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HomeMy WebLinkAbout0234 BISHOPS TERRACE - Health 234 Bishdps Terrace - Hyannis A = 251 170 i e i TOWN OF BARNSTABLE FC LC CATION P3g1 l QS SEWAGE # 200;)—0'7\ VILLAGE�r4N'l 5 ASSESSOR'S MAP & LOT 20- Iry INSTALLER'S NAME&PHONE NO. RoloiNWY-3 5(-PtiC 775--49-77(o SEPTIC TANK CAPACITY k 1600 LEACHING FACILITY: (type) Qp, c&OE«S c4- (size) I o� 2'A S NO. OF BEDROOMS 3 BUILDER OR OWNER A�QOEt2SOyJ PERMIT DATE:<' 'o 0 2• COMPLIANCE DATE:_0L-;t5- 0-,-k Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet .Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i �' ►- O � � � i -►C` r � C --- �- � � 0 Cr � d O' � �i � :yam 1 d0 M I 1 ,� l i '� �� TOWN OF BARNSTABLE WFATION r yc"� '�'�= SEWAGE # i, VIL1-,AGE ASSESSOR'S MAP &LOT INSTALLER'S N &PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER ATE: I L COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _ i 0 ( 0 r Vil Vi N 1 - Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS required for MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your MICHAEL DEDECKO cursor-do not Name of Inspector use the return key. COMPASS REALTY DEV CORPS Company Name P.O. BOX 2384 �- CompanyAddress =£ MASHPEE MA <i 0264V, W reaan n .-.. City/Town State A Zip Code 508-221-5003 4F> Telephone Number License Number r' A. B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eyajuation b the Local Approving Authority 5/21/07 Inspect6r-s7Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Observation of sewage backup or break out or high static water level in h distribution box due ❑ g p g e the to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c� 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has 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 asses if the well water analysis, performed at a DEP certified laboratory, for coliform Y P Y , p rY, bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w., ,•`''� 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 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. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 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)] 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 115 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: N/A Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) ' Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: n/a Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 1 Commonwealth of Massachusetts w W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight, yes vented, no sign of leakage. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gallons Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 11" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every 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.): no need to pump, tee's intact, structurally sound, liquid level equal with outlet invert, no leakage. 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.): 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): 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5121/07 � every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert equal with 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.): D-box is level and distribution is equal no solid carryover, no signs of leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): soil sand/gravel no sign of hydraulic failure, ponding dry, no damp soil, vegetation normal. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 4 Ucl .z- - 34 61r ,3.7 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 234 BISHOP TERRACE Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 5/21/07 every 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 ground water: 70 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: barnstable gis ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: barnstable gis shows spot elevation 72.42 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 COMMONWEALTH OF MASSACHUSETTS 'D Z 5 vo EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTEC ON , Ap, 1M See O" TITLE 5 o�q�x OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMEN SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: �Ih v -S /C��^ FAILE® INSPCTION Owner's Name: Owner's Address: d.7 4 �W � e, Date of Inspection: Name of Inspector: (please print) Company Name: 3 — �,y Mailing Address: 0 4Y Telephone Number(S oYl CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓;f'Fai Inspector's Signature: j�c =, Date: -1 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments 6 J ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6&� ,�S IS`,cl f / C y— f U/ Owner: ��✓`BPS' r� Oo Date of Inspection: -2— //-Od, Inspection Summary: Check A,B,C,D or E/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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipes)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ol241L d /��J G v�60 Owner: '.140a//erl Date of Inspection: C. Further Evaluation is Required by the Board of Health: A' Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,prodded that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for an inspections: Yes o Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ,,,clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool ✓Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow 1/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped �y portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] eS (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone Il 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 "ves" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ���f 1 7o e�- Owner: 47 c(F v�s � ' Date of Inspection: ,:;-I-//-O a 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 / (ove �_ 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 _L,'�_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes rno ice/ Existing information.For example,a plan at the Board of Health. t/ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �/ h oz'-"- /e�/ o&C� Owner: '4dkrs p� Date of Inspection: -//- Oal- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 C� 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): /1/'0 Is laundry on a separate sewage system(yes or no):� [if yes separate inspection required] Laundry system inspected(yes or no): /1/0 Seasonal use: (yes or no): /VO Water meter readings,if available Oast 2 years usage(gpd)): 0?1r00- 9"62 U00 C2c O/— G0 Sump pump(yes or no): /io / Last date of occupancy: L4i��.3 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM OF tank,distribution box, soil absorption system _Single cesspool Overflow cesspool —Pricy _Shared system(yes or no).(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if know/))and source of information: Were sewage odors detected when arriving at the site(yes or no): /�U Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �� Owner: �Ndi%rf0 Date of Inspection:_ '.�—//" OpZ BUILDING SEWER(locate on site plan) l/ Depth below grade: 13 Materials of construction:_mast iron 6,1 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK:�(locate on site plan) Depth below grade: 6 � Material of construction: (concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of judge 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 botto outlet tee baffle: How were dimensions determined: /moo Continents on ( pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as rel ted to outlet invert,evi ence of leaks e,e /' LI°M;'ih ✓)U �, 7` �G�is I/ "`IPi G3Lr h' GsrnCi'/ GREASE TRAP: locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain).- Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) �d�o/ Property Address: 6y Owner: �y� Qrfc✓1 Date of Inspection: —//-D 2- TIGHT or HOLDING TANK: AG' (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working.order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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 f bo etc.): / / J / /l'G Slit Gr 'Ye at-�1 x�/-7/ O i T PUMP CHAMBER: /y (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): a Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) / Property Address: ,7 Owner: H � Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type J— eachi /�x/ ✓� lng pits,number:� c./ �o l pC T� teaching 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.): 0PC rat of / / lvlb'c�✓ ' C�� 610 � lC /�?� ✓e CESSPOOL L(cesspool mustbe umped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL Y S STEM INSPE CTION FORM PART C SYSTEM INFORMATION(continued) Property Address: O 601 Owner• ✓��jp1 Date of inspection: _o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. I u � G� Z �O/ �J ' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYST/EM INFORMATION(continued) Property Address: , hp 7e t1— Owner• f 1 A d e'v- Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells i Estimated depth to ground water ZjV.2feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole thin 110 feet of SAS) �hecked with local Board of Health-explain: G�S Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: Yo u describe how you establi hed the high ground ate elevation: L11D o� s ra ' G S•/� S / O// i i0 ur we �. Q TC r 72,,�, O r L C9-r WNW I0 0 0 `I 0 0 0c2 i , r � 0 0 oo t O D 00 0 0 0 0 0 0 0 0 .>- T D 5 / 1 l��N (Y�Du✓?Ch/'AR'r A �� � � I No. '' • Fee $L F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for ;Bigoml Opotem (Construction 3permit `Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 24 4isops Terrace, Hyannis James Anderson Assessors ap arce Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Dan Johnson P O Box 1089, Centerville 804 Main st. , Osterville Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. i Plan Date Number of sheets Revision Date Title Size of Septic Tank k!bGU t z Type of S.A.S. Description of Soil; Nature of Repairs or Alterations(Answer when applicable) Title_5 1 ear__h—system te plans of Dan Johnson, ransistincl of a n-box arl 2 preCast ch trllaP s. With _t-nnP all around r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of Healt c� Signed . Date Application Approved by Date 3-.42 `d Application Disapproved for the following reasons Permit No. ` w t12� - a:71 Date Issued 2-0 No. Fee n Entered in computer: �. � THE COMMONpW VUEALTH OF MASSACHUSETTS'" . es ., PUBLICHEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for �DigpoM *p5tem Construction Vermit 4pl pation for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 234 Bishops Terrace, Hyannis James Anderson Assessor s Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Dan Johnson P O Box 1089, Centerville 804 Main st. , Osterville Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank r" Type of S.A.S. 2 - Description of Soil 1 Natur46'of Repairs or Alterations(Answer when applicable) Vj U —5! ssta,n +-eplans of"Dan Johnson, consisting of a D bOx and 7 nrAraet -hambersz_ '4itl stone all arcmnd, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in.accbrdance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Bo .of Healt Signed Date91p-d Application Approved by Date .2',4: d 2 Application Disapproved for the following reasons Permit No. 26 o7- o;lam Date Issued 2^2:) -0 2 —---—------- - • - THE COMMONWEALTH OF MASSACHUSETTS f Anderson BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(.", )Repaied ( X)Upgraded( ) Abandoned( )by Wm. E. _Robinson_ Septic Service at 234 Bishops Terrace has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.00-0'7/ dated Installer Wm_ E. Robinc;nn Rom, Designer nan ,Tnhngon The issuance of this e,t shall not be construed as a guarantee that the syste will function as desig Date �/ S102, Inspector G� �.,V /I _.�7 No. n t) 'U� Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Anderso PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigpool *p!tem Con5truction Vermit Permission is hereby granted to Construct( )Repair(A )Upgrade( )Abandon( ) System located at 234 Bishops Terrace and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thisgrinit.1 Date: a -o - Approved by 4 TOWN OF BARNSTABLE C LOCATION -03q A_ Aoipi C22WC�- SEWAGE # Q2Q-0"1 k VILLAGE 4,ArJfV1 S ASSESSOR'S MAP & LOT 25 -176 INSTALLER'S NAME&PHONE NO. _&1o4N Sort 5Eptic 775-'9-77(o SEPTIC TANK CAPACITY k i oOC) LEACHING FACILITY: (type) QRUc_-_k«S r_�, (size) 1 a 2 a S NO.OF BEDROOMS 3 BUILDER OR OWNER A 1QVC-Q5QV J PERMITDATE? oQ-.-AR-6 2L COMPLIANCE DATE:�l'aS`Ga Separation Distance Between the: aximum Adjusted G"ri . vate Water Supply.Welland LA aching Facility (If `Jweltezist �f�,yu on site or within 200 feet of le Feet ge of Wetland and Leaching Fa ci y3(gands ezis ; . within 300 feet of leaching facility) Feet WT �urnished by k Deck. O 5MI01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION <r- FORM I, b^/v ILL 9. J Ff/YJ o^i, hereby certify that the engineered plan signed by me dated X I g/f 2 concerning the property located at 1 2 9 B/S*oPs 7'e-XtR c9 -1Y meets all of the E - following criteria: • This failed system-is'connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. S • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface.Tlevation (using GIS information) 66 B) G.W. Elevation 30. + adjustment for high G.W. 8(111)_ 3 b . DIFFERENCE BETWEENNA and B 3 0 Y_ SaI� ri=sz le _F � SIGNED : AZ. DATE: 9 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:heilth folder.percexmp i I DISTRIBUTION BOX H •20 TEST PIT DATA REMOVABLE COVER 4"SCH 40 OUTLET LATERALS Performed By• Daniel B. Johnson DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST TWO 15.232(WATERTIGHTNESS, FEET AND CONNECTED TO Date : February 19, 2002 CONSTRUCTION,ETC) r' EACH DISTRIBUTION LINE WITH SOUD SCH 40 PVC PIPE NO OF OUTLETS: 2 4"SCH�407, 6" ! 4"SCH 40 INLET TEE TO BE o 0 6"(nglN) o o — MECHANICALLY CRUSHED 0" - 6" A, 10YR3/2 Loamy sand INSTALLED o 0 o o o STONE (<-3A"DIA.) 6" - 24" Bw, 10YR5/8 Loamy sand j STABLE LEVEL BASE 24" - 53" Cl, 10YR4/6 Loamy sand 53" -132" C2, 2 . 5Y8/2 Coarse sand No Observed ESHWT No Observed Groundwater LEACHING DRY WELLS -500 GALLONS I PERCOLATION TEST DATA ( "END"CROSS SECTION Date: February 19, 2002 FINAL GRADE TO BE STABILIZED MODEL. PRECAST CONCRETED � Soil Class : Class I (0 . 74 G/SF) 1 FINISHED GRADE(SLOPE = 021 Perc Rate: < 2 MPI (TP-1 ) ; ! I I 12 IMIN) H•20 C, CIO Depth of Perc Test : 53" - 71 " LEACHING DRY WELLS 2 0 0 0 0 /4"-1/-"DOUBLE 8'6"LX4'10"WX2'1"H WASH PEA STONE SCHEDULE OF ELEVATIONS OVERALL LEACHING AREA c' a 3 5' 25'LX1ZWX`H 0 2'1" E 3/4" 11/2"000BLE WASHED STONE Inv. Out Founuatioi, (existing) 96 . 8 d © `= o Inv. In Septic Tank (existing) 96. 4 Inv. Out Septic Tank (existing) 96.2 LEACHING DRY WELLS Inv. In Distribution. Box 94 . 20 ! � TO COMPLY WITH THE 8'6"' Inv. Out Distribution Box 94 . 03 j REQUIREMENTS OF 0CMR 15.252 Inv, In Leaching Dry Wells 94 . 00 Bottom of Leaching Dry Wells 92 . 00 Bottom(TP-1 ) No Obs . GW/ESHWT 86. 9 LZGMM 4 Existing Contour - - - 98 - - - ; NOTES 1 . All construction methods shall conform to the Title V ( 310 Proposed Contour CMR 15) and the Barnstable Board of Health Regulations . Test Pit I 2 . There are no known private or public wells within 015 ( feet/400 feet, respectively, from the proposed ledchin s Finished Floor Elevation FEE ! area . p p g i Basement Floor Elevation BFE 3. Existing SAS to be pumped and removed prior to �— installing the leaching area . Water Line W 4 . No changes are to be made in the field without the approval Gas Line ----G of the Board of Health and the design engineer. 5 . Proposed leaching area is not designed for use with garbage disposal . ! 6. Contractor to notify Dig Safe 72 hours prior to construction . (800) 344-7233. i SNI� - f0 - �• Y.� , 7 . Property line information taken from Subdivision Plan for \�oiNr t Bishops Terrace and existing bounds along property line. Septic Plan not to be used as a property line survey. 10 R . Remove 5 feet horizontally around the proposed leaching area LAREWtw p c Ay ,, CO, �. and vertically, approximately 4 . 5 feet (topsoil, subsoil, Qo� LA K 1010 i �� ' Cl - loamy sand layer, existing SAS and any leachate ti EAST 4-0 impacted soil) and replace with Title V fill (Reference 310 0 �o (' CMR 15 . 255 for specifications of fill (sand) j . The total �fr - 00 •� r ! amount of fill required is approximately 10 cubic yards. CALCULATIONS got 2 Bedrvo(ns (Existinq) 110 GPD/Bedroom X 2 Bedrooms - 220 GPD Percolation Rate - < 2 MPI (TP-Z) CENTERVICLE ?` , `,�,� F Soil Class : Class I (0. 74 G/SF) ? 5 ,, ! • . �� mot° o LONG �L/TTLf 0�� �, +�' * Septic System designed for 3 bedrooms per Title V Po/Nr Polar ��- '� r t PROPOSED LEACHING AREA: GREAT oo/NT "�w W CNR17TM/A'T _ 0 CA PA �A Leaching Dry Wells: 2 at 25' L x 121W x 2' H t i m s •s ' N NA NCy'1 Side Area: 148 SF X 0. 74 G/SF - 109. 5 GPD , to ; r ,� w ,A Bottom Area : '300 Sr X 0. 74 G/SF - 222.0 G2r) ao 1A4� oa N� ° h Total Leaching Capacity: 331 . 5 GPD c I a o s'►� 2 BtoNcs � � a" � I �A,NAN I� . 1r�a GAacE~ CAVE CA v�e� Oe hoely �` yfALMa efe MAID FARMS Ceti P r ` rtNra by 11 28 RO 1 Itr[i�ARr rlil �t C ov A s PA Uorrs. t' so" I DAL! MAIN O RD L ONG POND ..� i • a a G V e- e- �aj C Vv I �� C-" I SUBSURFACE SEWAGE DISPOSAL SYSTEM 234 Bishops Terrace, Hyannis SCALE: 1<i APPROVED BY DRAWN BY ATE 7d � 2f O2 Darual B Johnson D.S. Johnson ( : I �rr7 l Prepared James Anderson (508) 790 - 3757 C� ► �j�e"T �' y Tor: 234 Bishops Terrace, Hyannis, MA /1 n Prepared DC*aSTIC SLPTIC DESIGN, SNC. (508) 420-1404 DRAWING NUMBER By 004 Main street, Suits B, osterville, 2A 02655 J-748 rLAIV Of SEP i I L 1",,4NK SCA CE 1 A-Q (jJ ©v D SEE n,,re It pRy wEClS -- r`F .rrN(r zS�Lf /3�wx� N - ` (rF•1o} 98x9 � o s=,d0 98 TKC'EpsriNb Tbi' 6+r- dR CK Si vpF, 0 ( vOa (TAGLJrJ � -- -- SE Prl c TANK DECK i 9"SErrER y8+b i M EXrsr�NG Ha�sE ffE= r ov,b t r w nt o � cL W c rmo) 5 iS tf o t' TEIZrz�C E 5(4LE 4S Strow/yt �J vEH r boo PO oEcK T -J �M/Oj.) 6*)STlti6r 6-R-ADE � EXtjr�N 4� RND t'Dvt rzj SEW To £�u jrlNb 9 LSE W srEOL rb.rrr� E-Alj r/N6 f —Cl - ' -- '1 9oy:.gt dee`P�,a c.r gf�' 93,rt 4,oo See ,T e Tj if q,o3 i 91 ! IGOO GAIC ON DISr,-j -T(O,v SEprit Ti¢N/r dv� a,00 90 `� LEAcr4/nt(- 5' DXV LpELI.S ea NO L*J t too o+ro U+3o p+3o p+4o GiSJ ct+-60 0.�o pr Bo _.�_...._QtDo /tiro /ttp o