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Home My WebLink About0168 BISHOPS TERRACE - Health 168 BISHOPS TERRACE, HYANNIS A= 251 175 o �� f TOWN OF BARNSTABLE LOCATION !GS ;Sh SEWAGE# ZO Z l - 090 VILLAGE 14U C1 n n J ASSESSOR'S MAP&PARCEL 3/— /7,g'— INSTALLER'S NAME&PHONE NO. EXCgL�qA 0^ (4 en-0L53 SEPTIC TANK CAPACITY /SOO LEACHING FACILITY: (type) 7A t!K O^2LY r:(•�? NO.OF BEDROOMS OWNER Van CSSo0.. WQc,lc.^J, PERMIT DATE: 3'Z3" 21 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 REAR Al_ /OS„ AZ• IS�G " VA O32 30 O ' A3- Z2G " 83- 3G TOWN OF BARNSTABLE LOCATION O� � CS'-= SEWAGE # VILLAGE l� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER �5 PERMTIDATE: 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) G Feet Furnished by C( qa_ COP Sox r, a Q � �b No. ' - I `® Fee w o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. 110, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitatiott for disposal *pstrm ConstrUCtion Permit rt Application for a Permit to Construct( ) Repair()() Upgrade( ) Abandon( ) ❑Complete System X Individual Components Location Address or Lot No. &Sh0P5 MawOwner's Name,Address,and Tel.No. Oo,n Sa\Ve ko r e/ Assessor's Map/Parcel 4qannis SOB• 190• tg'+4 Installer's Name,Address,and Tel.No. S 3 g �caCcava�10n ,1\(, Designer's Name,Address,and Tel.No. 3-44 Rouk-,, 1'3o San4ta\ob Mo. 0LSto3 Type of Building: 0 S 3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 Type of S.A.S. Description of Soil �MINO O hon 84 1600 aOLNn ka11_ OM!g Nature of Repairs or Alterations(Answer when applicable)�5�a��a�i o� A� �SDD aoMor\ stpkAc, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , Signed Date - Q• LApplication Approved by Date Application Disapproved by Date for the following reasons Permit No. U-0 �� Date Issued _..+��------____ _____ -ifF.V______________________________ _____ No. Fee. ��1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yew' gotitation for Misposal bpstrm Construction permit Application for a Permit to Construct( ) RepairOO Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. \6% btS�o)S 'Ve M,�^N ( i,. { `,Owner's Name,Address,and Tel.No. jam,n c�1�tq c�i er Assessor's Map/Parcel 4 Ct�n±S ' +. 1 t 8 Sot 190, �cl+1 � Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel:No. 311 rKc ukc ;-So A, . 0'L3 i•d A Type of Building: Sol r tt-41^0.S 3 +� f, Dwelling No.of Bedrooms ! Lot Size sq.ft. Garbage Grinder() ) Other Type of Building' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) MIA- gpd Design flow provided AMA" gpd Plan Date Number of sheets Revision Date r Title Size of Septic Tank Type of S.A.S. Description of Soil kMAO. &AL of) n4 1_500 nr0\on AAnt , 00t% Nature of Repairs or Alterations(Answer when applicable) KC3U aaaNr� ",etJtc AnC'k 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 ofHealth. - Signed Pr1Ps`A..,� �� L. Date Application Approved by - Date Application Disapproved by ;_ _ Date for the following reasons Permit No. 7.t I Date Issued 1 n .Z/ 6 n....v.,.._. --__ ___________________,e-�.:.---�:.-�..._, -.-.-.-.--a.-.-.mow_.=.-_:�.�,�_-.-��.__r:._—_,__-_____ �_..__ __—__•- '•-`_ _-___ -____•- __ •-r (� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS v r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( } Upgraded( ) Abandoned( )byit at n S �e t rn,f ¢, has been constructed in accordance 1 � with the provisions of Title 5 and the for Disposal System Construction Permit No. Z (~ ® �dated31 1 3/L Installer ! Designer , #.bedrooms-* '-'(~ox( L OQL�Y * Approved design flow MIA gpd The issuance of this pe it shall not be construed as a guarantee that the system wil funct on as designed. I f, Date 1 t�I Z I Inspector 1 �1. r t No. Fee V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposat 6pstem construction J)ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �(nR ��ZnaS "gyp rtct c. ��lnnni 7 Kok OWt-X 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 permit "^— Date i a ,' Approved by { F,, a WE Town of Barnstable faRNSBM 9. E 1639• Inspectional Services Department �0 pTFD MA'S a Public Health Division 200 Main Street, Hyannis MA 02601 Oft ice:.508-862-4644 FAX: 508-790-6304 Thomas A. McKean,CI10 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) 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 ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located 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 ofa driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) O ERr-f pf',j'r 7 1�Arlj( ;f�py'-k� j der Repair deadline: y . 0,, or r-,e �u�k Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc I Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is Hyannis Ma 02601 3/14/2021 required for every y page. CitylTown 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. Inspector Information �S- on the computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. P.O.Box 151 44 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ® Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ` 3/14/2021 Inspector's SigrAlfure Date The system inspector shall s mit a c y of this inspection report to the Approving Authority (Board of Health or DEP)within days ompleting this inspection. If the system has a design flow of 10,000 gpd or greater, t inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ' r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): Precast 1000 gallon septic tank has leaked to seam level (half way)tank shows decay and exsposed, steel due to decay when mirrored and checked with light t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is H required for every y annis Ma 02601 3/14/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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: r 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis annis Ma 02601 3/14/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or P P 9❑ ® Y 99 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply Y 9 PP Y ❑ ❑ 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 11 of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 L_ Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �e 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021. page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 Description: existing 3 bedroom house. increase of bedroom flow will need to be approved through health and building dept Number of current residents. Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts t= - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding.tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. 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: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: unknown information. house built in 1972 per town website Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ®cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line. 26+feet Comments(on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts - p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 1000 gal Precast concrete If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 8" 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? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank leaked to seam line. tank has decay visable with mirror and light t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts io Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no box present 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owners Name information is required for every Hyannis Ma 02601 3/14/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,iq Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 6'x6' precast pit with stone. Dry at time of inspection. pit has stain line 30" below invert pipe 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 Comments(note condition of soil, signs.of hydraulic.failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts P Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . d.� 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): c Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is Hyannis Ma 02601 3/14/2021 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 back 0- 1 14oube 0 p Ac - 3� OC 13 o K t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ 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: town GIS mapping You must describe how you established the high ground water elevation: lot el. per GIS mapping el. 68 G/W in area el. 30' bottom of SAS 9'6" bleow grade of el. 68 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 h Commonwealth of Massachusetts ,io Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Bishops Terrace Property Address Burgess in care of Vanessa Whalen Owner Owner's Name information is required for every Hyannis Ma 02601 3/14/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 16 Town of Barnstable Barnstable Board of Health i WW ABM$ 200 Main Street, Hyannis MA 02601 I En MAt gh 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL# 7006 0810 0000 3525 3428 November 14, 2012 Francis Burgess 168 Bishops Terrace Hyannis, MA 02601 Re: 481 Main St. Centerville, MA 02632 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD OF HEALTH on Tuesday, December 11, 20�12 at 3 pm in the Town Hall, Hearing Room, 2nd Floor, 367 Main Street Hyannis, MA due to an unlicensed repair of a septic stem on Y p p Y or about August 19, 2011. Department of Environmental Protection 310 CMR 15.019 states "No individual shall engage in the construction, upgrade, modification, emergency repair, or expansion of any on-site system without first obtaining a Disposal System Installer's Permit from the Approving Authority." You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. do i1 .z PER ORDER OF THE BOARD OF HEALTH Th as McKean Agent :- Q:\Order letters\Sewage Violations\Request to Appear at B01-\168 Bishops Terrace.doc Burgess Company liiiilsce. 1 ►: 168 Bishops Terrace Hyannis, MA 02601 httpYAvww.burgessconlpany.biz VOICE Customer Misc Name Maryanne English-Fembrook Inn Date 8/19/2011 Address 481 Main Street Order No. City Centerville State MA ZIP 02632 Rep Phone 508-775-4999 FOB Qty Description Unit Price TOTAL 1 Excavate and identify septic system outbreak problem $ 100.00 $ 100.00 1 Drain Doctor(tried to-clear line(snake)to pits but crushed) $200.00 $ 200.00 1 Mini excavator to excavate dbox and crushed lines $ 375.00 $ 375.00 1 Provide and install new Dbox $ 500.00 $ 500.00 1 Provide and install 20ft of sch40 PVC fine and bac kfill $ 125.00 $ 125.00 SubTotal $ 1,300.00 Shipping Payment FSelect One... Tax Rate(s) Comments TOTAL $ 1,300.00 Name CC# -� Expires { Thanks for your business! Town of Barnstable Barnstable Board of Health j e`�'`j HARNWABMAKM ` 200 Main Street, Hyannis MA 02601 EC a��' 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-796-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL# 7006 0810 0000 3525 3428 November 14, 2012 Francis Burgess 168 Bishops Terrace Hyannis, MA 02601 Re: 481 Main St. Centerville, MA 02632 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD OF HEALTH on Tuesday, December 11, 2012 at 3 pm in the Town Hall, Hearing Room, 2nd Floor, 1 367 Main Street, Hyannis, MA due to an unlicensed repair of a septic system on or about August 19, 2011. �. Department of Environmental Protection 310 CMR 15.019 states "No individual shall engage in the construction, upgrade, modification, emergency repair, or expansion of any on-site system without first obtaining a Disposal System Installer's Permit from the Approving Authority." You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Th as McKean . Agent Q:\Order letters\Sewage Violations\Request to Appear at BOH\168 Bishops Terrace.doc Health Master Detail Page 1 of 1 x Logged In As: TOWN\miorandd Health Master Detail Wednesday, November 14 2012 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 251-175 Location: 168 BISHOPS TERRACE, HYANNIS Owner: BURGESS, FRANCIS P&GEORGINA D 3 Business name: Business phone: Rental property: G Deed restricted: ❑ Number of bedrooms : O, Contaminant released: (_ Fuel storage tank permit: I- Save Parcel Charages�s� `� Return-to Lookup Parcel Info Parcel ID: 251-175 Developer lot:LOT 27 Location: 168 BISHOPS TERRACE Primary frontage: 133 Secondary road: Secondary frontage: Village:HYANNIS Fire district:HYANNIS Town sewer exists at this address:No Road index:0126 Asbuilt Septic Scan: 251175_1 Interactive map GP (Groundwater Protection Overlay Town zone of contribution:District) State zone of contribution:IN Owner Info Owner: BURGESS, FRANCIS P &GEORGINA D Co-Owner: Streetl:168 BISHOPS TERR Street2: City:HYANNIS State:MA Zip: 02601 Country: Deed date:4/14/1999 Deed reference:C152714 Land Info Acres: 0.34 Use: Single Fam MDL-01 Zoning:RC-1 Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1972 2620 11092 13 Bedroom 1 Full + 1H Buildings value:$79,400.00 Extra features: $34,900.00 Land value: $105,100.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=251175 11/14/2012 Burgess Company - Hyannis, MA 02601 - Intuit Business Directory Page 1 of 2 Hyannis New York Los Angeles San Francisco Houston Portland Seattle Chicago Businesses: Sign In Search for... in City.State or Zip Contractors&Construction > Home Construction&Repair> Plumbing, Water&Sewer>Septic Tanks&Services Pond Burgess Company Content blocked by your organization No reviews fr (+ X-1 RnrnP�c(,mm�anv-Intuit 781-738-5936 � a -W 166 Bishops Terrace Lv Hyannis, MA 02601 _ ' f ° t . ,. I Get Directionsb a ra Map datac� 2 Fax: 508-827-4085 Most Reviewed - - Check out what people are saying. Business Information Sposabella Bridal International Inn Bar&Grill Keywords water,gas,sewer,electric,Title V Inspections, Utlility,Emergencies,Pumping, Septic My Salon &Spa Inc Field Jetting and Pumping, Mainline Clearing,Septic Design,Installation&Repair, j Cosmetique Locating,Video Camera Inspection, Flood Assistance,Cover Projects Pufferbellies Entertainment Products N/A I I Services Title V Inspections- Utlility Emergencies-Pumping-Septic Field Jetting and Pumping Ad blocked by V/PRE Mainline Clearing-Septic Design- Installation&Repair-Locating-Camera Inspection Flood Assistance-Cover Projects-Heavy Duty Machines and Men for your Projects. Industries Residential Commercial Supported Year established 2010 l Professional MBOH associations Awards and Massachuetts Title 5 Inspector#4427 distinctions Hours Open 24 hours - CrerwvY'ou E3usi6ess , - Promate.,your business online FREE. Business Description . ,� -- Unground Utility Service-water-gas-sewer-electric ......--- - — - - _ _._.-- _... _ .. -- ...... __. . LL jCustomer Reviews (0) i _. .........................--- ........... ........._._ _ _.... } 4 E—o reviews were found for Burgess Company. Browse our top cities Austin,TX Atlanta,GA Brooklyn,NY Philadelphia,PA Las Vegas,NV San Diego,CA Raleigh,NC Denver,CO Dallas,TX Boston,MA San Antonio,TX Nashville, http://business.intuit.com/directory/info-burgess-company-hyannis-ma 11/13/2012 r s S-11\ Commonwealth of Massachusetts Executive Office of Environmental Affairs ON Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 John Grab D.E.P. Title V Septic Inspector kip P.O. Box2119 a Ste/ Teaticket, MA 02536 WILLIAM F.WELD ' (508) 564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 168 BISHOPS TERRACE HYANNIS Address of Owner: Date of Inspection: 11/23/98 (If different) Name of Inspector: JOHN GRACI MARY PHELPS;12 BATES ST.FOXBORO MA.02035 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V code 310 CMR 16.303.My findings are of how the system is — Condit' Ily Passes performing at the time of the inspection.My inspection does Need9f Ffirther Evaluation By the Local Approving Authority notimply any warranty or guarantee of the longevity of the septic system and any of Its components useful life. Fails Inspector's Signature: Date: 11128198 The System Inspector sha submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: ' B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 169 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11123198 _ Sewage backup or.hreakout or hioh.static water level observed.in.the distribution b.ox is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ — Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cingged cesspool. SAS is in hydraulic failure. I (revised OMP97) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 168 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11123199 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (reyleed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 109 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11f23198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x _ Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)]15.302(3)(b)] (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 108 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:111`23198 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 9•P•d./bedroom for S.A.S. Number of bedrooms:? Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No Last date of occupancy: nIa COMMERCIAL/INDUSTRIAL: Type of establishment: nra Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: nla OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED TWO YEARS AGO. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed(if known)and source information: SYSTEM IS 26 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no) No (revlaed 04@TI97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 168 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11123199 SEPTIC TANK: x (locate on site plan) Depth below grade: 16" Material of construction:x concreate_metal_FRP_Polyethylene—other(explain) If tank is metal, list age nla . Is age confirmed by Certificate of Compliance Nc (Yes/No) Dimensions: L8'6^H5'7^w4'10^ Sludge depth:4' Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY ONE TO Two YEARS. GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:We Distance from bottom of scum to bottom of outlet tee or baffle:rva Date of last pumpingn't, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I rda BUILDING SEWER: (Locate on site plan) Depth below grade: 22^ Material of construction: x cast iron_40 PVC_other(explain) Distance from private water supply well or suction Iine:rOwN Diameter: nle Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 168 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11f23198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Capacity: rya gallons Design flow: rva gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rya DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rya PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Y.: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rya (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 168 BISHOPS TERRACE HYANNIS Owner: MARY PHELPS;12 BATES ST.FOXBORO MA.02035 Date of Inspection:11/23199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: 10DO GALLON LEACH PIT leaching chambers, number:Na leaching galleries,number: rrla leaching trenches,number,length: rda leaching fields,number,dimensions:rda overflow cesspool,number:Na Alternate system: Na Name of Technology._va Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY.THE PIT HAD 4'OF WATER IN IT.PIT SHOWS SIGNS OF HAVING 4'OF WATER IN IT. CESSPOOLS:_ (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: rda Depth of solids layer: nra Depth of scum layer: r0a Dimensions of cesspool: rda Materials of construction: nla Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) rda i Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: We Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na (revleed 007197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 168 BISHOPS TERRACE HYANNIS MARY PHELPS;12 BATES ST.FOXBORO MA.02035 11/23198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Qrrc�. g � Mal Apt tQ Qc a3 Page ! o! 30 (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 168 BISHOPS TERRACE HYANNIS MARY PHELPS;12 BATES ST.FOXBORO NIA.02035 11123199 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS AND VISUAL (rev1eed04)27197) rate 10 0[ 10