HomeMy WebLinkAbout0223 ARROWHEAD DRIVE - Health . 223;ARROWHEAD DR:
A -':270 075.
r
�I
i
j TOWN OF BARNSTABLE
LOCATION 02.3 SEWAGE# �70/.7 'O6�
VILLAGE yan►.oivs ASSESSOR'S MAP&LOT TO S
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /J DO
,7-X,90 O p
LEACHING FACILITY:(type)y'J�oa� 2SX/.r.8x .2 )(size) _7j /,1. X,
NO.OF BEDROOMS
BUILDER OR OWNER �_ iVo
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) ��� Feet
Furnished by
I.
i
Oac 4 N �
� o
O L
t O O
No. Fee.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - T6WN'10F BARNSTABLE, MASSACHUSETTS Yes
Q� 01ppYication for Mtoozar *paem Construction Permit
U
Application for a Permit to Construct( ) Repair X Upgrade( ) -Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot Ndaa5 Wnowke Q t'L/ w is Name,Address,and Tel.No.p,,,� $thIC01�
Assessor's Map/Parcel �,a �--7 5
Installer's Name,Address,and Tel.No. Sa-n S Designer's Name,Address and Tel.No.eASS Q
�-Mwmv-1 polo ►kk.626 f- EtveJ•s
50 2Tr�2 WNAEMU&I �� S v S 3 SS
Type of Building: Z
Dwelling No.of Bedrooms 3 Lot Size 2c)r cK9 sq.ft. Garbage Grinder (/J)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) V gpd Design flow provided �J4q gpd
Plan Date 2 IS_
(3 Number of sheets i Revision Date
Title
Size of Septic Tank Type of S.A.S. 2— SOU 6 CA(0A-AfbV—_S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable))051P4LL- I SL%>6PA_-111oJ1L Pe-"W 693 90X Z— Sorg
w 1 s cv o
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 Certificate of
Compliance has been issued by this Board of Health.
Sig / - Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
�l
;., No._ if e Fee
e t ' Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -4T�VIII�' Yes
OF BARNSTABLE, MASSACHUSETTS
Rpplicatton for �Dt,9tJo!5a1 ,pgtem Con.5tructton Permit- .
Application for it Permit to Construct( ) Repair.A, Upgrade( ) -Abandon*( ❑Complete System ❑Individual Components
Location Address or Lot Ndz�a3 Mik)wkE-M� bq-/ Owner's Name,Address,and Tel.No.A]4' grlJeol n A
6UPV�.,-cvti(�
2-'t'3 f_%&aU-.1NEPA) 5�L
Assessor's Map/parcel c7--1 0 /-7 5
+
Installer's Name,Address,and Tel.No. SCS„5 Designer's Name,Address and Tel.No.eASS eiy k� �" _6• l
()4UL MA"r► Z4sL� page i��3 4.p�nrc�i
Svc 3�S 3y Z�
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 2Ur cK sq. ft. Garbage Grinder (AJ)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.regriired) U gpd Design flow provided �4q gpd
Plan Date Z S' (3 Number of sheets ( Revision Date
Title
Size of Septic Tank 1 SOCK Type of S.A.S. 2—— 5oU Ci-tgm''��2S
Description of Soil
[ OCJ
Nature of Repairs or Alterations•(Answer when applicable)1 0S'l'P-UL. I SCO V'4IV,- �L'H=1v� . 6193 euX
Z' S
(��l.LcaJ Ci.(Ar(.��nS W( STy r.r✓ .
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'nbt to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
i' Sig no _ / Date 21
Application Approved by /,71 U Date
Application Disapproved by: `. Date
for the following reasons
+r
Permit No. Date Issued —
THE COMMONWEALTH OF MASSACHUSETTS
! BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS'IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X) Upgraded ( )
Abandoned( )by Paul- M(vZn iJ
at.aa.'� k tDwN Lad) WL_ has been constructed in coo dance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer POOL "mun t-i Designer P�aSS 21�� L 1 �nl nllr �"
#bedrooms 3 Approved design flow 3 9 gpd
The issuance of this permit shalknot be construed as a guarantee that the syste`mw'ihl nc�r• as esigned.
Date ��./ _ Inspectors .�
__ __
----- — — ------------� --------- Fee--��—��---��� ..
No. _ _ 6
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS
0tg�onl *pztem Construction permit
Permission is hereby granted to Construct ( ) Repair ( . Up ade ( ) Abandon ( )
System located at ,o2ot� AfZ4J.J►-( (��
i
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with itle S d the following local provisions or special conditions.
Provided: Constio must b�comp.eted within three years of the date of this
Date // Approved byUV' ) 1
A
r
i
Town of Barnstable
Regulatory Services
°.� Thomas F. Geiler,Director
Sr^B Public Health Division
639. i
o Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: ?LC 41-3 Sewage Permit# Assessor's Map/Parcel Z7D 75
Installer& Designer Certification Form
Designer: THOMA S /11C[—UA.N Installer: ?Nt "019 l AIJ
Address: R e 6 Address: 35U R:rZS
On 7_(2,�91 13 PAIL M P a7n 0 was issued a permit to install a
(date) (installer)
septic system at 2?-3 ,4WtA)P1F7A9 Dry., based on a design drawn by
(address)
BA SS P Arl, dated Z 15 13
/ (designer)
l/ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required was inspected and the soils
were found satisfactory.
Ott.
(Installer's Signature) Ala
Amyywrl
�V
(Designer' S ature) (Affix e tg gr t Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice fonnsWesignercertification fonn.doc
Town of Barnstable P a 3 6
Department of Regulatory Services
BAMSMOM Public Health Division Date
200 Main Street,Hyannis MA 02601
lAlt��Date Scheduled — Time I'tJ 2
D Fee Pd.
Soil Suitability Assessment for SewageDisposal
Performed By: T140MAS GLE wr,/ Witnessed By:DDN C / AJ r. A S
LOCATION&GENERAL INFORMATION vT
L.ocabon Address Z22 A � „ O� Owner's NameA� Q�
:/ Address �A/vTF}.�^M C �/'
Assessor's Map/Parcel: Z-7 0/7 5 Engineer's Name 1'[//'to J /"/1.L•.7EL
NEW CONSTRUCTION /REPAIR Telephone Q8. 396- �� I
Land Use 7`'- � Slopes(%) Surface Stones
Distances from: Open Water Body AM Possible Wet Area_Nk ft Drinking Water Well _R
Drainage Way_/t/A _ft Property Line >/d ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
140.Do'
CIA
gEx►
I L-1'fl.Op'
Parent material(geologic) QLYw,4 S44 / Depth to Bedrock /•�')`r
Depth to Groundwater: Standing Water in Hole: I�V Weeping from Pit Face /VQ �
Estimated Seasonal High Groundwater
DETE1 INATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION TEST Date Time
Observation
Hole# Time at 9"
11
Depth of Perc 10 Time at 6"
Start Pre-soak Time Qa fi Time(9" '1
X-C(Pre-soak •fit'- 1 1 (�J►I A7 `�
1AWv
Rate MinAnch L� 'I
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:NSEPTIC\PERCFORM.DOC
r ,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency-%Gravel
0 -A L-S Ib E3Z
I0 6IR
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency-%Gravel
A 3 2,
3D t 1' LS MA S 8
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Graven
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. -
Consistency,%Graven
Flood Insurance Rate May: 1 /
Above 500 year Flood boundary No_ Yes v
Within 500 year boundary No— Yes
Within 100 year flood boundary No_ Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring perv1�us!material exist in all areas observed throughout the
area proposed for the soil absorption system? *f
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required trai ing,expertise anj exp1rience described in 310 CMR 15.017.
Signature Date
Q:\S EPTIC\PERCFORM.DOC
_ -r.•--✓`w_r....•."w* -.r' � -�.,.-,..7,: n-1 ._-.-,_,.,r... .r--,�- ...�� �.. ,. ---. -,,.,. .,..gin^ -i,...,.ti.-;-r"^"_Y�-..,r*;...;
TOWN OF BARNSTABLE BAR-w Vj0 3917
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager AAA- A\1011f )tI
Address of OffenderrW2) Ayytx,() Ad, �lV MV/MB Reg.#
Village/State/Zip U'4 ()n)0t,'5 or)(OM
Business Name jam�/pm, on - 20
Business Address n r A
Signat:ure'<_of' EnfozcingY-Officer
Village/State/Zip
Location of Offense �/��� -Q (!�� -
Enforcing Dept/Division
O f f e n s e j� ! � ►l� Y /7t1/ /f'x" k-V)ll /.4)-7L<
Facts
i
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
E-C�
``''TOWN OF BARNSTABLE
LOCATION Z23AM �1 640 AlV- SEWAGE # ZOLZ
VILLAGE iJiS ASSESSOR'S MAP & LOT Z
INSTALLER'S NAME&PHONE NO.
seme ' /flee- ItA4- 1'014 /7AV-fe. ors �irLS'T e='�f
i
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNE
PERMTTDATE: �/400 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
i
a
w
No.
'(/6"" -C; ?;" Fee y v t'
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
��..• ••"' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplitation for 30i5pool *pg;tem Congtruction Permit
Application for a Permit to Construct( . )Repair( �)Upgrade( )Abandon( ) ❑Complete System 4 Individual Components
Location dress or Lot N Owner' Name,Address and Tel.No.
9-a3 ArPlt oti. i�£a97 �� /�J` 'P 04P EA1 7v,eA Q
Assessor's Map/Parcel O O 7 s- �e a 3 A"Gw /j fA )4
Installer's JVe,Ad s,and Tel.No. 7 'a �®' Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 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 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ���� /���/� /7'GvS� e Aoo c
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 is ed by this Board of HeBlth.
Signed Date 11_X1r_ 0-7
Application Approved by &AA16 Date 11 24 groy
1000,
Application Disapproved for the following reasons
Permit No. Date Issued
r.
TOWN OF BARNSTABLE
SEWAGE # ZCL
LOCATION 2� �� .
' VILLAGEn ASSESSOR'S MAP & LOT Z d-U-ls
INSTALLER'S NAME&PHONE NO.
' � /��j►�i'�c:L �ryt'.. y�liril ��i'LsE'• � �12ST ��(
! LEACHING FACILITY: (type) (size)
. i
NO.OF BEDROOMS
BUILDER OR OWNEIV
' PERMITDATE: D� COMPLIA DATE:
NCE
I
i
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
i Private Water Supply Well and Leaching Facility (If any wells exist
Feet
on site or within 200 feet of leaching.facility)
Edge of Wetland and Leaching Facility(If ahy wetlands exist
Feet
within 300 feet.of leaching facility)
Furnished'by
j el,j t
• ' Ili
Fee
NO.
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppitcation for 30i.5pozat bp!5tem Con.5truction J)ermit
0
Application for a Permit to Construct Repair O Upgrade Abandon Complete System Y3 Individual Components
Location dress or Lot No. OwneL's Name,Address and Tel.No.
Assessor's Map/Parcel 4),
? 00 7J 5`6;k
Installer's Name,Address,and Tel.No. 7 r Designer's Name,Address and Tel.No.
3 4v- y4,e
Type of Buieilding:
sF Dwelling No.of Bedrooms Lot Size 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 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Deicription of Soil
r. Nature of Repairs or Alterations(Answer when applicable)
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-
.34
stied by this I cate of Compliance has been Board of Health.
Signed Date
Application Approved by A�K Date
Application Disapproved for the following reasons
Permit No. Date Issued
- ————————---————————————————---———————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Comphante
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired (.,K)Upgraded 17/ C .17
Abandone by 12t
X,/P�C,IV /jpl rl �41r has bcen constructed in accordance
with the prpyisions of Tide 5 and the fo&Disposal System Construction Permit No�U dated
V
Installer_-V-ZZ-02� Designer A
The iska"nce of this permit sh I not be construed as a guarantee that the syst6m1will function as designeW
Date /00 Inspector %tTR)-A1AA u
E/
,.�•'
No.
-------------------------------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
liopozat *potent Con0trurtton 3permit
Permission is hereby granted to Construct Repair(.A )Upgrade Abandon,(
S Yst -0:4-t-
ern 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.
Provided:Construction must be completed within three years of the date of this Permit.
Date:w Approved by
k
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of Environmental Protection
one winter street, boston ma 02108 (617)292-5500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 223 Arrowhead Drive, Hyannis, MA Name of Owner: Kathleen Morris&Kathleen Ford
Address of Owner:
Date of Inspection: September 2, 1999 '
Name of Inspector: (Please Print) James M. Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: James M. Ford
Mailing Address: P.O. Box 49, Osterville, MA 026SS-0049 Map: 270
I Telephone Number: (S08)862-9400 Parcel. 075
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
✓ Passes
Conditionally Passes
Needs Further Eval By the Local Approving Authority
_ ails
Inspector's Signature: Date: September 6, 1999
The System Inspector shall su 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
V
SEP
1
404*0F 3 1999
-Ike
revised 9/2/98 Page Iof11
j Primed on Recycled Paper
.yA
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
INSPECTION SUMMARY: Check A, B, C, or D.
A. SYSTEM PASSES:
✓ 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 be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes,no, or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined"., explain why not.
_ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced.with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health)
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)
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)
THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS.THE PUBLIC HEALTH AND SAFETY AND
THE ENVIRONMENT:
t - The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for colifotm bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
I
I
revised 9/2/98 Page 3of11
r
-46
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA
I
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
D. SYSTEM FAILS:
You must indicate either "Yes" or"No" as to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
I
_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow.
I
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
j
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 1 of a public well:
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
I
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
coliforrm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
I
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public
j water supply well
i
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
i
revised 9/2/98 Page 4of11
i
i"
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
✓ _ Pumping information was provided by the owner, occupant,or Board of Health.
✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
n/a 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, excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for conditions 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.N.
✓ _ Detern fined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b)].
✓ _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 223 Arrowhead Drive, Hyannis, MA .'
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
FLOW CONDITIONS
RESIDENTIAL:
Design flow: n/a g.p.d./bedroom.
Number of bedrooms(design): n/a Number of bedrooms(actual): 3
Total DESIGN flow n/a
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry(separate system) (yes or no): No If yes, separate inspection required
Laundry system inspected(yes or no): Yes
Seasonal use(yes or no): No
Water inter readings, if available(last two year's usage(gpd): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: MA(Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
j PUMPING RECORDS and source of information:
Pumped 6 years ago-per owner.
System pumped as part of inspection(yes or no): No
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
_ Single cesspool
i ✓ 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(if known)and source of information: Approximately 30 years per owner.
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6ofII
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
BUILDING SEWER: _
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting,evidence of leakage, etc.)
SEPTIC TANK: None
(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 Certificate of Compliance_(Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day `
Alarm present:
Alarm level: Alarm in working order: Yes_ No_
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: None
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.)
PUMP CHAMBER: None
(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.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
i SYSTEM.INFORMATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, AM t
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
SOIL ABSORPTION SYSTEM(SAS): ✓
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits, number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number: 1
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.)
The overflow cesspool (6' Wx 4'6"T)was dry. The bottom to grade was 8'.
CESSPOOLS: ✓
(locate on site plan)
Number and configuration: 1 with overflow
Depth-top of liquid to inlet invert: --
Depth of solids layer: 12"
Depth of scum layer-
Dimensions of cesspool: 6' W x 4'T
Materials of construction: Block
Indication of groundwater: None (cesspool was dry)
inflow(cesspool must be pumped as part of inspection).
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
No liquid was present only solids on the bottom. The bottom to grade was 76".
PRIVY: None
(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.)
revised 9/2/98 Page 9of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA }
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
Map: 270
Panel: 075
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)
1q ,
f3 i S q
Ana- ios
revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 223 Arrowhead Drive, Hyannis, MA
Owner: Kathleen Morris&Kathleen Ford
Date of Inspection: September 2, 1999
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 30+/- Feet
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
Check local excavators,installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Using the Barnstable Topographic and Water Contours maps, the maps were showing approximately 30' +/-to
groundwater as this site. The high groundwater adjustment for this site (Ml W 29, Zone C, 7/99)was 4.8'.
I ,
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty
or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,
written or implied, relating to the system, the inspection and/or this report.
revised 9/2/98 Page 11of11
Locus o KEY:
x STING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION
Q PROPOSED CONTOUR:............. 2"PEASTONE
2 EXISTING SPOT ELEVATION:25.5 FLOW ESTIMATE: COVERS WITHIN 6" 3/4"-1 1/2"
PROPOSED SPOT ELEVATION:25.5 3 BEDROOMS AT 110 GAL/DAY= 330 GAL/DAY 101.31 OF FINISHED GRAD WASHED STONE
O TEST HOLE: ° FOUTOPNDATION ��-��c�m v INSPECTION PORT
O UTILITY POLE:-O- T� -fl,, a r� _���,,,
2 Q SEPTIC TANK:
" " ���r,�m �n ELEV.=98.37
FENCE LINE:
-� HYDRANT: 330 GAL/DAY x 2 DAYS= 660 GAL 1/g 3'MAX.
N RETAINING WALL:® egg COVER
Gy USE 1500 GALLON SEPTIC TANK ter^
Mq/ti4 a 97.95 (1'MIN)
S'T LEACHING AREA: ELEV.
USE 2-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF. DEPTH)WITH 98•2 ELEV. ELEV. 95.5
LOCATION MAP JELEV.
LOT 57&PART OF 58 a D-BOX H H ELEV.
4'OF STONE ALL AROUND (25'x 12.8'x 2'DEEP) (6"STONE UNDER) 4' 4'
(20,948 SF)
1500 GAL 25'x 12.8'
ASSESSORS MAP:270 PARCEL:75 SIDE AREA: (25'+12.8')x 2 x 2= 151 SF (0.74)=112 GAUDAY SEPTIC TANK
NOTE: EXISTING INVERT �6�OF STONE UNDER OR 97 52-500 GALLON CHAMBERS WITH
PLAN BOOK: 159, PAGE:41 ELEVATION AT CLEAN CHANICALLY COMPACTED 4'OF STONE ALL AROUND
BOTTOM AREA: 25'x 12.8'=320 SF (0.74)=237 GAUDAY ) ELEV. 25'x 12.8'x 2'DEEPFLOOD ZONE:C OUT=98.4 ( )
EE SIZES:
CAPACITY=349 GAUDAY INLET:6"UP, 13"DOWN GAS BAFFLE
OUTLET:6"UP, 14"DOWN AT OUTLET TEE
N bath TH-1 101.0 TH-2 101.0
BED bath KITCHEN TEST HOLE LOGS ELEV. ELEV.
BENCHMARK AT ROOM O/A HORIZON O/A HORIZON
LEFT CORNER OF LOAMY SAND LOAMY SAND
CONC.STEP ENGINEER: THOMAS McLELLAN,P.E. 10YR 3/2 10YR 3/2
ELEVATION= 100.90 8" 100.3 8" 100.3
WITNESS: DONALD DESMARIS,R.S. B HORIZON B HORIZON
BED BED LIVING DATE: 2-14-13 LOAMY SAND LOAMY SAND
ROOM ROOM ROOM 36" 10YR 5/8 98.0 30" 10YR 5/8 98.5
Stockade Fence PERCOLATION RATE: <2 MIN/IN C HORIZON C HORIZON
GARAGE PERC FINE-MED SAND MEDIUM SAND
/ S 77o12'2
4 E 48„ 2.5Y 7/4 2.5Y 7/4
/ 1011 149,70,
EXISTING FLOOR PLAN
1 120" 91.0 132" 90.0
\ NO GROUND WATER ENCOUNTERED
\
/ \ / 100 NOTES:
\ / f
/Stone Drive 1.VERTICAL DATUM: ASSUMED {
pqT/O \I / 2.MUNICAPAL WATER IS AVAILABLE.
s / 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
\ c
4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS.
\ 'CD
o / 0 5.PIPE PITCH= 1/8" PER FOOT(UNLESS NOTED OTHERWISE).
'` 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL.
u! co
co
000 / \
7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL.
p00\- \ 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL
PPRON 24" I CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS.
OAK + 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION.
10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'.
GARAGE // (`(f 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA.
/ Sy PAVED / J 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND
/ OR/VE / o IS SUBJECT TO CHANGE UNTIL SUCH TIME.
°nQ 13. EXISTING CESS POOLS ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED.
W�ORO M / c 14. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW.
U D 'OP fnd cl/V 101.31 0
cp
CID
1 o h th-2co
J
Y th-1 Sr /101 // /� 1 SITE PLAN
10 / I
99 Q .A LOCATION:
223 ARROWHEAD DR., HYANNIS, MA
St0 W \ 1 oA l 71, PREPARED FOR:
101- ckade Fence me fuxl
oy \ I ANA BENEDITA BOAVENTURA
14 DATE:2-15-13 SCALE: 1"=20'
N7 .561
7°1224"w // a w. '
BASS RIVER ENGINEERING
100 / TH'lOMAS J. Mc LAN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641
M13-05 508-385-3426