HomeMy WebLinkAbout0066 ARROWHEAD DRIVE - Health fi6 Arrowhead Drive
° Hyannis CP
A = 271 054
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TOWN OnnFB.�ARNSTABLE
LOCATION t 1. Y SEWAGE #
`rII:LAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK.CAPACITY ,,, Lp II
LEACHING FACILITY: (type) nil(W ►-f JQAsize) lL 1< Lo I
NO. OF BEDROOMS tt
BUILDER OR OWNER 11.
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) 511� � Feet
Furnished by J y
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LOCATION 66 �<<�w�ea//. [�f�✓Ci SEWAGE#
VILLAGE �yti�+��$'. '- ASSESSOR'S MAP&PARCEL 'MaP 2 I ?uw,f
INSTALLER'S NAME&PHONE NO:;<- I�+^') SOF- 3�S�S�1 G( 3
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS' ~
'PERMIT DATE: a- /� h COMPLIANCE DATE: r. M.,
v ti: Separation Distance Between the: Z_
-Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
rim ,,.
site or within 200 feet of leaching facility) ti , Feet
Edge of Wetland and Leaching Facility,(If any wetlands exist within
300 feet of leaching'facility) Feet
FURNISHED BY
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TOWN OF BARNSTABLE
L`ATION &/o AeakmfAD DR) ✓,c SEWAGE# ZW-y/7
VILLAGE -ASSESSOR'S MAP&PARCEL 171 5-4
638 39 5
li INSTALLERS NAME&PHONE NO. /V1 ' CQA TP-A67V9S - /NC. - ��g3
SEPTIC TANK CAPACITY I J�D�FONS
i r
LEACHING FACILITY:(type) { C 1,41f�l`"TGPMkS (size) -J7ZC7V(-jJ- f-zRh1,Jno�J
G�h�m�ElL ,
NO.OF BEDROOMS 3
OWNER A L-r
PERMIT DATE: �a f S�dU) COMPLIANCE DATE:
Separation Distance Between the: �y
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 fac )
ility) a) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist .
within 300 feet of 1 hing facility) Feet
FURNISHED BY
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rill
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r� :vow �aC�.-... !•�'_ ..... ... 3'� L�.�/ZD. s'17...::.-/ C7t7 -
No. Y1_7
. i !,. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpplicatton for Miopaal 6potem Construction Permit
Application for a Permit to Construct( , j Repair( . )Upgrade(Abandon( ) [VComplete System El Individual Components
Location Address or Lot No. W A-nVLt_--,,�,C Q-t Vc_ s and Tel.No.
Assessor's Map/Parcel
Installer's Name.Address,and Tel.No. ` S 2.BS-5 113 Designer's Name,Address and Tel.No. k5bco)-a�2-eb k 3Z
{JO�c �,G,G SalPVe�WLS , IhC .
+n k Ga_ v2. k YYIc� v
Type of Building:
Dwelling No.of Bedrooms Lot Size O 32 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day..Calculated daily flow gallons.
Plan Date to ' 1 Ll'?1'1 l Number of sheets Revision Date ?.4A
Title _S Dk�S4Gv►_
Size of Septic Tank S-0C7 Type of S.A.S.
Description of Soil, k_e�vy-N CA n& VVIQ r� C�c.Q--fie Sc�v1C�
Nature of Repairs or Alterations(Answer when applicable)
U P�t�`�.cSL� •�-o �v�,�iC yCc�S�VY�
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 WsObarMealth. 2 vZ
Signed I Ac Date I
Application Approved by Date
Application Disapproved for the ollowing reasons
Permit No. Date Issued
No. �i',i. «_ ."',( 'u'� t 1(" ti Fee�—
.THE COMMONWEALTH OF MASSACHUSETTS ; Entered in computer: . .
.Yes �r
_ PUBLIC.HEALTH DIVISION -TOW
N,;OF BARNSTABLE, MASSACHUSETTS
0(ppricat on' for M 'oogaY bp�tem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade(Abandon( ) 5/complete System .EJ Individual Components
A .i
Location Address or Lot No. Ude A iV c��.C' Qf w f. Owner's Name,Address andf Tel.No. CSv�j�
P
Assessor's Map/Parcel W ` `-`-'� �G� D�cr11L
Za 1 S Hen/ / U u/vent > C5
Installer's Name,Address,and Tel.No. L50C3�38S 5 l cl 3 Designer's Name,Address and Tel.No.
Po
3\?3 N�1�-vK•.�oc..l�-. `2c�• ,
va vt t S vhir `. 02 k « k .Mc- v
Type of Building:
Dwelling No.of Bedrooms Lot Size U 32 sq.ft. Garbage Grinder( )
Other) 'Type of Building' No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow A gallons per day. Calculated daily flow gallons.
Plan Date to ' 14 2.0 11 Number of sheets Revision Date "A
Title 'f U Sk.vv\- 6GS I
Size of.Septic Tank 5`0U 15 Type of S.A.S.
Description of;Soilt, C U c.f u
Nature of Repairs or Alterations(Answer when applicable)
' l�P ti r�c�� � S�_✓��� �iS�tiln.
.Date last inspected: t:
Agreement:
The undersigned agrees to ensure the construction and maintenance,of the afore described on-site sewage disposal system
4 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 Board of Health.
i Signed � Date��2 •UZ• �,
Application Approved by Date 17 -&L r/
Application Disapproved for the following reasons_
Permit No. 2 d 11 -If 7 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
3 0 0M S. Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (�)Upgraded( )
Abandaned( )by
at ,.,w61 ^.I has been constructed in accordance
with the provisions of Title 5 and'tye for Disposal System Construction Permit No. 2°f/'F//7 dated 2
Installer Designer
The issuance of this 7rmit shall not be construed as a guarantee that the sy tem wil u cti•n a designed.
Date L3 Inspector
. No. 101� ' �'1� / -----.----------------------------Fee
THE COMMONWEALTH OF MASSACHUSETTSIL
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
)0i!6Po2;a1 *pttem Congtructton Permit
Permission is hereby granted to Construct( )Repair( \/Upgrade( )Abandon( )
System located at
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. n
Provided: Construction must be completed within three years of the date of thi((sp b.
Date: " g' _- � Approved by 1Aila W4
02/oe/2012 15:49 5083856383 PKM CONTRACTORS INC PAGE 01
Town of Barnstable
I "
Itcgi lratory Services
2 _ Thomas F.Geilelr,Director
,"I` Public 11csalth Division
` Thomas McKean,Director
j 200 Main Street,111yalw1%MA OU91
OI'ttcm' 508-962A644
!'six: 508-190-6304
I
lliag"Jer&Dgibmma+Certification Form -
'� l?ate; 8 LoIL: Sewage re mit# 2aJ I'�f!7 Assessor's MapTure 1
Daffier: Installer: �K .�. 2S
7
Address; 9r 3 - l"4 Address: R,&X -1" -75 f L313 tf0K_d , ,euc 2,0
�M-.lovi Psa
. , AM Mpg o U L//
on 12 g ZD J was issued a penbit to install a
(date) (instal er '
septic system at le-Ift 905 based on a design drawn by
(aesigaer .
�zl rtify that Ste septic system referenced above was installed snbstantially accord'
q to
{ .the deSign, which may include minor approved cages such as lateral relocabiots of the
distribution box and/or septic tank.
I eettify that the septic referenced above was installed with major changes (i.e
k' greater tbjm 10' lateral relocation of the SAS or my vertical relacabon of cotzt ent
a of the septic system)but in accordance with,
Certified as-built by desig�r to follow. State&t,aeai Regulations- Ply revision or
a
i •
I1 er s 7 e at �
esigrier s Signahre) a'r s Stamp Mere}
BARMTATH.r. P 111" AL
LI WIL)L BE lS UPi AW
RE
LUNT
ATE , y t
4� �er Cdiifiatioa Farm Asvixd.aoc �• .t, ,s
'ro yvn of Barnstable P# a-5?-- 7
Department of Health,Safety,and Environmental Services
��oF1HE Public Health Division Date jp l
a o� 367 Main Street,Hyannis MA 02601
BARNSTABLA
MASS.
9�p>F16jq. �0 Date Scheduled ' Time ` Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed B �� Y���
y� �� FEE WitnessedBy�N�L�
:.
Q CA IC 1 T&PAN.]$IRA lY.F4
Location Address Owner's Name
Address
�-/-z'•-�.�,r;.>, 5 •�-t oaf
Assessor's Map/Parcel z7i /a,y Engineer's Name
NEW CONSTRUCTION REPAIR F/ Telephone fE -5-De
Land Use -24 Slopes % G2
P ( ) Surface Stones kJU
Distances from: Open Water Body !— ft` Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line /•U ft Other ft
SKETCH: (Street name,dimensions of lot,exact locations of test Doles&perc tests,locate wetlands in proximity to holes)
[l�
�1
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: 1/J Weeping from Pit Face N/
—14
lstimaieu Seasonal High Groundwater /L)
�ASQNAL:Ii(:CH.:9 AT T: BL .....;::.;;: <.,.;..;:
MethodUsed: �,1-� ��e �tri" . ...... ........................ ...................:...............................................
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.!tole: in. Groundwater Adjustment ft.
Index Well#___.•__. Rending Date:__T_ Index Well level.._•__ Adj.factor_ Adj.Groundwater Level__
:: :::: :::>.;;.::>:<:»:<>.::<::>::;: :PRC.OLATIIDN:.' ET:.::.::. ..::::::.Date..: :..:...::...::Ttmte:. ....
Observation J
Hole# I Time at 9"
Depth of Perc Z q Time at 6"
Start Pre-soak Time cci Time(9"- "
End Pre-soak eK
Rate Min./Inch L'Z
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
I
Depth from Soil Horizon Soil Texture Soll Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulderes.
A i ' c °/ Gravel)
10LrvIV&
DEEP:OBS�R�?ATTUNIQT� L(]rG Hale
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulderes.
Cos' ec % e
it
-c s o
E 'OSRVAA.1t QLE: QG<.<::' > ':
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Co i ' tenc °/ Gravel)
n�c :aBs �cor�:xoac:x
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
I
Flood Insurance Rate Map: /
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv9t,uxs material exist in all areas observed throughout the
area proposed for the soil absorption system? G�
If not, what is the depth of naturally occurring pervious material`'
Certification
I certify that on ci 41 (date)I have passed the soil evaluator examiq tiop approved by the
Department of Enviro ntal Protection and that the above analysis was performed by me consistent with
the required tr ' xp i se and expfinence,.des cribed in 310 CMR 15.017.
Signature _ _ Date b /5— Le�/
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
M
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Z
W s.
1 d
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY AS ED
SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR
PART A o 4 20�2
CERTIFICATION J U N.
TOWN OF BARNSTABLE
Property Address: 66 ARROWHLAD.DR,HYANNIS, MA 02601 HEALTH DEPT.
Owner's Name: GARRETTE KVIL C/O JIM MACNEILL
Owner's Address: MACNEILL&, ITCH PO BOX 549 SANDWICH MA 02567 4� 1.4
Date of Inspection: 5/14/02
Name of inspector: (please print) JOHN GRACI MAP
Company Name: SEPTIC,INSPECTIONS,,111C
Mailing Address: P.O. BOX 2119 TEATICKET, MA. 02536 PARCEL '
LOT
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT-
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
of the.time of the inspection.The inspection was performed based on my training and
true,accurate and complete as
intenance of on site sewage disposal systems. I am a DEP approved system
experience in the proper function-and'ma
�f
inspector pursuant to Section 15„34,0 of Title 5(310 CMR 15.000). The systei e d1d�en. r
_ Passes
X ColFuval,
es S�S�eM br � y �o" r•
_ Neuation by the Local Approving Authority
Fa
Inspector's Signature:
Date: 5/14/02
The system inspector shall suis inspection report to the Approving Authority(Board of Health or DEP)within
3U days ol'cumpleting ibis inystem is a shared system 0r has a desin flmv of 10,000 gpd or greater,the
inspector and the system owner shall suomit the report to the appropriate regional office ol'the DEP.'the original should be
sent to the system owner and copies sent t6 the buyer, if applicable, and the approving authority.
5
Notes and Comments
SYSTEM CONDITIONALLY PASSES TITLE V INSPECTION. RECOMMEND
"PO OVERFLOW. SYSTEMO
NEEDS
PROLONG THE SYSTEM'S USEFIJ,L LIFE. RECOMMEND RAISING CO
NI W TEE. ,;.- .
't 1,,5,
itions of use at that time.This
****This report only describes conditions at the time of inspection and under the cond
inspection does not address`iidw.the system will perform in the future under the same or different conditions of use.
'Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFAC"t"SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
Y CERTIFICATION (continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/CcAM MACNEILL
Date of Inspection: 5/14/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
SYSTEM CONDITIONALLY PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS
TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND RAISING COVER TO OVERFLOW. SYSTEM
NEEDS NEW TEE.
B. System Conditionally Passes:
X One or more system componeds,a`!Mescribfed 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.
n/a 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: n/a
n/a 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: n/a
n/a The system required pumping.more than`4 times a year due to broken or obstructed pipe(s).Tile system will pass
inspection if(with approval of the-=Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
i
ND explain: n/a
• S n
1
:1
4 IV
--Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
C. Further Evaluation is Required by theiBoard of Health:
_ Conditions exist which require Turther 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 JBoa;rd,4of.Health determines in accordance with 310 CMR 15.303(1)(b) that the system is
not functioning in a manfi%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
A
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 I 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.
'8.
The system has a septic tank and.SAS'.
the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method us'ed to determine distance n/a
"This system passes if the well;water analysis, performed at a DEP certified laboratory,for coliforni 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 i"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: ,
n/a
1,
i!•;x
!
�n4�, d�1
Page 4 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM.MACNEILL
Date of Inspection: 5/14/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or:system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent io the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
X Any portion of the SAS;cesspool or privy is below high ground water elevation.
X Any portion of cesspool o"r-phvy'is'within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is'within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 th!a"t 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 liave 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 systern 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
X the system is within 40.O:feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in:a"5:nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
+
Zone 11 of a public water-supply well
If you have answered"yes4,., any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large systern liaslailed. The owner or operator of any large system considered a signilcant threat
under Section E or failed under,Section C shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
tk-
Page 5 of I I
;n
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 66 ARROWHEAD:DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information,was pcgvided,by the owner,occupant,or Board of Health
X Were any of the system components Ypumped out in the previous two weeks
` , st=
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection '?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out'?
X _ Were all system components,excluding the SAS, located on site'?
X _ 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 ?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systemst'?,;
7. y1; iq
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no is? 1
X _ Existing information for example,a.plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CM 15.302(3)(b)] .
E`
Wage 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SI✓WAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02%
, ,LOW CONDITIONS
RESIDENTIAL i
Number of bedrooms(design): 3 . Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR'15.2L03 (for example: 110 gpd x 9 of bedrooms): 330
Number of current residents: n/a
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or n6):';NO
Seasonal use:(yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)):am
Sump pump(yes or no): NO w
Last date of occupancy: 9/1/01 {
COMMERCIAL/INDUSTRIAL .
Type of establishment: n/a
Design flow(based on 310 CM 15.203):'.n/agpd
Basis of design flow(seats/persons/sgft,etc:):.n/a
Grease trap present(yes or no): NO '
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title S;system(yes or no): NO
Water meter readings, if available: n/a "
Last date of occupancy/use: n/a <
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--:{•How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,a1tacl p evious inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
6
Approximate age of all components,date installed(if known)and source of information:
1965 Ill' ONVNEII x.
Were sewage odors detected when arriving at the site(yes or no): NO
•Y,•t
. .31j11 '•'- .
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
BUILDING SEWER(locate'on site plan)
Depth below grade: n/a
Materials of construction:_cast iron 40 PVC Xother(explain): ORANGEBURG
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,vent i ng,'evidence of leakage,etc.):
TOWN WATER '
i
SEPTIC TANK: X(locate on site plan)
Depth below grade: 0"
Material of construction: Xconcrete=metal_fiberglass_polyethylene other(explaiin'-a/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 5' X 6' CESSPOOL"
Sludge depth: n/a
Distance from top of sludge to bottom of outlet tee or baffle: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to,bottolii'of outlet tee or baffle: n/a
How were dimensions determined: n%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.):
SYSTEM CONDITIONALLY PASSES. UNABLE TO SEE CESSPOOL UNDER NORMAL USE,CESSPOOL.WAS
EMPTY ATTIME OF INSPECTION.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to botton.of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,;,tructural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
.. Ski ... . .
I:.
Sf •u"
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 66 ARROWHEND D.I 'AYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
1,
TIGHT or HOLDING TANK: i'(tan Y,k'must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction: concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a .
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: _(if present must'beopened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
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.):
n/a !
PUMP CHAMBER: _(locate on site plan) '
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
1 ,
44
i
1 {
Page 9 of I I ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
I
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
n/a leaching pits, number: nla
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
6' X 6 BLOCK CESSPOOL ' overflow cesspool, number:
n/a t• I'ti innovative/alternative system
ti Type/name of technology: n/a
t
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
OVERFLOW APPEARS TO BE STRUCTURALLY SOUND. OVERFLOW WAS EMPTY AT TIME OF
INSPECTION. BOTTOM IS AT 9'.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inletiinvert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a_
Indication of groundwater inflow(yes or n6):tiNO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction:.n/a :+
Dimensions: n/a
Depth of solids: n/a ,
raulic failure, level of ponding,condition of vegetation,etc.):
Comments(note condition of soil,signs of hyd
n/a :i r
Q
—Page 10 of 11
i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM MACNEILL
Date of Inspection: 5/14/02
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 ,,here public water supply enters the building.
�r
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
'I PART C
SYSTEM INFORMATION(continued)
Property Address: 66 ARROWHEAD DR HYANNIS, MA 02601
Owner: GARRETTE KVIL C/O JIM.MACNEILL
Date of Inspection: 5/14/02
a
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
5A
NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a
YES Observed site(abutting'jiroperty/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local'excavators, installers-(attach documentation)
NO Accessed USGS database explain: n/a
You must describe how you established, le high ground water elevation:
HAND AUGER- 12+ FT.
t
e.
h �+
ACCESS COVERS MUST BE WITHIN INSPECTION 9' MINIMUM.
6' OF FINISH GRAD PORT 3 ' MAX/MUM COVER
102. 81 FIRST 2 ' TO
BE LEVEL
CLEAN SAND BACKF I L L
99.4 � 98.25 9 .0 ll ' AROUND AND 2' OVER CHAMBERS
GAS
98.5 IteaFFLE� T-Q,5.9
3 OUTLET 10 HIGH CAPACITY /NF/TRATOR
'0 CHAMBERS /N TRENCH.FORMATION
FORMATION
D-BOX e.
1500 GAL
SEPTIC TANK 6- CRUSHED STONE OR
COMPACTED BASE
PROFILE -' NOT TO SCALE
1V .
PA
�1ApE F _
. � TP*p� ,: a
. �O TP*I �
p h
I N � 7 ='�v! t'� .5y��5._' /00.9 ,, ;; M � ri �./OdN/�sGPAC/�>Yy
L 0 T / �` C BY. TOP OFk�1NF14TRATORINd1AY
2 O 90J2t S. F. FOUNDATION
EL-I01.81 Ib•
CESSPOOLS
m (APPROXIMATE) �
P4T/0
`r \Ir
D-BOX h
150 GALL
SQPT, TANK
04 .
4
v
_• � LEGEND
CB CONCR
2, ar n
.r
-w WATER
L OCUS D O HYDRA
` —G GAS Cl
OV
OHIK�— -
�� y
x ..JI
. .. v r r
777
r
t
e
y
-
,
ACCESS COVERS _.
A S O RS MUST BE THIN
9 MIN/MU - �
I N ER T � V
. . L � ATIONS . l7 S:
Rl T�RIA
. GEl�1ERA L N//
6 :OF FINISH GRADE V TES
PORT `,
3 MAXIMUM COV '' .
ER .
INV
ERT ATBUILDING: 9.4
l02.8i : 2 DESIGN:FLOW.'
FI R5T 2 TO
NV r 9 I ERT tN SEPTIC TANK 8.5 3 E I. TH 5
BE LEVEL r BEDROOMS AT llO G.P:D. PER / PLAN /S .FOR THE DES/GN AND :CONSTRUCT/ON.
OF S
INVERT OUT SEPTIC AN 8.25 BEDROOM EOUALS 330 G.P.D. THE SEWAGE DISPOSAL SYSTEM ONLY.
TANK: � _
: pJ
INVERT IN DIST. BOX. 96 /T
' CLEAN SAND BACKFILL � r
2 E NO GARBAGE RI V RTlCAL DATUM !S'ASSUMED,o / g E, G GRINDER
rFOR BENCH MARKS
99.4 98 25 9 .0 AROUND AND 2 OVER CHAMBERS NVERT OUT DIST. BOX. 8.0
�. _ I 1
GA SET `SEE S l TE PLAN.
98.5 .v 96.9 INVERT 1N LEACH CHAMBER: 97.82
w. BAFFLE. 98. 17 97,82
SEPTIC TANK REOUIRED•
I0 HIGH CAPACITY 1NFI TRA TOR BOTTOM OF 6
3 OUTLET. LEACH CHAMBER 9 .9
- 330 G.P.D. X 200z - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
CHAMBERS I N TRENCH.FORMATION
D BOX ,,,, ADJUSTED GROUND WATER. NIA SEPTIC TANK PROVIDED: 00 A MAINTENANCE' OF THE SEPTIC C SYSTEM
1500 GAL 15 GALLON MINIMUM - S STEM SHALL
OBSERVED GROUND `WATER: NIA CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
`.. SEPTIC TANK 6" CRUSHED STONE OR
BOTTOM OF TEST HOLE I: 96.9 SOIL ABSORPTION SYSTEM REOUfRED BOARD OF HEALTH REGULATIONS.
COMPACTED BASE DESIGN PERC RATE C 5 MI NII NCH
PROF I L E : NOT TO SCALESOIL TEXTURAL CLASS I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER ~y'
EFFLUENT LOADING RATE - 0.74 GPDISF AREAS SUBJECT; TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0.74 GPDISF -_446 S.F. REOUIRED THAN 3' ` IN 'DEPTH SHALL BE CAPABLE OF WITH
' STANDING H-20 .WHEEL LOADS.
F PROVIDED: IO_HIGH CAPACITY INFILTRATOR
w
CHAMBERS IN TRENCH, 62 LF x 7.79'SF/LF 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR
- 463 SF x .74 GPD/SF - 357 GPD APPROVED EOUAL.:
c 7- 6. SEPTIC TANK AND D-BOX SHALL :BE REINFORCED
SOIL TEST T PIT JA l A & PRECAST CONCRETE AND`WATERTIGHT. D-BOX SHALL
I ND/CA TES I ND I CA TES
BE WATER: TESTED TO CHECK FOR LEVEL WHEN THERE
PERCOLATION OBSERVED IS MORE THAN ONE OUTLET.
TEST = GROUNDWATER
TP s/ Pl3287 Tp2 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE'.
1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR
FOR LOCATION OF UNDERGROUND UTILITIES.
0• 10I.0 O• /0/.0
Q LOAMY IOYR Q LOAMY IOYR ;
B. EXISTING CESSPOOLS TO BE LOCATED. REMOVED
SAND 3/3 SAND 3/3
ALONG WITH ALL CONTAMINATED SOIL AND BACK-
g• ...............:........................ l 00.3 1 0• .......................................... 1 00.2
FILLED WITH CLEAN SAND.
- LOAMY. IOYR p LOAMY IOYR ,
.?4•E D /6 SAND 4/6
A� 24 99.0 30" ... 98.5
# P Fo C MED-COARSE IOYR I MED-COARSE IOYR
o .; sTOCRAp A� SAND 6/6 SAND 6/6
t� o
TPs t
�J 42'
Q$
J
/ C'v v �.100. ' 10 HIGH CAPACITY
L O 1 ! " g. :i` INFILTRATOR CHAM .RS
BM. TOP OF ,.,. 8� -
J1 9032t S. F. o FOUNDATION 6 i
o
CESSPOOLS ,1,- NO WATER NO WATER
(APPROXIMATE) 120' 91.0 120• 9/,p
.i
PAT i/ =: Q
DATE: MAY �6. '2011
TEST BY: STEPHEN HAAS
°
Wf TNESSED' BY: DONALD DESMARAI S
D-box h PERC RATE: C 2 MI NII NCH 3
1500 GALLON
SEPTIC TANK
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if mil{
I S � P7r / G` SYS7-EM CUES / C/V
fah .ARR0WHE,A0 DR f VE . "AP e ,7 PARCEL .54
! . SA IT NS TA L� L , ( HY-A /VN / s > /VIA
PRE-FA RED FOR
4 PO 281,
r ^
( A/� y
f LEGEND
,
® CB CONCRETE BOUND
S CAL E : / _ ,2 p _j U/VE / 4 . 2 0
o, w W WATER LINE
^ n
_N1 �,' �' L OCUS K y, 4
1 / f `; HYDRANT
GAS L 1 NE
-�< OV
�, EAC L_ E SUFRV'EYI N I N
FAD W I RE5
°,afiq !"
� LIGHT .,POST
t /
: j'w923 Ro u t e� 5A
UNDERGROUND ELECTRIC LINE NE �'
..._,, Y d r mo u t t� p o r t MA 02675
T UNDERGROUND TELEPHONE LINE
508 362--813
--CTV- UNDERGROUND CABL EV l 5/ON LINE
._ -- 508 4-32-5333
40.4 .. SPOT ELEVATION
.-4
£XISTING CONTOUR ,
-1401 PROPOSE .::
D CONTOUR ,
C MAP
0 .
fD
2D 40
.-.
� JOB N0: .{ - , , ` .x, 1 �4{ F{E"L D CANAL CAL C. 5AH/C'FW CHECK. CFW DRN. SAH
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