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HomeMy WebLinkAbout0258 ARROWHEAD DRIVE - Health 258 Arrowhead Drive Hyannis A 270 091 1 ° a G a G Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 every page. Cityrrown Zip Date/10 State Code Date of Inspection . Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Imp°r`a"` A. General Information Men filling out ' forms on the computer,use 1. Inspector: only the tab key to move your cursor-do not DOUGLA S A BROWN use the return Name of Inspector key. DOUGLAS A BROWN INC ! ` ,SE'(3 Company Name it r� P.O BOX 145 Company Address :Er—ro VILLE MA 02632 City/Town 508-420-4534 Sate State Zip Code 14297 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 s 9/13/10 Inspe or' ;&nature 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. t5ins•09A8 Title 5 Oftial Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 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: ® 1 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. Check the box forges", "no"or"not determined"(Y, N, ND)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. ❑ Y ❑ N ❑ ND(Explain below): v t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 9/13/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 t5ins•09= Time 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 3 0l 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 every page. Cityrrown 9/13/10 State Zip Code Date of Inspection B. Certification (cont.) 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 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 dogged 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 t5ins•os,Oa Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 every page. City/Town ZipCode Date of Date of 0 State Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is 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. t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 9/13/10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins 09D8 Titre 5 Official Inspection Form:Subsurface Sewage[Disposal 9 Po System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Properly Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 9/13/10 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 3 500 GALLON CHAMBERS 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 years usage(gpd)): 08-287/09-203 Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 every page. City/Town Date/10 State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal 9 Do System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS reg uired for MA 02601 9/13/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: ACCORDING TO PREVIOUS INSP REPORT SYSTEM WAS INSTALLED IN 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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 t Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5X5.8 Sludge depth: 6 t5ins•os os Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 B Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 every page. Citylrown ZipCode Date of Date of 0 State Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 5 1. Distance from bottom of scum to bottom of outlet tee or baffle 29 How were dimensions determined? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 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.): 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 y El other(explain): 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 t5ins•OMB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE D-BOX NEEDS A RISER TO BRING CLOSER TO GRADE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: Isms•osoe Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 every page. Clty(rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): CHAMBERS HAD 6"OF LIQUID WITH STAIN LINE AT a 12" 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 t5ins.09W Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is required for HYANNIS MA 02601 every page. Cityfrown gat a/10 State Zip Code Date of Inspection D. System Information (cont.) 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.): r: t5ins•09J08 Title 5 6mcial Inspection Form:Subsurface Sewage disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•009 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 20 FT feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan,reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: OFF PREVIOUS INSP REPORT DATED 4/7/06 BY PATRICK M O'CONNELL I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 258 ARROWHEAD DR Property Address NARDONE Owner Owner's Name information is HYANNIS required for MA 02601 9/13/10 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file .sins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r New Page 1 Page 1 of 1 TOWN F BARNSTABLE LOCATION ?.Sfj �(/041j1 `�r SEWAGE#�nSPeeAtx� VILLAGE_AAVmnm,s _ASSESSOR'S MAP&PARCEL 49W 49/ rh* RS NAME&PHONE NO' f. 1771 SEPTIC TANK CAPACITY Sao LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: CGhff* E DATE: 41 -7 Opp 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Feet FURNISHED BY e� 3� �$ lq://www.town.bamstable.ma.us/assessing/2010/HMdisplay.asp?mappar--270091&seq=1 9/7/2010 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t by0 TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION a7o oq/ . Property Address: 258 Arrowhead Drive 1� Hyannis MA 02601 Owner's Name: Manuel daLomba Jr. W =� Owner's Address: Same Date of Inspection: April 7,2006 Job#06-79 _0 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT.ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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, glnii��� approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:\\`����P��\A.OF __X_ Passes Conditionally Passes = P HI cGn:_ Needs Further Evaluation by the Local Approving Authority =p Fails =v b EL.. :co Inspector's Signature: Date: 4/7/06 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 DER The original should be sent to the system owner and.copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching chambers have 8"of standing water with no high stains. Recommend pumping tank in next 12-18 months. ****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. f Page 2 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 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(l)(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: Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ' clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from 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 forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: I Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection'? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out 0 _X_ _ Were all system components,excluding the SAS, located on site _X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems?, The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] i Page 6 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daL;omba Jr. Date of Inspection: April 7,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x.#of bedrooms): 330 Number of current residents: 6 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No (if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 201,750 gal.=276 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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: 12/21/01 Were sewage odors detected when arriving at the site(yes or no): No i Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5'long x 5.8'wide—1500 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 11" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc.): Tees intact and clear,liquid level at bottom of outlet invert.Recommend pumping tank in 12-18 months. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: . Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 258 Arrowhead Drive,Hyannis I Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: I Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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 hieh stains present. Liquid level at bottom of all 3 outlets. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: _X_leaching chambers,number: Three 500 gal drywells 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.): Observed 8"of standing water in chambers with no high stains. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of I 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 258 Arrowhead Drive,Hyannis Owner: ManueldaLomba Jr. Date of Inspection: April 7,2006 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. Arrowhead Drove Water service .............. ............ ................................... . ................................. ................. .............. ............... .............. 8 37 18 29 3 ' 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: 258 Arrowhead Drive,Hyannis Owner: Manuel daLomba Jr. Date of Inspection: April 7,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: _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) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.25 and topo map shows property at el.50. RA - \� r- TOWN 9F BARNSTABLE OCATION _ � 141-1-Ow SEWAGE# -r. ILLAGE ASSESSOR'S MAP&PARCEL 1f7a ©q l 1T"-+M4!i,BRS NAME&PHONE NO'P<T iC'r-G(-on✓wt1 SEPTIC TANK CAPACITY 16'00 Red LEACHING FACILITY: (type) CovkTAffibAfS (size) 500 NO. OF BEDROOMS 3 OWNER ,nil �a�,oMbq PERMIT DATE: COld9E DATE: Z/ 7 Q(p 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 l ,�M �+ ./ _M �• Y �� .p ' ~ Y ~ Z TOWN OF BARNSTABLE Lr CATTON �°, �H/'lJGtl� 1 I l V/.= SEWAGE # -9,0,21 ;ILAGE *1aA0`,r2/S ASSESSOR'S MAP & LOT 7 70 —09/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3*—S00 �,�.���•y ��/�di�ze) NO. OF BEDROOMS BUILDER OR OWNER _!�1'latitiu /��9G0�1�19 PERMIT DATE: Z9=O/ COMPLIANCE DATE: 1/O/ 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 faci 'ty) Feet Furnished by .e.. f< • � a ��' 4 a �� i � �� s . ('� ��. �£ 6� " i ., No. l0`l t FEECOMMONWEALTH OF-MASSAC14USETTS Board of Health, �Ov� �� ��� MA. APPLICATION FOR DISPOSAL SYSUM CATRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon Complete System ❑Individual Components Location 4n,-ail l kp d ✓t I-A 0411 rVl�j Owner's Name Ma44 V e A ✓�4'1� Map/Parcel# 'Z-7 d 0 9 Address 2S—g- Lot# '3 2— Telephone# -7-7 t96 Installer's Name oey kfa4tG S�1 1112 Designer's Name Address / Address Led,. ak -zlgr Telephone# Telephone# Type of Building ICL�I � Lot Size i /7 sq.ft. Dwelling-No.of Bedrooms Garbage grinder.(d( Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.re uire ) 2i Z10 gpd Calculated design flow ?/Z d Design flow provided 3 ?r gpd Plan: Date Z 0 Number of sheets r Revision Date Title Description ofSoil(s) Soil Evaluator Form No. Name of Soil Evaluator 1 -ZIjD`�'�`� ' Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS _ V7Z f Dm d-/ 7 S V zQ A-/ b( /U CAAA-7 4,e► -f The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the =tem operation until a Certificate of Cpmpliance has been issued by the Board of Health. Signed —e Date -s...- n y.. i--+..F3.; f-i �Y._ .:el.:.,y'r+: ':' --'�+^.-•"4?`': ,,,+-r�Tf�-'�'ti•�w 5 ;, - -- No. 1-� lGj"9 -°-___ FEE ISO�' a .. Boart of Health, �-�0 (� MA. j APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT � 1 (Application fora Permit-to Construct( ) Repair Upgrade(l�bandonO Complete System O Individual Components y w Location z -� .�rro-r..�/,91 r J r--R a*,, , , Owner's Name v'tGZMV to( 'Dot�V Yn�� Map/Parcel# Z'7 d /Q 9 / y Address 2S r-rpZ i�.2e�Q Dr�v� Lot# 3 "Z_ Telephone# SZ 8—y?U— -7-7Q(p Installer's Name Joey �, t.CJP Designer's Name f 11r"t '„ &017 4S Address 12 / Address C) L 2�a f�H /0/1 ZOO y� Telephone# 6., . Telephone# 3F67— Type of Building CY Lot Size Fi 97 I sq.ft. Dwelling-No.of Bedrooms Garbage grindei-44/6 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures D gn�Flow(min.require ) Z Z0 gpd Calculated design flow 7i Z Design flow provided Lf gpd Plan: Date 2 �y Number of sheets Revision Date Title Description of Soil(s) L.1/ S'/�^ Soil Evaluator Form No. Name of Soil Evaluator O• 7f�+'�' �') Date of Evaluation l 3 d d DESCRIPTION OF REPAIRS OR ALTERATIONS ��r�iZ -(-o�n�► (x !�/r�4�'(�� S�(Q. �- �6�C G��GP .7- SDn SF / N/O /e���L�,r,.,.p CGt��'J The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5,and further agrees to not to place the tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ..r Date 1 L COMMONWEALTH EALTH OF MASSA'1,HUSETTS FEE -2-70 —O q I Board of Health, /O MA. C ERTIFICATEE OF COMPLIANCE J Description of Work: Cl Individual Component(s) Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ,Abandoned ( ) by. at has been installed in accordance with the provisions of 310 CMR 1t5.00 (Title 5) and the a proved design plans/as-built plans relating to application No. 1- t- , dated 1 Approved Design Flow 3 y 2-(gpd) Installer Designer 3# Inspector: W Date:1-�7/ I A , The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. tr � FEE i COMMONWEALTH Ef LTH OF MASSAC14 SETTS Board of Health, a"'H s&ir, , MA. t DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair/(( '-) Ab) Upgrade( andon( )'an individual sewage disposal system at Z �r�dt�//.��dQ r. ,A A q,"n.4 ,q , as described in the application for Disposal System Construction Permit No. �,"��� , dated Provided: Construction shall be completed within t ree years of the date of thi5lpermit. l to al conditions mus be mpt. Form 1255 Rev.6196 A.M.Sulkin Co.Boston,MA Date l Board of Health TOWN OF BARNSTABLE Cl LOCATION �° � oL�� �i�Vi� SEWAGE # f,201 -269 VILLAGE.- lo6ss�s ASSESSOR'S MAP.& LOT 0 -D INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4'b� LEACHING FACILTIY: (type) 'S00 �,� �►rd r,�i *ze) NO. OF BEDROOMS BUILDER OR OR OWNER �'J.mti�Ls �R9LOti'1/�1� PERMIT DATE:,� - 9-0/ COMPLIANCE DATE: Separation Distance Between,the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 fee of leaching faci 'ty) Furnished by Ir 1 - 2 5 'L X 13 'W X 2 .0 ' D ROUTE 28 leaching trench using Design Calculations r ` 2 , H — 1 0 500 gal. chambers With Number of Bedrooms: 2 o 0 g LO4 Of stone On SIC�E�S C�C eI�(�S• Garbage Grinder: No o � paved dr" Leaching Capacity Required: 220 Gal./Day z - wo 2 / ! LeachingArea Required: 220 Gal. 0.74 Gal. S .Ft. = 97 S .Ft. o --�---- 6, R / Proposed Leaching Structure: 1-29'L X 10.5'W X 2'D Leaching Trench o -sf y�q0 Leaching Area Provided: 462 Sq.Ft. o 0 �`aaP-_-en�e RO/�0 Proposed Leaching Capacity: 342 gpd > 220 gpd. req'd. 0 LOT 32 � 60 Q ,AREA = 8,971 ± SQ.FT. 99,06' X 2.75' S' 2.75' 0 �— B HOL _ Sl E r2" OF 1/8" TO 1/4" o .H, 1 X,' 98 84' PEASTONE (WASHED) w ® ® ® ® FST Tevyaw Road LOCUS 0 rt� 0 a ?I p 3 H-10 500 gal. chambers NO SCALE G � ,a 41 W E L L E S L E Y C l f\ 3/4" TO 1 1/2" WASHED CRUSHED STONE i �O� %V 0 w— z -J aLLJ ° TRENCH CROSS—SECTION 0 '� ~^` 2 ' 112, NO SCALE .`` 3-20.OIAM.ACCESS MANHOLES GENERAL NOTES to X 9 ,83' 46' �� O O r O utilit'Ie . `O 0 0J 1 1. ADDRESS: 258 ARROWHEAD DRIVE l� -� `t� 2. ASSESSORS NUMBER: MAP 270 PARCEL 91 overhead 99.81' O /� a C. q 3. DEVELOPER'S LOT: LOT 32 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN avid 0 dl e O - i— i ON THE GROUND INSTRUMENT SURVEY. INLET B {� /� 4 4 W E�!_E S E Y C R ' �TLET 5. MUNICIPAL WATER IS PROVIDED TO SITE AND - I v wQy padr�te f�a 0 1 V f M . I. S i I SURROUNDING PROPERTIES. S P p 983 X --__-_ •+------------..---•-----.._.,.----;..-----• 6. REFERENCE PLAN: PLAN BOOK 159 PAGE 41 STEEL REINFORCED PRECAST CONCRETE 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. " 264 __ _4-- ---_ _ PLAN VIEW 8• NO POTABLE WELLS ARE LOCATED WITHIN 100 FEET OF SAS. L0RROI 3-20"REMO\33 �BLE COVERS �lfl RO — 4 CONSTRUCTION NOTES D _ 3"min•alearonce 1. Contractor Is responsible for ofe notification ---- ___ ______ -_ '3__ _1NlET T-.. --� INLET 8•min, 2"min.inlet to outlet 8"mm. � � notification could levy -- OUTLET espon Digs 6' L, and protection of all underground utilities and pipes- -0"s-°" T C. 2. The septic tank and distribution box shall be set dP �e E Lq�a depth level on 6" of 3/4"-1 1/2" stone. hCF / na °As BAFFLE ' 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Glen E. Harrington, R.S. CROSS SECTION END—SECTION 5. The contractor shall install this system in accordance H—1 0 1 500 GALLON SEPTIC TANK with Title V of the Massachusetts Environmental Code NOT TO SCALE SITE PLAN and the Regulations of the Town of-li; a 4�s & 6. Provide a Acme Precast 1500 gal. H-10 septic tank, H-10 D-Box and 3 H-10 500 gal. chambers or equal. SCALE: 1 "=20' USE ACME PRECAST OR EQUAL 7, No vehicle or heavy machinery shall drive over the BENCH MARKON CORNER OF septic system unless noted as H-20 septic components. BULKHEAD ELEV.=100.00' (ASSUMED) 8. Install gas baffle or equal on septic tank outlet tee end. PERC TEST & SOIL EVALUATION 9. All existing inverts and site conditions shall be verified by contractor. Date of Perc. Test & Soil Evcl.: November 30, 2001 10. Existing cesspools to be pumped and leachote contaminated soil removed. Test Performed By. GLEN E. HARRINGTON, R.S., CSE 1_ Excavator: Joe's Septic Service zo °IAM.accEss MANHO E PERK TEST © T.H. #1 5' Test Hole PERK DEPTH=34"-52" No. 1 BEG. SOAK 0 12:10 PM `. -- DEPTH SOILS ELEV. END SOAK 012:16 PM Unable to soak with 24 gals. of water I •� !, to 0 98.97 USE PERK RATE < 2 MPI FOR DESIGN PURPOSES Ap ,•I I• � ® ® ® 34„ sandy lour, 1 !. ® ® ® ® 24" 11" 1ovR3/2 98.05' t...._-.,.....__-....,.._._ •. Bw loam sand STEEL REINFORCED PRECAST CONCRETE 34' 1DYs6 96.14' PLAN VIEW 3 H-10 500 gal. chambers coarse sand END-SECTION 84" 10YR7/6 9197' H-1 0 1500 GALLON CHAMBER C2 med. sand NOT TO SCALE 2.5Y5/3 138" 87.47' USE ACME PRECAST OR EQUAL NO GROUNDWATER ENCOUNTERED — r �P�ZNOFMq . PROPOSED SEPTIC SYSTEM UPGRADE CIY Eli C PREPARED FOR LEGEND o MANUEL DALOMBA H 4N . 1070 N AT EXISTING &ESSSPOOLS T �i' O BE ft BACKFILLED , F o 258 ARROWHEAD DRIVE PUMPED I.S-T **NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. 0 PROPOSED 150C GAL qN/TARP BARNSTABLE (HYANNIS), MA 10' min. from NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. o O O H-10 SEPTIC TANK house to septic tank �— —-"-- Septic tank covers must be Finished grade over system=2% slope away Existing House wlthir 6" of finished grade 5 HOLE x 104.46 DENOTES EXISTING PREPARED BY: First F. Elev.=101.47' DIST. BOX SPOT GRADE GLEN ER EXISTI ADE Existing Grade Elev,=99'± HARRINGTON -95 ------ EXISTING CONTOUR 9 LEDA ROSE LANE / 2" in. '�I III S = 0.02' Min. 2"-1/S"-1/2" �" m0x. � c c ' cellaU S=.01 Level for 2' washed stone Top Peostone Elev.=96.50' DEEP TEST HOLE M A R J T 0 N J MILLS, MA 02648 r 10' 50C GAL 2, s=01 o SEPTIC TANK M Bsmt. FL =lev.=92.72' q H_70 n 20' Inv rt Elev.=96.00' o, rn ro ro PERCOLATION TEST II GAS BAFFLE a °' 1a a, O o a a o 0 24 A11N Bottom of Lea h TEL: 508-428-3862 mOR EQUAL u li h 29 rench Eiev.= 94.00' Approx. location FAX: -4 F 508 28-3862 LEACH TRENCH s.53' existing water service � 6" OF 3/4"-ii/2" STONE � a g ° TBottom of T.H. #1 Eiev.=87.47' iJ; SYSTEM PROFILE _ Approx. location SCALE: 1 "=20' DRAWN BY: GEH DEC 14, 2001 In 6" OF 3/4"-11/2"STONE - -- .---- Not to Scale C existing water Service g FILE: DALUMBA.DWG SHEET 1 OF 1