50 00 ,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Argon Mig ogal *pgtem Congtruction Permit
Permission is hereby granted to Construct( x)Repair( x)Upgrade( )Abandon( )
System located at 37 Arrowhead' Drive, Hvannis.
by Wm E Robinson Sr Septic Sru.
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction ust a completed within three years of the date of this pegpit. O
Date: Approved by
14
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS).
I,William E. Robinson, Sr.,hereby certify that the application for disposal works
construction permit signed by me dated 12/16/96 ,concerning the
property located at 37 Arrowhead Drive, Hya,nnismeet all
of the following criteria: `
* There are no wetlands within 300 feet of the proposed septic system.
* There are no private wells within.150 feet of the proposed septic system.
. * The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
SIGNED:_ l/(/ ` L DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 4
(Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification
plot plan,this plan should be submitted).
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