HomeMy WebLinkAbout0279 ARROWHEAD DRIVE - Health �5.4 x�,xl a�q}, ���i'�ir���s�'A�'t�1SF:�'y'aY�� �' s'Kr,�� '� � �"+ y��K�•
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ICERTIFIED o
ICoDomestic Mail Only
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jm For delivery information,visit our w-ebsite at wivmusps.comll.
im OFFICIAL USE
I r`- Certified Mail Fee
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j ru Extra Services&Fees(dteckbox.add lee as epproprfeae)
❑Retum Receipt Owdoop» $ _
j 0 ❑Retum Receipt(electronic) $ PostrnaA.. _
l7 ❑Certified Mail Restricted Delivery $ f ,He to -
0 ❑Aduft slgnatme Requited $
❑Adult signature Restricted Delivery$
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rq Total Postage and Fees
r"q' sa± David Mcfarland
c3 $"� 279 Arrowhead Drive
56 Hyannis, MA 02601
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Certified Mail service provides the following benefits:
■�A receipt(this portlon of the Certified Mail label). for an electronic return receipt,see a retail
■A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate
■Electronic verification of delivery or attemptefs Tarim receipt for no additional fee,present this.
'delivery. 'h ''-, 1 USPS(&-postmarked Certified Mail receipt to the
■A record of delivery pncluding the recipients retail associate.
`signature)that is retained by the Postal Service" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
c to the addressee's authorized agent y
Important Reminders: Adult signature service,which requires the
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First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Maii®service. Adult signature restricted delivery service,which
■Certified Mail service Is notavallable'for requires the signee to be at least 21 years of age•
International mail. and provides delivery to the addressee specified
■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail). t,
of Certified Mail service does not change the ■To ensure that your Certified Mail receipt Is
insurance coverage automatically Included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark If you would like a postmark on
■For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail Item at a Post Office"'for
the following services: postmarking.If you don't need a postmark on this
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of delivery(including the recipient's signature). of this label,affuc it to the mailpiece,apply
yyyy You can request a hardcopy return receipt or an--appropriate postage,and deposit the mailpiece.
+7 r electronic version.For a hardcepy return receipt,
complete PS Form 3811,Domestic Return
y Receipt attach PS Form 3811 to your mailpiece; IMPOUARM Save this recelpt for your records.
'I Ps Form 3800,4di jof5(Reverse)PSN 7530424DO-9047
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CERTIFIED iIL
F�• ti: -)L U.S.POSTAGE>>PITNEY BOWES
Town of Barnstable _
Public Health Division
• 6ARNSTABLE. i :J • ' �=
MA5g �, 200 Main Street t ZIP 02601 $ 006.73
02
Hyannis,MA 02601' 0000336455 APR. 12. 2016
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7015 1520 0001 2273 3258
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David McFarland
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279 Arrowhead Drive
�' Hyannis, MA 02601
COMPLETE / COMPLETE • • DELIVERY
w 6 ■ Complete items 1,2,and 3. A. Signature,
Agent
I ■ Print your name and address on the reverse X ; +'
so that we can return the card to you. ❑Addressee i
B. Received by(Printed!Name) C. Date of Delivery
I- ■ Attach this card to the back of the mailpiece, � I
I. of on'the front if.space permits. I
6 1. Article Addressed to: D. Is delivery address different from item 1? 0 Yes
h II! IIaIv IiIdI I MIII cI If aI I rI lIa InI IdI III II I I I II I II III I II I j If.YES,enter delivery address below: _ El No
279 Arrowhead Drive
Hyannis, M 02601 3. Service Type ❑Priority Mail Exp
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❑Adult Signature ❑Registered Mail
❑Adult Signature Restricted Delivery ❑Registered Mail Restricted
❑Certified Mail® Delivery
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9590 9403 0922 5223 8279 84 ❑Certified Mail Restricted Delivery ❑Return Receipt for
/ I ❑Collect on Delivery Merchandise
2—Article_NOmb_er(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation'"'
-- ❑Insured Mail ❑Signature Confirmation
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15 152�:. 0001`:d2273 3258 i.❑Insured Mail Restricted Delivery Restricted Delivery
w 70 p�►�jj (over$500)
d PS Form 381 ,July 2015 PSN 7530 02-000 9053�' Domestic Return Receipt e I .
Town of Barnstable Barn
Regulatory Services Department A&AffmftCft
NAMDi H i Publc Health vision
m
200 Main Street, Hyannis MA 02601 2007
Office: 508-862 4644 � Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL # 7015 1520 0001 2273 3258
David Mcfarland
279 Arrowhead Drive
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 279,Arrowhead Drive, Hyannis, MA was last
inspected on Mar 01/2016,by James D. Sears, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Main cesspool is structurally unsound; the septic tank needs to be replaced.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
I
PER ORDER�OFHE BOARD OF HEALTH
Thomas McKean, R.S., CHO -
Agent of the Board of Health "
Q:\SEPTIC\Conditionally Passes Ltr\279 Arrowhead Dr Hy Mar2016
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j Town of Barnstable Barn
MMMNIUM
Regulatory Services Department sky
BMWSPABM
KAWL
1639. Public Health Division
on m
�p 200 Main Street,Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304Thomas A.McKean,CHO
CERTIFIED MAIL# 7015 1520 0001 2273 3258
.David Mcfarland
279 Arrowhead Drive
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 279 _Arrowhead Drive, Hyannis, MA was last
• inspected on Mar 01/2016,by James D. Sears, a certified septic inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system"Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Main cesspool is structurally unsound; the septic tank needs to be replaced.
You are ordered to repair or replace the septic system within sixty(60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S., CHO --'s
Agent of the Board of Health
6-1
Q:\SEPTIC\Conditionally Passes Ltr\279 Airowhead Dr Hy Mar2016
i
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� �OfTHEl�ti .
Town of Barnstable
HARN3IAHLE, •
p 9 Regulatory Services Department
rfD MA't -
Public Health Division
200 Main Street,Hyannis MA 0260.1
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6,-2007
Rev. 7/6/15
DEADLINES TO REPAIR-FAMED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000) _
J
An"x"marked in the ❑ is the failure criteria and-associated repair deadline -
60 DAY DEADLINE CRITERIA
❑Discharge or ponding of effluent to the surface of the ground
❑Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1)YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or.cesspool
o Any portion of the SAS, cesspool, or privy below high groundwater elevation
o Any portion of the cesspool within'a Zone 1 to a public well
o Any.portion of a cesspool within 50 feet of a private water supply well with no
acceptable water.quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2)YEAR DEADLINE CRITERIA.
❑ Single Cesspool
❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation
of a driveway due to H-10 c6mponents; etc)
o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code
§360-9.1)
OTHER
MAin CeJf oil 4 S' II, -o �Q 1c,Cc wt1 5 b`-+c,nk
Repair deadline:
Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every �H annis MA 02601 3/1/2016
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. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer, �v
use only the tab 1. Inspector:
key to move your
cursor-do not James Ford
use the return. Name of Inspector
key
Ford Septic Services, LLC
".6 Company Name
P.O. Box 49
Company Address
Osterville MA 02655
Cityrrown State Zip Code
508-862-9400 S12482
` 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. 1 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 Furthe aluation by the Local Approving Authority
3/14/16
Inspecto Signature Date
The s t m 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
r 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
r
Y
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E I always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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 for"yes", "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):
The septic system is a cesspool that overflows to a 1000 gal. leach pit. Some of the blocks in the
cesspool have come loose and have fell in and now the cesspool is structually unsound. The leach pit
was dry and seems fine.The scum line was 2' below the inlet pipe with no sign of failure. The
cesspool should be replaced with a septic tank.
t5ins-3/13 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
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
J
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. Cityrrown 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 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 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
El ® than 1/2 day flow
(Sins•3/13 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every �H annis MA 02601 3/1/2016
page. CityfTown State Zip Code Date of 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.
❑ ® t 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-
110,000gpd.
❑ ® 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.
15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
i
J
.' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. Cityfrown 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): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
(Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
' r
Number of current residents: . 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection Yes Z. No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
unavailable
Sump pump? , ❑ .Yes ® No
Last date of occupancy: unknown
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
t
Industrial waste holding tank present? ❑ Yes ❑ No
'Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
l5ins•.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
a
•t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
MCI 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town 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: unknown
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w., 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
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:
pit was added in 1980 -as built
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
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: 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:
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M e 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
n/a
Depth below grade:
t R feet
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:
Date
l5ins•3/13' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
t
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town 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 ❑ other(explain):
N/a
t
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, E No
(Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17.
r ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w. 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. Cityrrown 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
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.):
s .
' r
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
i
4
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
i
y Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.,,a "• 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1 - 1000 ag I.
❑ 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.):
The pit was dry. The scum line was 2' below the inlet pipe. There was no sign of failure. The cover
was 3.5' below.
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration.
1 with overflow pit
Depth—top of liquid to inlet invert 5
Depth of solids layer- 10
Depth of scum layer 3
Dimensions of cesspool 5x5
Materials of construction block
Indication of groundwater inflow ❑ Yes ® No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
r
r
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
_
page. City/Town 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.):
Some of the cesspool blocks have come loose and fell in. making the cesspool unsafe. recommend
replacing the cesspool with a septic tank.
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.):
N/a
t5ins-3/13 Title 5 Official 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
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is
required for every Hyannis MA 02601 3/1/2016
page. Cityrrown 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
I
qR a
a o
o
'. curl . AQ
Pt ►
13S a9
b �
(Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
t. .
t
i Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
page. City/Town 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: 30+
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:
Topo and water contours map
❑ Checked with local excavators, installers -(attach documentation)
❑ Accessed USGS database -explain:
1
You must describe how you established the high ground water elevation:
see above
Before filing`this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
4 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,. 279 Arrowhead Drive
Property Address
David Mcfarland
Owner Owner's Name
information is required for every Hyannis MA 02601 3/1/2016
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
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
. i
TOWN OF BARNSTABLE
LOCATION #
VILLAGE ✓✓���' ASSESSOR'S MAP&PARCELa 7a
INSTALLERS NAME&PHONE NO. QPV,�' Ze4ea ,04- 77-"o]V
SEPTIC TANK CAPACITY At"""� -40-,,-4 Iroo CA l
LEACHING FACILITY:(type) o..��`�C-T��iT (size)
NO.OF BEDROOMS 3
O W N E R e,f,, 1 0 Z�.f2
PERMIT DATE: 6�/� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `• Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY �� �� , G��o�`�/✓�`
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No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftplitation for MispoBal 'M Construction j3Ermit
Application for a Permit to Construct( ) Repair('grade( Abandon( ) [:]Complete System Individual Components
Location Address or Lot No. 79 OoZ Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ") 7 0
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Zt> Lot Size sq.ft. Garbage Grinder( )
Other Type of Building 4-1-T 4�pzlp_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 0,A-',dr Type of
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ���T��� �/�G� -7a ✓�� /�
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 Ith.
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. (O Date Issued
016— I� I
No: ( Fee bD
�\ THE COMMONWEALTH OF MASSACHUSETTS `,N�Entered incomputer: .
PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS jyY s
ftplicatlon for BIsposal *pstem Construction i3ermit
Application for a Permit to Construct( ) Repair( grade( Abandon( ) [:]Complete System A Individual Components
J
Location Address or Lot No..-)79 Qoui cad® ®OZ Owner's Name,Address,and Tel.No. \`
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J%
���h Gtl80E`vi�` 77 S— 0,07 ��7i1✓'�/'' �.'r :��j -/���
I
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building
g �cB'„/� No.of Persons .- - L_ Showers,( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided ,! gpd
i
Plan Date t Number of sheets, Revision Date
Title
Size of Septic Tank /�4/i/tC+jt Type of S.A.S.
Description of Soil
Y Y S
. F
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Ith. a /�
Signed Date
j Application Approved by ! Date
Application Disapproved by Date
for the following reasons
Permit No. 0 ate Issued
THE COMMONWEALTH OF.MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded
. Abandoned( )by
at 7 9 �l'GP�l o Gee ycriJ.lj >6l- has been constructed in accordance _
L � CIO
with the provisions of Title 5 and the for Disposal System Construction Permit No.��6 dated — ;L�
Installer ��/97 ZG�'�o�'G.� Designer '
#bedrooms Approved desig ow gpd
The issuance o this[ermit shall not be construed as a guarantee that the system will nct•l n designed.
Date Inspector
�•'�No.� Pd -4(`3�-------------�--A,----------------=-----•-----------•---------- --------------------Fee---���=------ — ...
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEAA'LTH DIVISION-BARNSTABLE, MASSACHUSETTS
disposal stem Construction permit
Permission is hereby'granted to-Construct( ) Repair(� Upgrade(� Abandon( )
System located at'�79. ��OG�//j��i�� A!PZ
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the:following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permi
Date Approved b
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town a Barnstable
...................0 F.............................................
Apli irFation for Eliiplaii al Works Tmitrnr#inat .eranit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
279, Arrowhead Dr. Hyannis.H ais MA 02601
................--•-•-•-------............................ .----..---•--..............---•------ --•--•-••-•-...---•---....---......-------•. .........---..........-.-......--------•--
Location-Address or Lot No.
David, McFarland 27q Arrowhead Dr:,__Hy� i ,__M�__-__Q2�iQ],____-•___
...........:........__...............
Owner Address
W A & B Cesspool Service 128 Bishops_Terms_e,..HxsE1 �...MA.....Q2Q1.._..
..............
Installer Address
d Type of Building Size Lot............................Sq. feet
U g— ._--.Expansion Attic ( ) Garbage Grinder ( )
�. Dwelling No. of Bedrooms ......................... —
aOther—Type of Building ............................ No. of persons..........-3............... Showers ( ) Cafeteria ( )
Otherfixture--------------------------------------------------------------------- -•-•------------...-----•-••-•----•--•---•-••••--......-----•---...---------
W Design Flow............................................gallons per person per day. Total daily flow...........................................:_gallons.
GG Septic Tank—Liquid'capacity...--_--....gallons Length................ Width................ Diameter---------------- Depth................
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x Seepage Pit No-------------------- Diameter.................... i--.. Depth below nlet.................... 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..........................
( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P1 ------------------------ •- ...........................................................
cr
O Description of Soil........................................................................................................................................................................
0
W ----••-•-•---------------------------•••-•--•-••-••----------.....-•-------------------•-------------------------------------------------------•--•-•----•••---------------------------------•--------
VNature of Repairs or Alterations—Answer when applicable....irista.11ati-on.--Df-.a...pre-.cast.•100.0__gall.on,
stone Packed �.eaek�_.P t (.overf low)
...--------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L T
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i,5sued by the board of lth. r
Sign d .. -•--- �/ 12� $/�Q..........
f Date
Application Approved By....... ... l 1 $�$0
Date
Application Disapproved for the following reasons--------------------------------------------------- ...........................................
--•..............•--........--•-•------•-----._.._.....-•---•------•---...-------•-••--------•----.........-•---•-•----••--••------••----------.-----• •---•-•--•••-•-••----•-------Da......-••-•-----
PermitNo.............80........................................ Issued.... ------------------••---•-------
Date
No....$D.-1?7. YHR$p.....5.00.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town a Barnstable
...........................................OF..........................................................................................
Applirtatiun for Dhipaii al Works Tonutrurtiun "[.'runt
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
279.Arrowhead Dr._.__•H�rannis,.MA_.__.02601
Location•Address or Lot No.
-David McFarland. 279__Arrowhead Dr.e.,.._Fly_ann ss•.NIA._..Q2 41.......
............................ .
Owner Address
a A & B Cesspool Service 128 Bishops-•Terrace. Hyannis,__MA.....02601.....
Installer Address
Type of Building Size Lot............................Sq. feet
N oms...__._...3Dwelling— o. of ...............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons..........3--------------- Showers ( ) — Cafeteria ( )
P., Other,fixtures .................................
W 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........................................
a
a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.--................. Depth to ground water........................
a ••---•-••----------- 1..
ODescription of Soil..................................................................................................................\.....................................................
U ---•--••-•----------•-•••-••-•••••-•-•----••••--•--••-•----------•-----------------•-----------------••••-------•-------•-•.....----•---•---------...--••------------••-•--------•--•---•......-•••••••.
W ••-•--------•---------------------------•--•--•---------------•-••• . --------------------------------------------------•
U Nature of Repairs or Alterations—Answer when applicable---Uirtallatlp]Cl__o;l"__A..p_re:nQa_st...
1DQQ.. A11DY1,
stonePacked leach- pit (overflow L.....................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Dispo al System in accordance with
ii
the provisions of :." 5 of the State Sanitary Code—The undersigned further ag -not to place the system in
operation until a Certificate of Compliance has been,issued by the board of health.
.. `- --- 12�_ $� Q.....
Date
Application Approved By----•- ,,... ._C..-= __� I........ ............. ----•------
D ate'
Application Disapproved for the following reasons:................................................................................................................
-•---•-----------------------------------••----------------------------------.-....------------•--••••-•---•-----------------------•-••-••---•--------••-•-•----•--•-•----------•--------------
Date
80- " ..
g
Permit No......................................................... Issued•.-.•12-•-- -•----- --$0
................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............Town................ Arnsta.bl ................................. .........
Tnrtifiratp of Toutplittnre
THIS IS Tp CERTIFY That the II '�v'dual Sewa e Disposal System constructed (( ) or Repaired (X)
A B Cesspool Service, 1 � tishops errace, Hyannis, MA 02601
by.. .............. .•---••--••........._...... ................. -- -----------. -------•----.--. ......._......._.._-...
279 Arrowhead Dr., Hyannis --'ffav1d McFarland
at......................................................................................................................................................................................................
has been installed in accordance with the provisions of TLC j of The State Sanitary Code s d cribed in the
application for Disposal Works Construction Permit No..�- ..7d. ................. dated.-...---12�--IgNor.---..-.-.-__.__...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �
DATE. __9�a�........ Inspector /0� '-% �Y.. ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
$0- 707 °.......Town........OF...........Baxnstable 5 00
NO....................... EE.._......._..�.........
13ispostt1 Workii T.Aunutrudion amit
Permission.is hereby granted...........A & B Cesspool Service .
to Constr or RRe Ir X) Individual Sewage Disposal System
4 A�owhe D�.,. Hyannis -- D.avid McFarland l
atNo. ........ ............ ................-... ---• --•---..... ....... -----•......
St et
as shown on the application for Disposal Works Construction P t N ...0 ._. . _ Dated.........12/.- lgP.............
-----.. ... . .- • .ff!lll . --- •.. ---•------••-•----
1'Z/ C�/$Q Board o Health
DATE.................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS