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Home My WebLink About0063 ARROWHEAD DRIVE - Health 63 ARROWHEAD DRIVE, HYANNIS A.=271 124 f - 4 0 q C ..ASSESSOR'S MAP NO. � '77- PARCEL LOCATION , SEWAGE PERMIT NO. VIILADE -�f I N S T A LLE-R'S NAME ADDRESS B U I L D E R OR OWNER -Z j DATE PERMIT ISSUED i. DATE COMPLIANCE ISSUED %�� '� '� . � �� F. �a��y � 4 � �, �; �,_ J U ` DEC 2 1 Y99A COMMONWEALTH Or M%SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 ad )/ TRUDY CORE laySecretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Corruuissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A //� CERTIFICATION Property Address: 6 3 k�OIN h,0a1,0,r, Name of Owner �}G Address of Owner: 3 go Date of Inspection: Name of Inspector:(Please Print) IOSPD 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: 4—C C t& Mailing Address: ! /-7 /3LlL✓✓/�� t_��- D Telephone Number: S �°h� S �} 2466 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 s age disposal systems. The system: _ Passes t _ Conditionally Passes _ Needs Further Ev I the Local Approving Authorit v • F Z y6 Inspector's Signatur Date: The System Inspecto all submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS I j revised :9/2/98 Page Iof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION(continued) Property Address: 63 Arrowhead Drive,Hyannis Uwner: Harold McLaughlin Date of Impection: 12/12/98 INSPECTION SUMMARY: Check A, B, C, or D: A./ SYSTEM PASSES: V 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 more system components as described in the "Conditional Pass"section need to laced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Heal:�allwinstances. h il Indicate yes, no,or not determined(Y,N, or ND). Describe basis of determinatio If "not determined",explain why not. The septic tank is metal, unless the owner or operator provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was' stalled within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is crac ,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pas ' spection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup o reakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a b an, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health►. broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The•system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass Inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 63 Arrowhead Drive,Hyannis Property Address: Harold McLaughlin Owner: 12/12/98 Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Boar ealth in order to determine if the system is failing to protect the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF TH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANN ICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or priv • within 50 feet of surface water Cesspool or vy 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 W SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEA AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorpti 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 so* sorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank a oil absorption system and the SAS is within 50 feet of a private water supply well. The system.has a septic to and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply w ,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from p tion from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. hod used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM l PART A CERTIFICATION (continued) 63 Arrowhead Drive,Hyannis Property Address: Harold McLaughlin Owner: 12/12/98 Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: ,A)D_ 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No yBackup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool. I Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool: Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day.flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. o 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria aboLarge The system serves a facility with a design flow of 10,000 god or grey System)and the system is a significant threat to public health and safety and the environment because one or more of ollowing conditions exist: Yes No the system is within 400 fa a surface drinking water supply the system is wit ' 00 feet of a tributary to a surface drinking water supply the syste s located in a nitrogen sensitive area(interim Wellhead Protection Area:IWPA)or a mapped Zone 11 of a public wate upply well The owner or o ator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the epertment for further information. revised 9/2/98 Page 4orit i I , I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 63 Arrowhead Drive, Hyannis Property Address: Harold McLaughlin Owner: 12/12/98 Date of Inspection: 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. v _ None of the-system components have-been pumped•forat least two weeks and-the-system has teen 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 system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _✓ All system components 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 on 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 unacceptable) 115.302(3)(b)) _ The facility owner(and occupants,if different from owner).were.provided with information on tha.propermaintenaaw-of SubSurface Disposal Systems. revised 9/2/98 Page sof11 i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 63 Arrowhead Drive,Hyannis Owner: Harold McLaughlin Date of Inspection: 12/12/98 FLOW CONDITIONS RESIDENTIAL: i7A�-gfpr9�G / _1 Design flow: �- g.p.d./bedroom. NO �� J'Aj d1�1.T7/e W� `�U/ /y/,'3 aJi-Plr. Number of bedrooms(design): — Number of bedrooms(actual):_ Total DESIGN flow Number of current residents:, n Garbage grinder(yes or no): fze& Laundry(separate system) es or If yes, separate inspection required Laundry system inspected (yes o no Seasonal use(yes or no): Water meter readings,if available(last two year's usage.(gpd): '� d Sump Pump(yes or no)': "0� lQ 199(0 //_� 19 Ve � •T�P .�� .D Last date of occupancy: q& (� COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: qpd 1 Based on 15.203) Basis of design flow Grease trap present:(yes or nopp�resent: Industrial Waste Holding Tank or no)_ Non-sanitary waste dischargedTitle 5 system: (Yes or no)_ Water meter readings,if able: Last date of occup y: OTHER, ascribe) Lasl date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informa io � System pumped as part of inspection: (yes or no)-/-v0 p/ri NP/e 49,e If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components date installed 6f known)and source of information: Ov T3� /Y�4�'r O/Gt Sewage odors detected when arriving at the site: (yes or no) LAJ 0 revised 9/2/98 Page 6of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Arrowhead Drive,Hyannis Owner: Date of Inspection: Harold McLaughlin 12/12/98 BUILDING SEWER: (Locate on site plan) ^� ' Depth below grade: 3 Material of construction: --cast iron—40 PVC_other(explain) Distance Mconditiokof vate water supply well or suction line � DiameterCom nt joints, venting, evidence of leakage,etc.) SFJLUC-TANK: q!/I c fsspe o (locate on site plan) Depth below grade: �6 Material of cgtls��tior}Y. concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list agge/`_ .ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 6 w X 7 I e D•[/ G►-ud e I'D 6077'^z, Sludge depth: _ A"a„, II Distance from top of sludge to bottom of outlet tee or baffler /� t 7 113 Scum thickness: DAY Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlel tep or baffle: How dimensions were determined: 6raA sekdsna Comments: (recommendation for pumping,condition of inlet and outl t tees baffles,depth of liquid level in relation to outlet invert, structurat-integrity, eviden a of leakage,etc.) -A Nd N It QC .►/ rt I Ur .• C''09VPrIN e G SE P (locate on site plan) I Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) I Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle- Distance from bottom of scum to bottom of ou ee or baffle: Date of last pumping: Comments: (recommendation for ping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leak ,etc.) .001 revised 9/2/98 Page 7orn i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Address: 63 Arrowhead Drive,Hyannis Owner: Harold McLaughlin Date of Inspection: 12/12/98 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_Polyethylen �.ther(..Pl.i,) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in workin rder:Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condi' n 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 equ , evidence of solids carryover, evidence of leakage into or out of box, 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,conditi of pumps and appurtenances,etc.) i revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Arrowhead Drive,Hyannis Owner: Harold McLaughlin Date of Inspection: 12/12/98 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible; excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number, dimensions: overflow cesspool,number: EP4PP Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of pondi g, damp soil, condi'on of vegetatio etc.) 022 a S15P,s ole stiff i C. Ov ESSPOOLS:_ (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 groundw r: inflow ( spool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.I " PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hyd is failure,level of ponding, condition of vegetation, etc.) i revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 63 Arrowhead Drive,Hyannis Owner: Harold McLaughlin Date of Inspection: 12/12/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' ►Locate where public water supply comes into house) low" r{2o D � ISTWTS. ; SIC = 3q ; = .3-7 s.y' o Up �ssf a742,,e5e o� N N oT revised 9/2/98 Page 10of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address` 63 Arrowhead Drive, Ayannis Owner: Harold McLaughlin Date of Inspection: 12/12/98 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater_Feet D, , / ovt 77er" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site►Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers J 1-11 Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) �o�.L �a �� QU�►'Tldw � O /5 !j�d c�a.np. s t d� vrru r C iPSS/Odd _ -Pn Cdvy�r2�J / 3, #/w c�3 0 av�q E- .1 9,g &7 -1,9 ms 7�4�4 revised 9/2/98 Page 11of11 j