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HomeMy WebLinkAbout0252 ARROWHEAD DRIVE - Health 252 Arrowhead;,Dr ve Hyannis . NFE y A = 270 090 a i e 0 u¢ it a b Q TOWN O cB�ARNSTABLE LOCATION (�S I����hQ 1Jr SEWAGE VILLAGE CcA n 'S SSESSOR' MAP&PARCEL IN6'AUAW4?.=S NAME&PHONE NO.. �X-1Q SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 .OWNER. We ) Suc.S, C PERMIT DATE: C ATE aP. 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 Arrowhead Drive Water Service j •1 14 40 28` 49• 4 � Commonwealth of Massachusetts7s w Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 required for p 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 Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name ' VQ 189 Cammett Road Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ~ April 25 2008 Inspector's 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. 07-289 Ocwen.doc•08/06 ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 r � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mills MA 02648 April 25, 2008 required for p every page. Cityrrown 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 ® 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 I indicated below. Comments: Tank has liquid only, no solids. Leaching system shows no signs of hydraulic failure. 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 07-289 Ocwen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 �• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 required for p 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. 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has aseptic tank and SAS and the SAS is less 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 . ❑ ® 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_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. 07-289 Ocwen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mllls __ MA 02648 April required for pl 25, 2008 i every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. ❑ ® 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 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. ❑ ® 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. 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, 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. 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls _ MA 02648 April 25, 2008 every page. Cityrrown 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 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? ® ❑ Was the site inspected for signs of break out? ® ❑ 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 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. ® ❑ 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)] 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 i Number of current residents: 0 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 108,750 gal. _ 9 ( Y 9 (gpd)): 148 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: November 2007 Date 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): 07-289 Ocwen.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property.Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mllls MA 02648 Aril 25, 2008 required for _ p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ 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) ❑' . Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information:. Compliance date: 10/19/06 Were sewage odors detected when arriving at the site? ❑ Yes ® No 07-289 Ocwen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 r Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mllls _ MA 02648 April 25, 2008 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 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) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 01. Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 11 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? Visual 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane Marstons Mills MA 02648 required for April 25, 2008 every page. Cityrrown 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.): Tank has liquid only, no solids. Liquid level was found at bottom of outlet invert. Tees are intact and clear. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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): 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 every page. Citylrown 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 0 11 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.): No solids or high stains present. Liquid level found at bottom of single outlet pipe. Pump Chamber(locate on site plan): Pumps in-working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls _ MA 02648 April 25, 2008 mo every page. City wn 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: ® leaching chambers number: Five Infiltrators. ❑ 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.): No standing water in infiltrators and no signs of hydraulic failure 07-289 Orwen.dac•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven_ Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls _ MA 02648 April 25, 2008 every page. Citylrown 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, etc.): 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.): 07-289 Ocwen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 13 o1 115 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address -- Ocwen Asset Services C/O Jack Creaven Owner Owner's Name information is 167 Lovells Lane M: :--!nns P•.IIlls MA 02648 Ar required for ,___ _ ., _— pil 25, 2008 every page. Cityrrown State Zip Code Date of Inspection D. Systein information (Cont.) Sketch Oi Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at leas, two rn—innort reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where puu,ic wiLer supply enters the building. Arrowhead Drive Water Service / / \ \ \ \ \ \ \ \ \ \ \ \ \ \ _ \ \ \ \ \ \�\-\/ \ \ \ \ \ \ \ \ `/ / / / / / / 14 40 28 49 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 Arrowhead Drive, Hyannis MA 02601 Property Address Ocwen Asset Services C/O Jack Creaven_ Owner Owner's Name information is required for 167 Lovells Lane Marstons Mllls MA 02648 April 25, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record It 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: U�GS topo map and town GIS. You must describe how you established the high ground water elevation: Town ground..1-3ter contour map shows water at el 25 and topo map shows property at el. 50. 07-289 Ocwen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 115 Town of Barnstable OFtME l� Regulatory Services BARNHABM Thomas F. Geiler,Director v MASS. E1639. 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 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. QASEPTIC\Disclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE 1.f1• 'LO.O ION �S � 17Q SEWAGE# No ' 04Y 'VII,LAGE Iz,o.r1,n , S ASSESSOR'S MAP&PARCEV", -70 r, INSTALLERS NAME&PHONE NO. Cc na 4,c�Q �v� s�'� Yag YoQ2fs SEPTIC TANK CAPACITY t 'C LSc�O 1-F t � .� •: LEACHING FACILITY:(type) (!ft tr,r-I}rQ 6 (size) µ NO.OF BEDROOMS OWNER I)a ma se-2n C) PERMIT DATE: /®//7A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d 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) f Feet FURNISHED BY ` 4 9 c . No. �o Fee 0Ve, THE COMMO'i WEALTH OF MASSACHUSETf'S Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppYication for �Diq;paal *- pgtem Con.5truction permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 2 S2 4tr0. )0e,9- ( DO-N`2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z't b —rj 0 Installer's Name,Address,and Tel.No. ��P � e Designer's Name,Address and Tel.No.£h��k<ci��� t.Jo2t•) `{L$ �pL� i13 �C.7 /tw. (lossF:t.(d rcd4c� Type of Building: + Dwelling No.of Bedrooms Lot Size 90 l a ^ sq.ft. Garbage Grinder ( ) Other Type of Building S_!mot,(t .Ll No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 a gpd Design flow provided 330 gpd Plan Date 1 o't —2� `��� Number of sheets �L Revision Date Title Size of Septic Tank :1 on,( Type of S.A.S. Sin-41 T-�t4--� LLr�CL Description of Soil SS?A IkL", Nature of Repairs or Alterations(Answer when applicable) �J�e( Tk�+ �—�` ✓ I✓mac, 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. Signe Date /O Application Approved by Date /� _ 2 Ze— Application Disapproved.by: Date :for the following reasons Permit No. (D Date Issued © `' ...�- - . •r . .,-....�niar:a�7"."'�''.,�`.:w- .,�J� °�t'.''%.�:�.tv...Jw:r-w:. "-e�"V.L::�S:rN+"""`- -.... k!""'+4r=.:+i:}�`o.^a;�vro.=,r.. .. .-,- .v,,,.".� /Ves . . No. Y t Fee , 0 THE C7.MMG'1WEALTKOF MASSA&USE—T-TS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for � gpogal gppgtem ongtruction Permit rApplication for a Permit to Construct( ) Repair( ) Upgrade'4) Abandon(' ) W Complete;System ❑Individual Components Location Address or Lot No. 2 S 2 Adio J�1 w c( T�r,�Q Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2t—4 Installer's Name,Address,and Tel.No. C fin 'c�n .��h'i(In j Designer's Name,Address and Tel.No. v � _ ( - i3ox c,j 1 1Zw. GustF,cic) vC��F � SRO ��vG `(GLb N✓-'d n �t� 'o(P 5 r T") 1 Type of Building: + Dwelling` No.of Bedrooms Lot Size �� — sq.ft. Garbage Grinder ( ) -Other Type of Building 5 1 -L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 336 gpd Design flow provided 3 y gpd Plan Date Number of sheets Z- Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ) Soo p t Th-r, k zo f-r ¢��+-{w i✓P�-�c L, ry y�q Date last inspected: Agreement: „ f 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. Signed Date / `1 60�, Application Approved by Date I ea Application Disapproved by: Date r for the following reasons Permit No. � ~�D C1 CK �.,- _,_Date Issued lo ? ———————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance Yr 1 THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded) 'Abandoned( )by at 2�2 (yr�o�� � has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoO �7 7 dated :� Installer-(�-�" C Designer E�1(l�no a.L.w� (.Job c 5 #bedrooms 3 Approved design flow '_� C) gpd The issuance of this permit shall/knot be cornstrued as a guarantee that the system will furfctio'n as dKsigne�d. Date /� N Inspector_ �1,., '-�� v No. - '-� `t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS I i!5poga[ *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade Abandon ( ) System located at 2-j Z. A<-1 o a I.lk ,,a_J ,, bl- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special con itions. Provided: Construction must be ompleted within three years of the dat of this perm t Date Approved by Town of Barnstable ; OSRegulatory Services Thomas F.Geiier, l4irectar, WANNOWA Public Health Division Thomas McKean, Director -----__.�_-- 200%fain Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508 740-6304 Instaallea er ertifi fifta wd%— Date: 1Q -q-f-''� Sewage Permit# Q10 - 4�(��Assessor's Maap\Parcel�70 0 Designer: — Installer: Addreas:. . � b Ad&ess: t onN�4as issued a permit to install at< date) (installer) 2�Z 1 septic system at ArvvLAtoA T:._.9\4Gl rnvk,c based on a design drawn by p� (address) dated 16 L� 21 (designer) I certify that the septic system referenced above was installed substantiWl;y according to the design, which may include nriinor approved changes such as lateral relocation of the ` distribution box.and/or septic tank. 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. t / P�J H OF Njgss ! nstaller's Signature) g� PETER T. N o MCENTEE T4 CIVIL cn o NO.35109 lei GG _ 9�� 9�C/ST (Designer's Signature) (AI= mp Here) 14 $AN E WILL NQX AL=E12 &Q!U 'r= 1FQJl N A-NA? A OU1,161' CABALA" 1tF.��i�'1?:��1'�,}➢�.�A��i�,�.'j��,p � H,e—C i�.AL�IDdV S�nN,,, T7EtA:°diC Y011. Q: HeulthlSegtic/Designer Certification Form.).26-04.doc Town of Barnstable P#' $ Department.of Regulatory Services ,,, ,,," : Public Health Division Date Q ' 200 Main Street,Hyannis MA 02601 r, Date Scheduled Time! Fee Pd. 0 0 Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed LOCATION& GENERAL.INFORMATION Location Address Owner's Name ° . ' fie.tc�t rz� 5 �'KA Address Z5-2 g24z0u3 ac+.-4 OLc.o ( Assessor's Map/Parcel: 0 0 Q Engineer's Name NEW CONSTRUCTION REPAIR V Telephone# Land Use' l2esest } o`( Slopes'M Surface Stones N Distances from: Open Water Body>ZfJU ft Possible Wet Area?t o y ft Drinking Water Well 7 ft Drainage Way _!e�ft Property Line �� ft Other ft SKETCH:(Street name,dimensions of lot exact locations of test holes&perc tests,locate wetlands�n proximity to holes) N a Q Parent material(geologic) 6A&'CC Al U j�aS Depth to Bedrock r 3Z Depth to Groundwater. Standing Water in Hole: > Weeping from Pit Face ,4VA Estimated Seasonal High Groundwater t DETERMINATION FOR SEASONAL HIGH WATER TABL . =j m Method Used:Depth Observed standing in obs.hole:�`P_ in. Depth to Soil mottles: in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr. Index Well# Reading Date: Index Well level,� m-�, Adj.thCtor. Adj.Groundwater 1dvel,,,e PERCOLATION TEST Date Time,. Observation 7i Hole# me at 9" Depth of Pere lam_ Time at 6" Z NI`'`� 1 nGL, Start Pre-soak Time @ ' �:1 �O/4 LL '15me(9"-6") -— J 1'YI R J 3 eJ }tJ' End Pre-soak �albr S , }{Za Rate MinJlnch Site Suitability Assessment: Site Passed _ SitcFailed: 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 Conselrvation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consiste yell ffZ3/3 DEEP OBSERVATION HOLE LOG Hole# 2' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA), (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% . o-- ' - A • 5L to �'i�'3/ - Z4 6 5(- IdV4s/Y DEEP OBSERVATION HOLE'LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy.%Gravel) i DEEP OBSERVATION HOLE LOG ; Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones'.Boulders. o s' Flood Insurance Rate Man: 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 pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _X�e S __ 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 . i the required training,expertise and experience described in 310 CMR 15.017. 'Signature Date ---� . I Q.\SBPTIMBRCFORM.DOC .T COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE 7RECEIVED MAY 0 8 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A _ CERTIFICATION MAP Property Address: 252 Arrowhead Road PARCEL. ' Hyannis LOT ' Owner's Name: Jose'Costa Owner's Address: Date of Inspection: 5/1/2003 Name of Inspector: (please print) Kevin J. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 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: .,� 1 J Claw! 2(� 1 t 11`,57z11U1 Passes Conditionally Passes QFJPQ„✓L @ IVI VA412 y S-I� y�i, dl�. =Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: 1 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 nt � .�. t.._C,c��.... �:'T ` . o�.�.r :� .� e-,-�"'_ t'.4•\�^.g Cc. lcr z;-S �a �.l�ae;,-�. .:\:•..� L C A< 7z' ****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: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D C. 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: 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 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: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 C. Further Evaluation is Required by the Board of Health: onditions 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. _The system has a septic tank and SAS and the SAS is less 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 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. 3. Other: 's y.Y Yww •a�AJ�•C-�-.. rc�W\ r Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 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 Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _iz Liquid depth in cesspool is less than 6"below invert or available volume is less than '/a day flow _IZRequired 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. ZAny portion of a cesspool or privy is within a Zone 1 of a public well. _Z Any portion of a cesspool or privy is 50 feet of a private water supply well. _jZ 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 determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a acility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the fo owing: (The following criteria apply to large systems in addi ' n to the criteria above) yes no _the system is within 400 feet of a surfs drinking water supply _the system is within 200 feet of a utary to a surface drinking water supply _the system is located in a nitro n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water sup y well If you have answered"yes"to any estion in Section E the system is considered a significant threat,or answered "yes" in Section D above the lar system has failed.The owner or operator of any large system considered a significant threat under Sectio or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner s Id contact the appropriate regional office of the Department. i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 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 —te'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) _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? 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 baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? xl 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)] ` Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa .Date of Inspection: 5/l/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 0� $j, Number of current residents: _ Does residence have a garbage grinder(yes or no):,e� Is laundry on a separate sewage system(yes or no):,Cb[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):" 22, Water meter readings, if available(last 2 years usage(gpd)): �l = �G��,f?jj, act 3<nk 6�11j Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment:_ Design flow(based on 310 CMR 15.203): d Basis of design flow(seats/persons/sgft,etc. . Grease trap present(yes or no): Industrial waste holding tank present es or no):_ Non-sanitary waste discharged to a Title 5 system(yes or no): Water meter readings,if availa Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):,�a� 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 _ Averflow cesspool 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) _Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):/Uc'J 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: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspections 5/l/2003 BUILDING SEWER(locate on site plan) Depth below grade: -Q Materials of construction:_cast iron 1--"4'0 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Cesspc�l &EP9FfeTAdNK: (locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene _je!-6fher(explain) G3�-:��L If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: x Sludge depth: y" Distance from the top of sludge to bottom of outlet tee or baffle: -Q) _ Scum thickness: 1;)" 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:`—r-Z - Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ✓--- C -S-r- s� * \n , Aa .� \. l . 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 ou t tee or baffle: Distance from bottom of scum to bo m of out tee or baffle: Date of last pumping: Comments(on pumping recom endations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evi nce of leakage,etc.): i Page 8 of l 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 TIGHT or HOLDING TANK: (tank must be p ped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete meta fiberglass polyethylene_other(explain): Dimensions: Capacity: Viorking Design Flow: y Alarm present(yes or Alarm level: der(yes or no): Date of last pumping: Comments(condition tches,etc.): DISTRIBUTION BOX: (if present must be ened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribu ' n to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate o tte plan) Pumps in working order(yes or Alarms in working order(yes no): Comments(note condition pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type __Zleaching pits,number: leaching chambers,number: 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.): p cu.c.r-- 44\o GES S: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 ac 5' x I? Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction; ,�►o� _ + �3s e,vG Indication of groundwater inflow(yes or no):A.2c-:) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): t < < 5 � .vl — 4-1.s j S a�w � ZTT` �r`�t�.'�Csc��. �w.`.�.� t.txa^C''e✓r^ PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note conditio of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 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. n 6 A\- I - sS O Gcss�� 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: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 SITE EXAM✓ Slope Surface water Check cellar Shallow wells Estimated depth to ground watery feet Please indicate(check)all methods used to determine the high ground water elevation: _-\—Abtained from system design plans on record—If checked,date of design plan reviewed: 5�g> 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: //�_S°ZI ��LIYL 4 �E3 f - Ael Commonwealth of Massachusetts Executive Office of Environmental Affairs & C De artment of Mq� .z Environmental Protection Z 1996 William F.Weld Govemor Trudy Coxe te seuery,EOEA g (J David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION buyer v Property Address: ,Qsa I"Jhead P,-i✓e yyG��i S Address of Owe•: �' QUA�e Tr' Road Date of Inspection: SI6t6/96 —3/a�96 (If different) !'(�pvi/c e :yiou.yT'a/n Name of Inspector: Caro/yl1 T Q ay�if, SRHclwr'�h, m�9 Oas"63 Company Name, Address and Telephone Number: C T Eny;4eei-i✓/� 48 6u/l y L pnE. sQ�,a'w I c ,^'q 035 63 CERTIFICATION STATEMENT (54 J&0-- 1 cer14 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: —Z Passes _ Conditionally Passes _ Needs Funher Eval:iation By the Local Approving Authority _ Fails Date: 1)7,m�h v !9 99 Inspector's Signature: r %'``• •;�-••.�-•� '�•�``•/ �"'`�'u;;?rah :'::,`•'� i The System Inspector sha!l submit a copy of this inspection report to the Approving Authority within thirty (30) days of co s inspection. If the system ;s a share; systen.-: or ha- a design fiov: of i0,000 gpd or greater, the inspector and the system owner shali submit the repo" to the apnrep-!a:c reg;c-at o ;ce of the nepa.^,men.? of Environmental Protection. i ne origa;:. ",v,.-U Uc ._ �.•.. C _ ,C', aj r°. ._ : .: 'Y' INSPECTION SUMM4,R1: Check A. B. C, or D A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or,more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. 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, 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 conforming septic tank as approved by the Board of Health. (revised £/15/55; 1 One Winter Street • Boston.Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: A5�P- q/-110a/hPQ6/ 404r_41C, Aly0n17i5 Owner: E/hi/y QaN�G'TT Date of Inspection: 6/9(0 B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 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 -ill pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH'AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (A.ND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERWNES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE E,�VIRO,'.N1E'�T: ..1_•'��.�__ t flf' ' lic. A �rf't.l 1a11. Gllu JlI1' OVJViF/li V•' J)JlC• ' a'•v IJ' .Vu flCl�ti ltl�i�.. lu u J� ••�•� -�r'r "' '-'-' _ •• surface water supply. _ The syster• hay a septic tank and soil absorption system and is within a Zone I of a public water supply we ° _ The system has a septic tank and soil-absorption system and is within 50 feet of a private water supply .veil. _ The systen-, haJ a septic tank and soi: absorption) system and is less than 100 feet but 50 feet or more frc:r. a private supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm- __D]• SYSTEM FAILS: _ - - - --- - ------.— --- ------- ------ -- — --- I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. - _ 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. 2 (revised 8/15/95) I . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / CERTIFICATION (continued) Property Address: o"'S� f�/`/`ou1C'a U VI-1-Vel y ahn�5 Owner: �jss/ lY Q6i TT Date of Inspection: Dj SYSTEM FAILS (continued): 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 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: The follow;ing criteria apply to large sy s*ems in addition to the criteria above: The oe_ign fiov: of sys;ern is i0,0 :: gp� or grease: Marge System; and the system is a significant threat to public health and safe;, and the environment because on, or more of ih,� folio%vine conditions exist. the system is within 400 ieet of a surface drinking water supply the s<'ctem is \+ithin 200 feet of a tributary to a surface drinking water supply _ the s-\soe.n;r is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IVA'PA) or a mapped Zone II of a public dater suppiy we;' The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5:00 and 6.00. Please consult the local regional office of the Department for further information. (revised-8/15/95) 3 t 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ��a ffri Ou��P4p ��`ivP� �{ygr/rlis Owner: ��;/y 0,71i r e 7-7- Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, ec.c-wpaat, and 9e&+ef+feaW. 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 \vaier have not been introduced into the system recently or-as part of this inspection. NL As built plans have been obtained and examined. Note if they are not available with N/A.(IOC47*n Plea Orl/y) NOThe facility or cl\velling was inspected for signs of sewage back-u e o� i�SDeGno`� p g g P• r101lLCPSs •q'T �!� d1V&j11n9 V/The system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. in �;n �/AII system components, ��the Soil Absorption System, have been located on the site. C«Qoo/ CPSs�Oo/ ,/The k manholes were uncovered. opened, and the interior of the se E 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 locat:on o the Soil Absorption System on the site has been determined based on existing information or approximate: b. ... _ .. _. v.•e.n ?,ovideP \601 Infn­np.!inn on the f ron­ maintenance of Sub- Surface Disaosai Svs!em (revised 8/15/55" 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: /�i`i`Ou/�1Pa q�0�`i✓P yGr r»i 5 Owner: Cyr,'/y Qa�/GTT Date of Inspection: o't/a6�y6 3���Q(rs FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: .I Number of current residents: vZ Garbage grinder (yes or no):1167 uloS�e spy-,eno�✓�r i��� /7� !�S e- Laundry connected to system (yes or no):_ J/vO/fir/ Seasonal use (yes or no): /70 \•Pater meter readings, if available: / � Veto e f/o u/ �or�la3 yea DEi' iUu7`Pr �eDr Last date of occupancy: COMMERCIAIJINDUSTRIAL: Type of establishment: Design flos.•:_ allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes-or no)_ Non-sanitary waste discharged to the Title i system: (yes or no)_ Pater meter readings, if available: Last date of occupancy: OTHER: iDescribe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information: t �i»OPG� CIOOMX 3 kea�s er go Oe,` EMi/y �a/•�77'�C ur�P:�7"pwnerS �9 �� System pumped a ra^ n`�n. Wes or no' -Y5 / /p/orl A1�T�9& !? .e?. %olurnr, n,::r...:: �0O gallons by eo �115he Reason for pumping C25S�OT O/ l`egyi/PC[ �n �Y�q rlv 7`�bns t/ TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool t/ Overflow cesspools ...Pri Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE'AGE of all components, date installed (if known) and source of information: 0-,P T -47Le �S -R)r �egs�oo `02 /0/may/80 �or- /f it few ljOh� i Pe co f-a& (O re P-Fler0 i cvq?#a� Sewage odors detected when arriving at the site: (yes or no) /0- tre•.ised 9/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: x5�� Owner: EN��'/�, (jc�r r e'77— Date of Inspection: 6 SEPTIC TANK:tiI� (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffie: 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: 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:19 (locate on site plan) Depth below grade: " Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum, inickness. .Distance from top of scum to top of outlet tee or baffle: 'D:5t2-ce f-o n boty— !"P.Orn (i' ('tl:'ai too n• nanr Comments: (recommendation for pumping. condition o-' inlet and outie: tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc (revised e:_5/351 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) /0-,ve Ilya Property Address: ,75�9- fJ.,- 0 Jh Pu HniS Owner: ^-e- T- Date of Inspection: a/�6�9( 31,-A96 TIGHT OR HOLDING TANK:N/W (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —Other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:/t/,'� (locate on site plan' Depth of liquid level above outlet invert: Comment<_:nts:mute ii c:U U:�li L u::.• i'y c.. �!'.�i v. .".Jencc of lcanagE I:::O c, of box, etc PUMP CHAMBER:A'14 (locate on site plan) Pumps in working order.(yes or no) Comments: _ (note condition of pump chamber, condition of pumps and appurtenances, (revised 8/i5/95) 7 o r) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �L�c—,1L al4 Pu a/ tve, //ya�n c,5 Owner: e/hi/yre7'7— Date of Inspection: 9/a6/96 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by no methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number. leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) eyi• e 0,11 Ihu r CO w/`el I-&Q o 5i lJoCh-Pai Ay a)2oye- T mi-e-AT) -ne cle.yat'okQ5 ,jek lever CESSPOOLS: -Z (locate on site plan) Number and configuration: / .orer-F100 S 70 Depth-top of liquid to inlet invert: /off- Depth of solids layer: Depth of scum layer: /M Dimensions of cesspool: (o r 'OrNeTer �169 fjelo J /eT invert TU b"7 o�C055P�o Materials of construction <'OilCP2T2 b/CCK h/ o/ � JOc-7T-� noN G inflow (cesspool must be pumped as pan of inspection) Comments: (note condition.of soi:, signs of hydraulic failure, level of ponding, condition of vegetation, etS.; e e�Pd cv.� .have �O / he- . �/i�/6TTP� �n.�Tz!/ev/v„ 3/�/96 by /�icv/ nods •e/Q/J 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.) (revised 8/15/95) 8 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5� Owner: Eli/y 6tf1-�eT7- Date of Inspection: ,L1,-2Z176 r-- 3/.2-11?6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' - t I ' I 1 � 2S� /IrrDG/�1eac� Qr. . N 6 z it c � �erj✓`�rJo� #a. � � ess�� CessPoo/ #/ , DEPTH TO GROUNDWATER Depth to groundwater: a-Lp-30 feet method of determination or approximation: el- /D e%v at 7e e 7uble IP�«rio� A.y—The 5. r-e is ,be7`criee-� a-D�3D-FTUhovP SPc�IPve/ �e Gzji�� � q'rDuN�wu7`Pr = o�CJ-3o f'ee7- r (rev'-sea 6/15/95, 9 1 Mai 07 03 11 : 25a Kevin Sullivan 508-888-0242 p. 2 COMMONWEALTH OF MACRON SETTS NiENTAL AFFAIRS EXECUTIVE OFFICE OF DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FO SEWA—NOT FOR GE DISPOSAL US A FORM ASSESSMENTS RY SUBSURFACE PART A CERTIFICATION Property Address: 252 Arrowhead Road _Hyannis Owner's Name: Jose'Costa Owner's Address: Date of Inspection: 5/1/2003 Name of Inspector: (please print) Kevin J. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 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 15340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes _,LNeeds Further Evaluation by the Local Authority Fails Inspector's 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. Notes and Comments P T j" o L C V�G� �"� C►v�G �.+�. --Oki P�.�'►o:..� �- l C U v-.\ r—d-t+: Jam'•�� @ x - C�6a Q.T��a v..� ****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. Ma8 07 03 11 : 25I` Kevin Sullivan 508-888-0242 p. 3 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART A CERTIFICATION(continued) I Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. 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: 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: I 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 obstruction is removed ND explain: May 07 03 11 : 25a Kevin Sullivan 508-888-0242 p. 4 Page 3 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 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. _The system has a septic tank and SAS and the SAS is less 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 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. 3. Other: _ May 07 03 11 : 25a Kevin Sullivan 508-888-0242 p. 5 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 252 Arrowhead Road _Hyannis Owner: Jose' Costa Date of Inspection: 5/1/2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _jZ-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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/a day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped JlAny 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. ZAny portion of a cesspool or privy is within a Zone l of a public well. _,Z Any portion of a cesspool or privy is 50 feet of a private water supply well. __j`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 faits. 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 determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a acility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the fo owing: (The following criteria apply to large systems in addi ' n to the criteria above) yes no the system is within 400 feet of a surfa drinking water supply _the system is within 200 feet of a utary to a surface drinking water supply the system is located in a nitr n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water sup y well If you have answered`yes"to any estion in Section E the system is considered a significant threat,or answered "yes" in Section D above the lar system has failed.The owner or operator of any large system considered a significant threat under Sectio or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner s Id contact the appropriate regional office of the Department. Ma8 07 03 11 : 26a Kevin Sullivan 508-888-0242 p. 6 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 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? ,Z-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) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? 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 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 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)[3I0 CMR 15.302(3)(b)] May 07 03 11 : 26a Kevin Sullivan 508-888-0242 p. 7 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT SYSTEM.INSPECTION FORM OR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL PART C SYSTEM INFORMATION i Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): � DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x 4 of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no):.�[if yes separate inspection required] Laundry system inspected (yes or no):— Seasonal use:(yes or no):6-2n, Water meter readings,if available(last 2 years usage(gpd)): �k = 04�� Sump Pump(yes or no):'[ Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 3 I0 CMR 15.203): d Basis of design flow(seats/persons/sgft,etc. . Grease trap present(yes or no):_ Industrial waste holding tank present es or no):_ Non-sanitary waste discharged to a Title 5 system (yes or no):_ Water meter readings,if availa Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or 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 __,Averflow cesspool Privy Shared system (yes or no)(if yes,attach previous inspection records, if any) f _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): Approximate age of all components,date installed(if known)and source of information: l��c.J ? , �a J` ri"a �v��...� •�. Fes,n� �.....Q i '� Were sewage odors detected when arriving at the site(yes or no):ALL) May 07 03 11 : 27a Kevin Sullivan 508-888-0242 p. 8 Page 7 of I 1 OFFICIAL INSPECTIONASSESSMENTS SUBSURFACE SEWAGE DISPOSALS STEM INSPECTION FORM SUBSURFACE PART C SYSTEM INFORMATION (continued) Property Address: 252 Arrowhead Road Hyannis Owner: lose'Costa Date of inspection: 5/l/2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron L-*"40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIe gp*NK: (locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene -06ther(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of . certificate) Dimensions: L-t'r Sludge depth: Distance from the top of sludge to bottom of outlet tee or baffle: Q _ Scum thickness: 1 " Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 6" How were dimensions determined:`�i.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.): 1�'1.�: .� Cam.��, -�-�� 3r �.�... � `a ���"l.-�.. S t'1 •� I�-�Ae.,,c..u•-G 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 ou tee or baffle: Distance from bottom of scum to bo m of outlet tee or baffle: Date of last pumping: Comments(on pumping recom endafions,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evi nee of leakage,etc.): May 07 03 11 : 27a Kevin Sullivan 508-888-0242 p. 9 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose Costa Date of Inspection: 5/1/2003 TIGHT or HOLDING TANK: (tank must be p ped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_meta fiberglass_polyethylene_other(explain): Dimensions: Capacity: hallo Design Flow: gal ns/day Alarm present(yes or no): Alarm level: Alarm i orking order(yes or no): Date of last pumping: Comments(condition of al and float switches,etc.): DISTRIBUTION BOX: (if present must be ened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribu . n to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): --------------- PUMP CHAMBER;F(yes te o ite plan) Pumps in working or Alarms in working oo):Comments(note conp chamber,condition of pumps and appurtenances,etc.}: May 07 03 11 : 27a Kevin Sullivan 508-888-0242 p. 10 Page 9�of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 252 Arrowhead Road Hyannis Owner: 3ose'.Costa Date of inspection: 5/l/2003 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _�Zieaching pits,number: leaching chambers, number: 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.): '—Q, cc o 4'%o GE@9p00tS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 Depth-top of liquid to inlet invert: Depth of solids layer: "— Depth of scum layer: Dimensions of cesspool: Materials of construction: 57- Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note conditio of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): May 07 03 11 : 27a Kevin Sullivan 508-888-0242 p. 11 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/l/2003 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. y � f el c !E 6 70 O May 07 03 11 : 28a Kevin Sullivan 508-888-0242 p. 12 Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 252 Arrowhead Road Hyannis Owner: Jose'Costa Date of Inspection: 5/1/2003 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: _j,Abtained from system design plans on record-If checked,date of design plan reviewed:�Q 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: � T N Septic-Inspection-Info>t mation- :.:::: .::::::::::.: 5/12/2003 :::f sib 1233 090 1270 Hyannis >tiicsr Kevin Sullivan <ist 5/1/2003 ..................................... NFE ........................ <•`:r~ is# e Liguid level in leach pip 1"over the invert failing Old overfloow pit has outlet from cesspool 12"above failing leach pit and is dry.High water level staining exist in overflow XX ......�.... G....]. .............:........:..::::.:.....::.... .....:::: tj a .L"9 C A.T ION S E W A GPE RNIIT N . 'Xk Nye � so IA I N S T A LLER'S NAME i ADDRESS OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED b OA 4' Y L 8/ f No.......l�. Fps .................. THE COMMONWEALTH-OF MASSACHUSETTS BOAR® 0?,f HEALTH ......... . pphrati OF......... -A.!� ................................................... r", for 16pos al Works Tonstrudion Vernfif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... o. . ............... .-----------------...... ---- ------------..._...............:------ --- L i A dyress( -- or Lot No. .......... . W ..---..... -Av__ f. .............. -----••--._..__._._ ............................................... Owner .r, r Address �....,..t. ................. ................................................... .........•----.-______ Installer Address Type of Building Size Lot____________________________Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No: of persons____________________________ Showers — Cafeteria a Other fixtures -------•------------------------ - WW' Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity._...__.__._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.............. Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-•--------------------•--=............................................... Date......................................... ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ...... -.................................................. --•---•.............................................................................................. O Description of Soil____________________________________ x :... ----••.. w UNature of Repairs or Alterations-Answer when applicable.._ , ------- •nk.a....le;,. :..h: �✓�� .Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board oof�healt . Signe •-•-�J .... .... ............... . .............................. Date c Application Approved By...... -- .....•• . . ... .. .. .... Date Application Disapproved for the following reasons:........................................ -----------------•--•---------------•---•------------•-•----------•-- .............................•----...--------------____.•----......_....•------------•=----------•-••-----•••-•--•--•-•--------------_________._-_------------ Date PermitNo..................................•••••-..._...__.... ................Issued_ D Date - a No.......,/l. P....� Fi 'w.......ya..... y THE COMMONWEALTH OF MASSACHUSETTS R ` BOARD HEALTH .a ... O F........ ........ ...:...... ..... ..................................................... Appliratuau for' Ditivnsal Works Tonotrurtivart Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• �q ................. .._..... : .��o. �% � p.....a_1? _.......•---•••••--...._._................-• ---• •-•-•••••-•-•...........•--•--.........._--•-•- M A ........_...Ltss��l or Lot No. .......... .11 ..... ......•... ..... .......................••• ...^••--....... W A�A �U Ow er -,�I Address 14 14 Installer Address UType of Building Size Lot............................Sq. feet I-., Dwelling—No. of Bedrooms..........................................::Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. persons.__.__.....__.__...._._..._. Showers ( ) — Cafeteria ( ) Other fixtures --•--- ------------- -- W Design Flow............................................gallons pe person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid-capacity............gallons' Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed b ' Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --••----------------------------------•--------......--•-----------•-----------..........._.._...---.........................................................O Description of Soil.................=...................................................................................................................................................... x . ----•--•------------•--....----••-----•----••-•••••--•-------•------------•-••--••----.....-•-•-•---•----•--•--•-•------•--•--------••••----------•-••-•-----••-•••-••••---•--•-----•------------------- Uw . ••-•••-••-•------------------••-------••••=_-•-------•---•------.....---•---•--•--•----....•--- --------- ---------------------•--•-- } Nature of Repairs or Alt ations—Answer when applicable... D. i.. _ .:.1. /Qi •.- ��il` ---------------U..e,0 f.4------ ` F �`----------------------•----.. Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healt . Signe -•-• ....................... ................................ D at Application Approved BY - �, G2-. � -- ��-- ------- - Date Application Disapproved for the following reasons:-------•-------------------••--•----•-•-----•---•---•--•------•-----------------•----••••-••-••-----......_._. ......---•.........................•----...--•-•-------•-•--•-------•-•-.....•-----.......---------......I._....---........------•••-•••••---•-----•---------••--•--------•-----•-•-•----•-••-----•...... Date PermitNo......................................................... Issued..........-----------------•--•-•-••-••----•--...•..... Date THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF "EALTH v . ..: :.......,.oF........... ...... ..... ...........:..... Trrfifir tr Of TonwHFaurr ' THIS S TO CERTIFY, '13, the f 1 Sewage Disposal System constructed ( ) or Repaired bY••-••--•... ... oltrl/L_:._,�. . ° �'. .._..... r Installer at__'-'--� v '?, - ... d _._ .... • . t has been in �lleliaccordance wi I e provisions of 5 f T e State Sanitary Code as descri a in the application for Disposal Works Construction Permit iv T //°° dated "- �. `... �_ THE ISSUANCE OF THIS 'CERTIFICATE SHALL NOT BE CO GU ANTEE THAT THE SYSTEM N ... L FUNCTII SATISFACTORY. ----DATE. Inspector_:. ..... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH low .........OF.......... FEE........................ ,arks 05unii rmit {�s Permiss' n is hereby ante ..... d a!L!K.IiLs>Gs.----- --- ':...-- to Constr t ) or Repair an Individual Sewage Dispos Syst �,. ,..... at No" /( L( --••--•-•----2. --y- ------•-6�vlla�-------G Street ....Lk. "A. as shown on the appllcarion for Disposal Works Construction P r fit No. _____________ __ ed..,&.....Z �-r�-�.... .. Board of Health DATE•f• 1---------------•--•------•--•-•------•-•........................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' I LEGEND 7g PROPOSED CONTOUR LOCUS 79 PROPOSED SPOT GRADE 3 We11esley r Po_ 159'PC'A% ` �--97----�' EXISTING CONTOUR a` Rd TEST PIT EXISTING CESSPOOLS a TO BE PUMPED & FILLED f W EXISTING WATER SVC. Princess WITH SAND Pine Rd M 5 13°14'22"W Rd w m 4 ( G EXISTING GAS SVC. o t Rd dole 77.50' _---{ i i �\ cr x `SS i SHED —OVA-t — EXISTING OVERHEAD WIRES o a`0 00 TP-2 TP—.1 J 9 996 I � BENCHMARK N WEST MAIN STREET f 3_5.3'_ 9.D—BOX �3 1 PR _OPOSED. 1 } 31' 99 0o I: ,; —— LOCUS MAP N.T.S. _:_:. — BENCHMARK: x �-- — Ln CORNER of PATIO 000 ' ELEV. = 100.00' 27' GENERAL NOTES: (A55UMED DATUM) N PROP, 9 O SEPTIC x 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL S� TANK BOARD OF HEALTH AND THE DESIGN ENGINEER. CONC. N 99 PATIO 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS`�6 N OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. f N SEWER INV.=97.55 99 N l 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR St) ^1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE lt� N0. 252 Z DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 1 1/2 STY. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ' F i ENGINEER BEFORE CONSTRUCTION CONTINUES. T.O.F. a 100,. 8lTCONC. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. x DRIVEWAY 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF x THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 99 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. c� •SS � 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 00, 199 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. 99 O� 9 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY x s 270-90� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING APN 9.0270 CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. 77,50' 1 t AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). N 12°47'36°E ��`� of 44ss9�y o PETER T. GF I9 9 -4 McENTEE F ROPOSED SEPTIC SYSTEM UPGRADE x 9 E O.P. `90> 922 Ix 9 o CIVIL 8 9 ! No. 35109 52 ARROWHEAD DRIVE, HYANNIS, MA 96 ARROWHEAD DRIVE j, R£CIS1E��� �Q for: Deborah Domasceno, 54 Murphy Rd, Hyannis, MA 02601 G : Surveying by: SCALE DRAWN JOB. NO. OG Works HOOD SURVEY GROUP 1"=20' P.T.M. 221-06 field Road P.O. box 1724 02644 Mashpee, MA 02649 DATE CHECKED SHEET NO.. (508) 477-5313 (508) 539-7799 10�17�06 P.T.M. 1 of 2 ' F.• O PREVENT NOTE: F NISH GRADE SHALL BREAKOUT, PROPOSED T BE < EL..96 8 < ELEV. TOP FOR A DISTANCE OF 15' AROUND THE FOUNDATION FINISH GRADE: 99.7t PERIMETER OF THE S.A.S. (Existing) EXISTING F.G. EL.99.5t F.G. EL.99.5t MAX. COVER OVER S.A.S. = 36" MAINTAIN 2% MIN SLOPE OVER LEACHING AREA ------------- Ir 4" SCH 40 PVC PERFORATED PIPE WITH SCREW CAP SET TO WITHIN 3" OF FINISH ' GRADE TO SERVE AS INSPECTION PORT. L = 18' L = 10' I L _4, a 4' SCH 40 PVC 4' SCH 40 PVC 4" SCH 40 PVC ® S= 2% (MIN.) 10" 14„ ® S= 1% (MIN.) 6' ® S= 1% (MIN.) 11" EFF. PROPOSED DEPTH :e 1500 GALLON INV.EL=96.75 INV. EL.=96.48 SEPTIC TANK INV.7 ' � L.= .65 GAS INV.ELEV.=96.30 2 5 UNITS AT 6.25'/UNIT = 31.25' 2' BAFFLE INV.EL=97.00 ' EFFECTIVE LENGTH = 35.3' INSTALL INLET & OUTLET TEES GAS BAFFLE TO BE INSTALLED ON USE 1 ROW OF 5-HIGH CAPACITY INFILTRATOR CHAMBERS (H-20) TIE IN TO SEWER J OUTLET TEE AS MANUFACTURED BY IN SERIES SURROUNDED W/STONE TO FOR A 10.8' X 35.3' S.A.S. OUTSIDE HOUSE TUF-TITE, ZABEL, OR EQUAL INV.=97.55 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING � _ SOIL ABSORPTION SYSTEM (PROFILE) PIPE INVERTS PRIOR TO CONSTRUCTION. N.T.S. 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED 2" LAYER OF SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 1/8"-1/2" DOUBLE 310 CMR 15.221(2). BREAKOUT ELEV.=96.80 — WASHED STONE 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM ELEV.=95.38 3/4"-1 1/2' DOUBLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 4' WASHED STONE (3) 5" DIA.OUTLETS 4' 15.5" � 2" T.P. EXCAVATION OR G.WF 2.8'EFF.WIDTH=10.8N. ABOVE BOTTOM O ' SEPTIC SYSTEM PROFILE NO G.W. EL: 88.7 i 15.5' 12" SOIL ABSORPTION SYSTEM (SECTION) 8" N.T.S. 6T„ T 2" DESIGN CRITERIA D—BOX NUMBER OF BEDROOMS: 3 BEDROOMS SOIL LOG SOIL TEXTURAL CLASS: CLASS I 35 3' DESIGN PERCOLATION RATE: <5 MIN/IN r---•- I DATE: OCTOBER 16, 2006 (P-1 1,466) DAILY FLOW: 330 G.P.D. DESIGN FLOW: 330 G.P.D. PROPOS O ED S•A-S' SOIL EVALUATOR: PETER T. MCENTEE P.E. GARBAGE GRINDER: NO 0 0 0 0 0 0 0 0 0 0 0 o WITNESS: DONALD DESMARAIS - HEALTH AGENT PROPOSED SEPTIC TANK: 1500 GAL. CAPACITY o0000000 00000000 I �47.61 „� 28"--�i Elev. -TP- 1 DepthElegy. TP-2 Depth LEACHING AREA REQUIRED: (330) = 445.9 S.F. 28f-- 99.8 A 0" 99.7 q 0" .74 Closed End Plate ODen End Plate o SANDY LOAM SANDY LOAM USE 1 ROW OF 5 HIGH CAPACITY INFILTRATOR UNITS W/STONE. tOYR 3/3 10YR 3/3 99.3 6" 99 2 6" AS SHOWN FOR AN S.A.S. HAVING THE DIMENSIONS: 35.3' x 10.8'. G B � B _ SANDY LOAM SANDY LOAM SIDEWALL AREA: 2(10.8'+35.3') x 0.92' = 84.8 S.F. 10YR 5/8 10YR 5/8 = 96.3 42" 97.7 24" BOTTOM AREA: 35.3' x 10.8' = 381.2 S.F. c c 36" TOTAL AREA: 466.0 S.F. 16"• F U u DESIGN FLOW PROVIDED: 0.74(466.0 S.F.) = 344.8 G.P.D. W -{� 75 �+ I----34 I'3 MED. SAND MED. SAND a 48" PROPOSED SEPTIC SYSTEM UPGRADE 1 25„ 10YR 6/6 10YR 6/6 Side view End View �j 252 ARROWHEAD DRIVE, HYANNIS, MA HIGH CAPACITY INFILTRATORS, H-20 LOADING Prepared for: Deborah Damosceno, 54 Murphy Rd, Hyannis, MA 02601 Engineering by: Surveying by: SCALE ' DRAWN JOB. NO. INFILTRATOR CHAMBERS LAYOUT 88.8 132" 88.7 132" Engineering Works HOOD SURVEY CROUP N.T.S. P.T.M. 221-06 S.A.S. YOUT NO GROUNDWATER OBSERVED 12 West Crossfield Road P.O. Box 1724 DATE CHECKED SHEET NO. N.T.S. Forestdole, MA 02644 Mashpee, MA 02649 PERC RATE <2 MIN/IN. ("C" HORIZON - TP 2) 10 17 06 ' � (508) 477-5313 (508) 539-7799 � � P.T.M. 2 Of