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Home My WebLink About0038 BUMPUS ROAD - Health `38'Bumpus Road Hyannis . P ; A 310 038 e '� R I a e i I I i o ' I f C)LJ ✓� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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. A. General Information fl157 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs F rther Evalu on by the Local Approving Authority 1-6-11 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system,or has a design,flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewa Disposal°System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town 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 - ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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 passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/ 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. t5insp official document•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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 CM 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. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts H L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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): t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town State Zip Code Date of Inspection D. System information (cant.) 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) 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. El Other(describe): Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years i Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal V Sludge depth: 6 Distance.from top of sludge to bottom of outlet tee or baffle 26 Scum thickness. 0 Distance.from top of scum to top-of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp official document•03f08 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 ;M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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. q 9 :) Tank is in good condition with baffles installed and no sign of 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): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 , li Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. it Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-9.4'x42' ❑ 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.): Leach field in good condition with no sign of back-up into d-box or observation port. f t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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.): t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 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. 0�' iDast r t5insp official document-03/08 - 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 38 Bumpus Rd Property Address Mary Samuel Owner Owner's Name information is required for every Hyannis MA 02601 1-6-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. I t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE :A 4 LOCRTION 1? &/�625' /gel SEWAGE # J 006 VILLAGE Logddl5 ASSESSOR'S MAP & LOT 3/D- 38 INSTALLER'S NAME&PHONE NO. 5-09-9VO-9738 SEPTIC TANK CAPACITY 1910 601 LEACHING FACILITY: (type) 3Xews /o-��14 (size) s9. y x 9 2 NO. OF BEDROOMS BUILDER OR OWNER _�1v10-fu/1-1 PERMIT DATE: // 9 0 G COMPLIANCE DATE: // /7-o b 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 leachi g f iii Feet Furnished by Le &&l f o7— r `vnrm�G o I '5 " o . tr1 TOWN OF BARNSTABLE LQCATION�-fg �y��%v s J !d SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C-`s Sod LEACHING FACILITY: (type) ,� � (size) NO.OF BEDROOMS BUILDER OR OWNER <^ C)o'( S a i^ PERMITDATE: 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 4 i i f I; I. ^^ll • 1 LC-CAl10M SWA G E PERMIT NO. VILLAGE - Cw.-�tifJ INSTALLERS AM & DDRESS t B U I L D E R OR : OWNER e � � 2:::2 a DATE PERMIT ISSUED DATE COMPLIANCE . ISSUED - � '„� i v ..y,,, .� - _ ..,,,. .,,. _ _ _ � �� 3 � _� T ;::, 4 , . _ al.a t No. � � Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS \1� 0(ooftcation for Mioaal *pgtem Construction Vermtt Application for a Permit to Construct(4 )'Sepair(,/,-<pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 38 ,8c/,lPC-'5 /<,,:; Owner's Name,Address and Tel.No. a el Assessor's Map/Parcel Installer's Name,Address j v and Tel.No. 3 Og—2 '80—775 Designer's Name,Addyess and Tel.No. Ja5epLi D,� C3/ ;-O S L=sYy • � ccrcs Type of Building: Dwelling No.of Bedrooms lj' 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) X,%3rV11 /SDI C�s�� A5 "c r*.VA Xa 4a 5 z5 /® Q cli /c y � i�as>�i=r� Le"',Tl, /Va ��oHti 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 Board of He lth. Signed J O Date Application Approved by Date Application Disapproved for a following reas;_01;;6L A�r V Permit No. Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 41 11 \1..1 01ppliCatton for Zt!6po.5a1 6petem Conotructton Permit Application for a Permit to Construct(4,4-Repair(/_,)-T_1_pgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. J?BC�gC1,W`D 4/5 1:2 o v�,l Owner's Name,Address and Tel.No. Assessor'sMap/Parcel H/'��/ Installers Name,Address,and Tel.No.3 0$—zgO�57_ � Designer's.Name,Address and Tel.No. Type of Building: ; Dwelling No.of Bedrooms f' Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day.' Calculated daily flow gallons. Plan-Date Number of sheets Revision Date Title Sze of Septic Tank. Type of S.A.S. + Description of Soil: Nature of Repairs or Alterations(Answer when applicable) TW57,V11 /51;00 6sue/ S'i_-/�T/G r.0h4 D— d�r + :9 le4- ezz 5 a—" /D 4i6/i�k /—� �, - S�lsii 7`L, A/n Sra`it= Date last inspected: { Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate-of Compliance has been issued by this Board of He lth., Signed % cv , ' Date Application Approved by ��% 9 //�/ �� .� /1 Date Application Disapproved forth following reasons v v U -- I Permit No. Date Issued Mp ------------------ -------------------- . THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE,;MASSACHUSETTS Certificate Hof Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired Upgraded( ) Abandoned( )by r f at . E h s e n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,, dated Installer ,J25,_- 0 a.�rpi>s' r' Designer The issuance of this permit shall not be co st/rued as a guarantee that the system wilIc as esigned. Date Z _ „ / Inspector . i 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS It5po5al *p$tem Con5trurtton Permit Permission is hereby granted to Construct Repair( 4-)-Upgrade( )Abandon( ) System located at ' r �,/S 92."/— a r and as described in the above Application for Disposal System Construction Permit`Jhe applicant recognizes his/her duty to comply with Title 5/and the following local provisions or special conditions, Provided: Constru lion ' ust be completed within three years of the date oft.'srpermi4 r' ` �.. Date:_ t Approved by ) l Town of Barnstable Regulatory Services Tbo moo F-,,Geuer. Dire Pablit Health Divhlon Thowab McKean,Dirwtor 200 Main Sn-�Hysunka,MA 02601 Ofri", 508-862-4644 Fax, .08-700-6304 Date: Sewage Permit$ Assaaar's MapTaretl a2 -TT nc-�hvzec A Address., Addros: MA On Si<e issued a permit to a fdate ".Onstallet) vs septic system at based on a desip dnwn by (designer) kly that the septic 3ysterin referenced above wss installed substantially according to *c certif the design, which may inrludt. rWnor approved changes such as iatrml refocadon of the distribution box and/or septic tarok, f ccrtiA- that the septic system referenced above was insWled with major changes O x. greater than 10, lateral relocation of the SAS or any vertical relocation of aay, component of the septic system) but it accordance with State & Local RegWahona, Plan revision or certified as-built by designer tO f011Ow 11 'Ir o PETER T' McENTrEE Y42V(�nstall CIVIL No. 35109 M SK Me (Affix Desismir'is SK Ir A, : ! ems Comh"von F%offl c Town of Barnstable FINE l°� Regulatory Services sSrABLY Thomas F. Geiler,Director �9 .•� Public Health Division rE0 MA'S a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 22, 2006 Ms Mary Samuel 38 Bumpus Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 38 Bumpus Road,Hyannis,MA,was last inspected on June 1st, 2006 by, Troy M. Williams, certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in failure. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL DEPARTMENT Thom A. McKean, R.S., C.H.O. Agent of the Board of Health k AA _3 � b n f 1 �, TROY WILLIAMS 1 9 SEPTIC INSPECTIONSLOF Certified by MA Department of Environmental Protection (508) 5b5-1500 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSE` 7S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT .OF ENVIRONMENTAL PROTI'CI'ION TITLE 5 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CEIZ'TIFICA`I'lON Properrh Address: 38 Bumpus Road Hyannis,MA Owner's Manic Mary Samuel Owner's Address: 38 Bumpus Road � . Hyannis, MA 02601 Date of Inspection: June 1,2006 UUU y CD Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections \�� + '} �'• Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the inforrnation 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 DEf approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system Passes Conditionally Passes Needs Further Evaluation b) the local Approving Author it) Fails Inspector's Signature: h�r.Q�c., �_. Date: G / t 10 6 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I leallh or DEf)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 Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification Is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. 'This report only describes conditions at the time of inspection and under the conditions of use at that time. 7 his inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 paee I 0 r I Pat;L 2 ill' 0111ICIAL INSPECTION PORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE S1MkG i DIS110Sf11 SYS'I'l?M INSPECTION 1"ORM PART A CERTIFICATION (continued) Properly Address: 38 Bumpus Road Owner. Hyannis,MA 1)�►le of luspectiunc Mary Samuel June 1,2006 Inspection Summary: Check A,1A,C,I) or C/ALWAYS complele all of Section 1) A. System Passes: I have not bond any 611,01 mation which indicates Ibat it of the failure ciileiia described in 310 CM12 15.303 or ill 310 CMIt 15.304 exist. Any failure criteria not alualed are indicaled below. Comments: It. System Conditionally Passes: One or tuore system components as described in the "Conditional Pass"section need to be replaced or repaired.The system, upon completion of the ieplacclortil or repair, as approved by the floaid o Ileallh, will pass. Answer yes, no of not delcriniuu((Y,N,ND) in the _ for the following statements. 1 not determined"please explain. _ fhe septic lank is metal and ovei 20 years old* or the septic lank(whet r melal of not) is structurally unsound, exhibits substantial ioliltrrtion of exliltralion of tank failuee is irk went. System will pass inspection if'the exisling lank is ieplaced with it complying septic lank- as approved by ill, (lit] of Ifealth. 'A ineial septic lank will pass inspection if it is stiuclnially solid, k, caking and if a Ceililicate ol'Conipliance indicating that the lank is less Ihan 20 ycais old is available. ND explain: Observation of sewage backup or bleak out o sigh static water level ill the disl6bulion box due to broken or obstructed pipe(s)or due to it broken,settled or tit en dish ibution box. System will pass inspection if(with approval of hoard of flcalth): -- broker ipe(s)are replaced _ obs action is removed 'trihulion box is leveled of replaced ND explain: The syslern requ it pumping moie than 4 times it year due to broken or obstructed pipe(s).The system will pass inspection if(w i approval of the Board of I leuhh): _broken pipes)are replaced -- obsliuction is removed ND explain: 2 Page 3 of I I OFFI(.'IAL INSPECTION FORM - NOT FOR VOLUNTARY ASSLSSMEN`T'S SUBSUIr:I ACE SLWAC."E, DISPOSAL SYSTEM INSPECTION I�Ol2M PART A CI'RTI F ICATION (conliruied) Properly Address: 38 Bumpus Road Hyannis,MA Owner Mary Samuel Date of Inspcclion: June 1,2006 ('. Furllier I!:valuatiou is Itequired by the hoard of hcallh: Conditions exist which require lumber evalualiou by the hoard of I dealt, in order to dcterrriine if the system is tailing to protect public health, safely or the environment. 1. System will pass unless Board of hcallh determines in accordance with 310 CM It 15.303(1)( )) Il►al the system is not functioning in a ,►annex which will prulecl public hcallh,safely and the env' nninent: ------ Cesspool or,privy is within 50 feet of a stil duce water Cesspool or privy is within 50 lect of it bordering vegelaled wetland or a sall,mar I 2. Syslcni will fail ,,,less ilic 1)o:u-d of health(and Public Waler S pplier, if any) dclermi11CS that the syslcn►is I'll ncliontJig 1, a tuauner that protects the l►ublic hcallh 'afely and euvirirnn►enl: The system has a septic tack and sail absorption sysl- i(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water so y. The system has a septic tank and SAS and e SAS is within a Lune t of a public wales supply. The systeiu has a septic tank and SA' and the SAS is within 50 Iccl ot'ji private water supply well. The systen►has a septic lank a SAS and the SAS is less Than 100 leet bill 51) feel or snore born a private water Supply welt**. M• wd used to dcienoioc distance - _--- — "*This syslem passes if t well wales analysis,perla hied ill a DEP certified laboratory, Im coliforn) bacteria and volatile( 'a,ic compounds indicates that the well is fine from pollution from that facility and the presence of an Ionia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided dial no other lailure criteria e triggered. A copy of llte analysis nuisl be attached to this 1,61-111. 3. Other: 3 I Page 4 of t 1 O1i'hICIAL INS1'1?C'I'ION 1,0121V1 — NOT F0112 VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC1'1ON F'OIiIYI PA RT A C1 12'1'lli'ICATION (conliiloctl) Property Address: 38 Bumpus Road Hyannis,MA Oweer: Mary Samuel Dale of Llspeclioo: June 1,2006 1). Syslen► hailli a C,l iteria applicable fo all sysleuls: You !oust indicate "yes"or"no" to ci►ch of the following loi all Illspectiolls: Yes No Backup ol'sewage into facility or syslein Component due to overloaded of clogged SAS or cesspool _- -� 01scbarge of pouding of effluenl to the surtace of the ground Or surface wafers due to an overloaded or clogged SAS o[cesspool Static liquid level in the disiiibukon box above oullel invert due to all overloaded or clogged SAS or cesspool ?:f OV—R,- Gs __ liquid depth ill it Is less than 6" below invcit or available volume is less Than %clay flow ltequiied pulupiug loore than 41 tittles io lilt last yeai NOT due to clogged of obstiucietl pipe(s). Number of lilies pumped Any poitioo of the SAS, cesspool or privy is below high ground water elevation. Any )of lion of cesspool of l►iivy is within I00 Icet of if Surface Willer supply or Iribulary to it surface water supply, Any poilion of it ccsspoul of privy is within if Louc l of a public well. Any portion of•a cesspool of lit ivy is within 50 feel ol•a piivalc water supply well. Any portion of a cesspool of privy is less Ihau 100 led bill grealer than 50 feet from a private wale[ supply well Willi uo acceplable wales quality analysis. 1"11his System passes it like well water analysis, perfilrlued al a DIA, cerlilied laboratory, fill.colili►rn►bacteria and volatile organic compounds indicates Illal flit! well is lice Iron►pollution from Thal facility and like presence of ammonia nitrogen Will hill-' IC iilrogen is equal la or ICSS lliai 5 pplu,provided that no Oiler failure criteria are triggered. A copy of the analysis must lit: allached to Ibis fori►.1 _A-5 (Yes/No)The syslein falls. I liave lletermilled lbal olle of lllore of Ille above lailtire cilleria exist its dcsciihed in 310 Clvllt 15.303, therefore t1►e system fails. The systcul owner should contact the Board of I lcalth to delellniue what will be necessary to correct tilt: failure. 1 . Large Sysicnls: 'f'o be Considered a Iarbe systcul like syslein luusl serve a facility Willi if esign Ilow of 10,000 gild lit 15,000 gpd. I You Inust indicate either"yes"or"no" to each of the following: (The following criteria apply to large syslcills in addition to the grit is above) yes no _ _ the system is within 1100 feel of a suifacc drinkil water supply _ lilt system is within 200 Ices of a ttibulary it surface drinking water supply Tile systelvi is located Ill a Illl[ogell se Ilivt area(loteiint Wellhead Proleclion Arca- IWI'A)or a mapped "Lone 11 of it public water supply I If you have answered "yes" to ally title Ion in Section 1:the system is considered it significant threat, or answered "yes" ill Section 1) above the large • stein lids failed.I'lle owner or operalor of ally large system consiacied a significant threat ui►tler Section , r failed under section 1)shall uhgracle the system in accordance Willi 310 CMR 15.304.`hhe sysivat owner silt d contact the appropl iatc regional office of the Deparlmclit. q Pagel S of I I OPFICIAL INSPECTION FORM — NOT 1�012 VOLUNTARY ASSESSMENT'S SUBSUIWACL SP-MAGE DISPOSAL SYS'1 EA/1 INSI CI'ION V012M 1'A RT 13 c11�.cl.r.IsI� Properly Address: 38 Bumpus Road Owner: Hyannis, MA 1):Ilc of luspeclio►►: Mary Samuel June 1,2006 Check if the following!lave.been done. You nu►sl indicate"yes"of"no"as to each of the following: Yes No - I'uo►l►iog iulornu►tiou was providcd by the owner, occupaul, of 11gard of I leallll Were airy of the system componeuls pumped()ill in the previous two weeks'? Has the Syslen►received norrnnl flows in the previous two week period '? --_- - Have Bilge vulunies of water becil iotroduced to ti►e Sysleul rcccolly or as earl of ILiS iospectian '? ✓. ._...__ Wei-(; as built plaits of Ibe system oblaioed aiul exarnioad'? (If They were not available pole as N/A) Was the facility or dwelling inspected 1,01-signs of sewage back up? Was the site inspected fur signs of break oul '.' Were all syslcill components, excluding the SAS, located on site '! Weic the scli(ic lank nnaoholes uocovered, opened, and Ibe interior of the tank inspected for Ibe condition of Ibe baffles or tees, utaleilal of construction, dimensions, depth of liriuid, deplb of sludge and depth of scorn? Was the facility owr►ci(and occupants if dificicol froul owner)provided with inftxn►atioll on Ow proper roainlenancc of subsurface sewage disposal syslerus ? The Size and localiou of file Soil Absorl►tion Sysfen)(SAS)on the site has been determined based on: Yes no Existing iufolmalioll. Vor exan►ple, it plall al like Board of lleallh. _ Delerrninetj in the field(if ally of the failure cl ileiia related to fart Cis at issue approximaIion of distance is unacceptable) [310 CM 15.302(3)(b)j S I Pagc'6 of OPI,KAAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SURS1,11 ACE, SEWACW DISPOSAL SYSTEM INSPECTION I4OIiM PA RTC SYSTEM INFORMATION Properly Address: 38 Bumpus Road Uwocr: Hyannis,MA Date of Inspection: Mary Samuel June 1,2006 PLOW LONIATIONS It ES11)EN'I'IA1. Number of bedrooms(design): `/_ Number of bedrooms(actual): _� DI-,SIGN flow basal on 310 CMR 15.203 (tor example: 1 10 gpd x 11 of beilnuims): y yo Number of current residents:�__ Does residence have a garbage giinder(yes or no): Nu Is laundry on a separate sewage systeiu(yes of iui):wo fit yes separate inspection reyuiredf I-.aundry 5yslc111 iospeclCl(yes or nn): _A4_vt. Seasonal use: (yes or no): M6 _ Water meter icadiugs, it available(last 2 years usage(gp(1)): Sump trump(yes or no): ,k1J Last date of occupancy: COMMLItCIAL/INpUS'1'Itlikl. Type ofcslablishnienl: -- Desigo flow(based till 3 10 CM1Z 15.203): Basis of design flow(seats/poisons/silft,elc.): Giease trap present (yes of no): huhislrial waste bolding lank present(yes or no): Noll-sanitary waste discharged to the`fille S s eni(yes ix no): Water meter icatliugs, if available: - ---- -:-.- -_._ Last dale of occupancy/use: _— -- - - -- GL'NI ItitI. INhOItIVIA'I'I0N l'lluipinb Itecords Souicc of inl`uilualiou: ti 5 Z -- " ,-- Was system pumped as pall of the inspection(yes of no): ll'yes, voloole puiuped. --_-gallons - flow was ilnaolily puoiped deterinined•? _ Reasoll for pumping: -- TYPE 01'SYS'1'1,fvl Septic tank, distribution box,soil absorption system Single cesspool -�Overflow cesspool _ Privy —Shared syslenl(yes of no)(if yes, attach pi-evioiis iuspoclioll records, if any) Innovative/Allernalive lcchnology. Attach a copy of tltc cuiienl operation and maiulenance contract(to be Obtained from system owner) — 'Cighi lank --Allach a copy ol"the DET approval —Other(describe): -- _ At'proxintate age of all coniponenls,date installed(if known)and source of information: Were sewage odors delecled when arriving at the silo(yes of no): Ajb 6 ('age% oft OPTICIAL INSPI'C ION DORM - NOT FOft VOLUNTARY ASSESSMENTS NTS SURSURFACE SI WACL DISPOSAL SYSTEM INSPECTION DORM PART C SYSTEA11 INI+ORMATJON (continue(j) Property Address: 38 Bumpus Road Owner: Hyannis,MA Dille of luspcclioll: Mary Samuel June 1,2006 IWILDING S1?WER(localc on site plan) bepill below grade:_ f Materials of ctmstnlcliun: /cast iron 40 I've ,/ other(explain): Dislance from private wales supply well or suction line: -- Comments(on condition(ifjoinls, venting, e.vidcnce of'leakage, etc.): Sl�l'"17C"RAMC: (locale on site plan) Depth below grade: — -- Mulerial of construction: _—_concrete---metal __fiberglass - -pulye lhylcue ollet(cx)lain Iflank is Metal list age: - - Is age cuufirulcal by it Ccilificale of Corlyllia c(yes or uu): _(atfaeb a copy of cCl llflcale) - Dimensions: Sludge deplb: Distance; front top of sludge lit bollom of ollilct ice or baffle: Scilm thickness: _ ----- --- Distance floin lop ofscunl to lop of outlet tee ui bafl Distance floin bullom of scum to botluul of uulle c of baffle: low were dimensions determined: - Cuuurleuls(611 puugliog rcconinlendalion' nlcl auel uullct lcc ur baffle coudilion, slnlelural inlegiity, lieluid levels as related to uullct invert, evidence of akagc,etc.): G12L.ASE TRAP; _(locale on site plan) Dcp1b below grade: Maleri;il of i unstnli lion: cuociele _ oleta) bergl;iss— pe ethylene olbci (cxpluin):-------- -- Scum Ibickiless: Distance fiuul(ill)of sciuu to lop of oollcl Ice or baffle.- -- 1.)islauce trot bol tot il ill-scum to butlom of'outlet I• or baffle: Dote of last pumping:— -- ----- Comnlenls(oil pumping iecumincudalious, i ct and iwllcl lee or baffle condition,sfruclural infegrity, Liquid levels as related to outlet invert, evidence of lea' gc, etc.): i • Page s of I I• OI- V IAL INSPECTION ItORM — NOT FOR VOLUNTARY ASSE? SIVILNTS SUBSURFACE SE WALE DISPOSAL SVS'IT!M [INSPECTION FORM 1'A W1' C SYS`1 EM INFORMATION (couliuued) Properly Address: 38 Bumpus Road Owner: Hyannis,MA Dale of Inspection: Mary Samuel June 1,2006 TIGHT or I101,I)ING TANK: (lank niust be pumped at time of inspe, tan)(locale on site plan) Dnplh below grade: _ Material of construction: _ concrete metal fiberglass polyethylene— olher(explaiu): -_-- _gallons Design Flow: _ _-- ----gallouslilay Alarm present(yes at.no): Alm ill level: Alarm ill winking order es or nu): Dale at'last piuupiug:— -- — --- Coll iiculs(condition of alarm and float ' itches,etc.): DISTRIIILITION BOX: (if plescifl must be opencd)(locale oil site au) Depth of liquid level above outlet inver(: _ Conuucnls (note if box is level and disu ibulion to ouilels equal, y evidence of suliils carryover, any evidence of leakage into or oul ul box,ctc-): PUMP CIIA IV[lllIt. (locale ua site plan) Pumps in walking order(yes ar uu): _ -- Alanns in working order(yes or no): —-- Conunenls(no(e condition of pump chanibcr, condition of uilps and appol lenauces, etc.): 8 f Page ) of OFFICIAL INSPE(AAON WItM —NO`L' l OR VOLUNTARY ASSI?SSMIwrs SUBSURFACLe SEWAG I)ISI'OSAI, SYSTEM INSPECTION DORM I'A RT C SYSTEM INFORMATION (continutcl) Properly Address: 38 Bumpus Road Owner: Hyannis,MA Dille of luspeclion: Mary Samuel June 1,2006 SOIL ABSI)Iil TION SYSTEM (SAS): �_(locale on si(e(dau,excavation not required) if SAS not located explain wily: Wylie —- leaching pits, nunibei: - - Icachiog chambeis, numbei: _ - leaching galleries, nunibci: -- leaching trenches, nuukber, Icoglh: -- leaching t►cIds, nuiubci, dimensions: - ovedlow cesspool, uumbei:_A___d,Y - innovalive/alternative syslcun Typc/nanie of technology:------._.__._._..-------_------_____-- Couuucnls(note condition ol'sOil,signs ofliy(liaulic luiluic, level ofponding, damp soil, condition of vegetation, etc.): C _a------ �S 5�,._.l S CJ�-c�• bto�— �....-.�t.- cL +�: :..� w.J ti % �c�(„ ��ac.✓ G� �- �- CESSPOOLS; (cesspool must be pumped as pill(of inspeclion)(localc on site plan) Nombcr and configuration' •- Dcplh lop of liquid to Intel invcil. 'r Depth ofsolids layer: -- Deplli of scum layer: --- Dimensions of cesspool: — � �—_- Maleiialsofconsliuclion: Indication of groundwater inflow( es of no): _A44 ---- -- Comments(note condition ofsoil,signs of hydraulic failure, level of ponding, condition of vegetaliun,etc.): �� L ��."w`"�-_fit-�--S-.�.�".-------- ------- ----- — - PRIVY: (locale till silt plan) Materials of consti uctiou: Depth of solids: -- Corumcnls(note con�liliou of sail, ZC ___ ol'ponding, con(lilion o1'vegelation, etc-)-. Page,Ill of I OFFICIAL INSPECTION DORM — NOT VOR VOLUNTARY ASSESSMENTS SUBSUIWACL SEWACIFE DISPOSAL SYSTEM INSPECTION DORM I"A UT C SYSTEM INFORMATION (conlinued) Property Address: 38 Bumpus Road Hyannis, MA Owner: Mary Samuel Ilalc of Inspection: June 1,2006 SICl?7'CII Oh SEWA('.I' DISPOSAL SYSTEM Provide a sketch of(he sewage disposal system including lies to al leasl Iwo permanent reference landnucrks or bencluuuks. Loewe all wells within IOI) ied. I..Ocille where public wales supply en(eis (he building. V' �O L 1' t 15 Io Page I I of OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RTC SYSTEM INVORMATION (continue(I) i N-operty Address: 38 Bumpus Road Owncr: Hyannis,MA Dale of luspecliollt Mary Samuel June 1,2006 SITE EXAM Slop c Snrlilce W11C1 Check cellar y Shallow Wells 11Slinlilled depth to glound water _1-St`jest Adjus(ed high ground water cleva(ion — (eel, . Please indicate(check) all methods used to(Icleluuue the high glound wafer elevation: Obtailied Irool system design Flans oil record - It'checked, (tale ol'design Mall reviewed: Observed site(abniting property/obscrvatioo hole; within ISO (eel ol'SAS) Checked with local ll(lard of 1Ic11111-cxplaiu: Checked with local excavalors, installers- (;Vlach docunleulalioil Accessc(I 11S(..iS (lillahllsc-cxplaill: n, t 36 zvia� 2 s- .j 1— , You nulsl describe how you cslablishe(I the high ground water clevalion: kA IZ , 1 This report has been prepared and the system Inspected as of the date of inspection. This report is not a warranty or guarantee that the system will(unction property In the future. There have been no warranties or guarantees, either expressed, written or Implied,relating to the system, the inspection and/or this reporl. II P# qj Town of Barnstable —.--�-- pp THE Tph, Department of Regulatory Services � BARNSTABLE. � Public Health Division Date l/v�✓� MASS. a Sop 039. �� 200 Main Street,Hyannis MA 02601 ATfO MAt A Date Scheduled 60 Time r Fee Pd. Soil Suitability Assessment for Sewage A osal Perfonned By: �Q��1 1 C C n -,�- Witnessed By: LOCATION & GENERAL INFORMATION Location Address 3 ?j,a M p 0 S Owner's Name W)AVI'A:S M6 Address S'rAv►1 Assessor's Map/Parcel: 310 —03 N` � Engineer's Name Pek r NEW CONSTRUCTION REPAIR Telephone# (5'a$) 411—5 3 C3 Land Use ear Slopes(%)_ _ Surface Stones N Distances from: ,Open Water Body Possible Wet Area 10-f it Drinking Water Well f� ft , Drainage Way .J c c ft Property Line ej ft Other f ft r SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximit 0 holes) tV Co C •F Q 1-7 • 1 � i-o t Parent material(geologic) C Depth to Bedrock 1 N` Depth to Groundwater: Standing Water in Hole: N/ Weeping from Pit Face Estimated Seasonal High Groundwater �Q DETERMINAT�IPON FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment R• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level— PERCOLATION TEST Date� Time_LLA — Observation Hole# Time at 9" Depth of Pere ' Q, Time at 6" Start Pre-soak Time Q ✓1L T� � �Jq c c^ Time(9"-6") -�---/� End Pre-soak Q/t ° c Zo , Rate Min./Inch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)weelc prior to beginning. Q:HEALTH/W P/PERCFORM DEEP OBSERVATION HOLE LOG Hole # I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Gonsisfency,%.Gravel).... ._.�. A 5L 16 V23/3 CI 1i—C. `Sc,vVj 7S I'-Z42) CZ C Sand 2r 5;' Y _S7 &Y-6,,re1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) /� q �„,.e(,&L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) _Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe ions material? t Certification I certify that on �� l (date)1 have passed the soil evaluator examination approved by the Department of Envirornnental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 1.5.017. Signature Date �'1 1 LZf �o Q:HEALTH/W P/PERCFORM �T o-1 -� COMMONWEALTH OF MASSACHUSETTS 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION FEB 2 6 2003 TITLE 5 "g*',OF&� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIVIENtTr SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 38 Bumpus Road Hyannis MA 02601 Owner's Name: Michael and Susan Morgan Owner's Address: same Date of Inspection: February 20,2003 MAP Name of Inspector: PATRICK M.O'CONNELL PARCEL- Company Name: SEPTIC INSPECTION SERVICES CO. 'SOT Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: (508)428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: e/� ..� Date: 2� 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 Cesspool with overflow pit. Liquid level in overflow pit 12"below inlet pipe. ""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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well`*. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than b"below invert or available volume is less than 'h day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. f Page 5 of 11 OFF ICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X_ _ Pumping information was provided by the owner,occupant, or Board of Health X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ — Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) i Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):440 Number of current residents: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2001-20,000 gal. 2002-38,000 gal.=79 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Last pumped 12-18 Mos.Prior to inspection. Source of information: Homeowner Was system pumped as part of the inspection(yes or no): Yes If yes, volume pumped: 1000 gallons--How was quantity pumped determined? Sight glass on truck. Reason for pumping: Cesspool Inspection TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _X_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: Cesspool installed 1960 overflow installed 1980 Were sewage odors detected when arriving at the site(yes or no): No i Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 BUILDING SEWER X (locate on site plan) Depth below grade: 18" Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line:28' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: 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 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: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X—teaching 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: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Liquid level in pit 12"below inlet pipe. CESSPOOLS: X (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with overflow Depth—top of liquid to inlet invert: 8" Depth of solids layer: 3" Depth of scum layer: 1" Dimensions of cesspool: 6'dia. X 7'deep Materials of construction: Cesspool block Indication of groundwater inflow(yes or no): No Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Outlet tee intact cesspool is structurally sound. PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 38 Bumpus Road,Hyannis Owner: Michael,and Susan Morgan Date of Inspection: February 20,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide-a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Wl� � > } Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:38 Bumpus Road,Hyannis Owner: Michael and Susan Morgan Date of Inspection: February 20,2003 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _X_Accessed USGS database-explain: Checked w/town GIS and USGS topo maps You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.20 property is at el.40 TROY WILLIAMS SEPTIC INSPECTIONS X0 Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Denr1�1,�,MA 02660 COMMONWEALTH OF NIASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF 2 DEPARTMENT OF ENVIRONMENTAL P `TION ONE HINTER STREET. BOSTON, MA 02108 617.29 -�� RfEE/Vf0 �� WILLIAM F.WELD �y Governor row1998 eCOXE• NO,, 9 CO7iE T ARGEO PAUL CELLUCCI �� y6j(TyO�, DA D .STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO F K CpC mmissioncr PART A e � CERTIFICATION 38 13�.,, s Rif. u w.,., ; s Property Address: a f f /r8 y Address of Owner: Date of Inspection: `f (If different) Name of Inspector: T r o y W i 11 i a m s I am a DEP approved system inspector pursuant to Section 1S.340 of Title S (310 CMR 1S.000) /�y U h N, s Company Name: _Troy Williams SeDtic Insaections Mailing Address: 10 HltmmpI priVp _ South DPnnis , MA 02660 026a I Telephone Number: 5 n R 1 3 8 5-13 0 0 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: ZPasses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature J it�, c �,,v Date: ��I t �� ! The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 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: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1S.303. 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. 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. - (—i—d 04/25/97) _ Paga 1 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Bumpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection:February 11, 1998 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: /`11119 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, IT APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. . The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) o.... 7 -f in - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Bumpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection: February 11, 1998 D] SYSTEM FAILS: N//9 You must indicate ei;,,er "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 into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: A///9 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 above: 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 11 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. (revised 04/25/97) M1 Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38 Burnpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection: February 11, 1998 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yeses No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components-have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,excluding the Soil Absorption System, have been located on the site. 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. ✓ 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 System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) paq• 4 0[ 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 Bumpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection: February 11, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: y0 .p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: If Garbage grinder (yes or no): Nd Laundry connected to system (yes or no):IV6 Seasonal use (yes or no): /Yo Water meter readings, if available (last two (2) year usage (gpd): _y - yr a'�y�.//o� r 9C Sump Pump (yes or no): /J6 Last date of occupancy: 6 COMMERCIAUINDUSTRIAL• I/Ij9 Type of establishment: Design flow: aallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: / 6 ✓ 1�t r r� -•/1-�)�...� �U v+. •� c7 w h t.., System pumped as part of inspection: (yes or no)A/< If yes, volume pumped: gallons 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) VA Technology etc. Copy of up to date contract? Other �- APPROXIMATE AGE of all components, date installed (if known) and source of information: 01,-S 4 I b t— �I! (� �i �o roll. rf G L G.c�c/Z. Jp 1 r (✓!.�> 0.CA d t!/'w -o AC >0(,✓'S /--ri f,p� 14-1 Sewage odors detected when arriving at the site: (yes or no)/V6 (revised 04/25/97) Daq• 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Bumpus•Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection: February 11, 1998 BUILDING SEWER: A1119 (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:/",/11 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: 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 dimensions were determined: ' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: (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: (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.) (revised 04/25/97) _ Page 6 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Bumpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection:February 11, 1998 TIGHT OR HOLDING TANK:ti119 (Tank must be pumped prior to, or 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 level: Alarm in working order_Yes;_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:•.,A,14 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: N119 (locate on site plan) Pumps in working order: (Yes or No) Alamo in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/3S/97) a Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 38 Bumpus Road,Hyannis,MA Date of Inspection:Kathleen Maddison February 11, 1998 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number.(- 6 �x� J_e -/ w 4-k S S leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil,, signs of hydrauli failure, level of ponding; condition of vegetation, etc.) .AI Wu 7a v .J -]'- �� K �� nA S' ty L��`� w a W/'0.� G✓ �_ ✓- G//- i"t7 �.JJ,S, � // O '�. D S i t"L S G� � S�!J'✓'Q�✓ �t L. .__�i �al,—L 9/� 40 v o M (tf+� f 4 T�t .!7 4.C T W t l t ✓� CESSPOOLS: (locate on site plan) Number and configuration: 0— Depth-top of liquid to inlet invert: Y" Depth of solids layer: 3 Depth of scum layer: ,V l Dimensions of cesspool: 6. x' S • t ck Materials of construction. L' ,00 l . /�/v k Indication of groundwater: Al-AJ_ inflow (cesspool must be pumped as part of inspection) se- A ,,,C-f"1,- Comments: (condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)•� r~ I c t.. o a-. a u c✓7Clo...i o h ✓-'0. Iv✓t ur torn l<t... it- via tti c �� PRIVY: A-11 + (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/2s/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Owner. 38 Bumpus Road,Hyannis,MA Date of Inspection: Kathleen Maddison February 11, 1998 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) w:ti-i- i3—, a,3 ab .. 12 ' I. _S 4, G1,I(,r e (revised 04/25/97) a Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 Bumpus Road,Hyannis,MA Owner: Kathleen Maddison Date of Inspection: Febniaiy 11, 1998 Depth to Groundwater A/?Fee1 adjusted high groundwater level 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 Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) I L34.I+ . s So ✓�aJl yrd d( ✓ 7L ff I / 1 13d f� h. o /L��L �. G c./c`S / / u h S 4- C-ck y i (revised 04/7S/97) Page 10 of 10 No................ Fss............ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD F HEALTH / oF.-.. .--- ..........................._.--. �. Appliratiun for Biapos al Works Tonotrnrtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at --... —_.... ` JI.............. sr ............................... .............. ocat r;. s or Lot No. ---- -------------------- ------------------------------•-------•--- -.-...--•-------------•-----------.-.----•---- / ownevA ......Address holaller Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures --•------------ •------------ ......... W Design Flow............................................gallons per person per day. Total daily flow____......._......._................_......_gallons. WSeptic Tank—Liquid capacity............gallons Length................. Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4�+ ------------------------------------------------------------- ------------------ -------------------- --------------- ------------- ...__...-------------- O Description of Soil......................................... x - - w -------------------------------------------------- / ---- x .............................. .•-------•--------•------------•---------•---•--•-----•----.........-----•--• --------- ---------- -- ----- -- -- -----------•..... ------------ U Nate e of Repairs or Alterations—Answer when applicable _..... _..`.__d4 _ .. .... ...�........ .............. �-'`"`cam'-------- ---------- - --- -5-----------------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TH TAIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued y the boar of ea Sig d �( t Application Approved BY - ��lP..... r. y. �s �-- -=---- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------............................... ..........•---.--•---------------••••---......_.....--•------•...-•-------------.....---••-•--•-------------•-•--.........•-•----••------•--------•------------•-------------•--•--------------••-•..... Date Permit No......................................................... Issued-----'f �� Date No--------------- �$. ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA._ H ...�............'•'� 1-�.OF.....�.. �....L• ..``. --- -----------•I ApPliratiun for Disposal Works Tonstru.rtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System a -2 .......... Y ocatioa-Address or Lot No. ...... • • . ....................... .............................^........_._.. .......---'._.._._.......___..____...__..._ Address .._.I -..... 1.4 pstaller 1 Address QType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria PaOther fixtures -------------------------------- - - -----------------------------------------------------------------------•--'---'-------..----_..... W Design Flow............................................gallons per person per day. Total daily flow__._.__......_......_.......................gallons. WSeptic Tank—Liquid*capacity......._....gallons Length................ Width---------------- Diameter________-__-_- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching_ area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water•-_.--_________._...___- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------- ........................ •---------------------- --------------- ..--- ----------------------------------------- •--------------- 0 Description of Soil...... -•'•"-'--'-'------•---- :» -------•--'-------------------- x .• W --------------------------------------------------------------- ............................................................. - ;---------'-------------- UNature of Repairs or Alterations—Answer when applicable..r&:�'?' �..fi--_•-------o.............................................. . ter`1 . ......................... : �------------ - 19-reem-ent-: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been, u isses' ed by'the board of heatt9. ed Date Application Approved BY...... ` - .�u.... � "`................ - Date Application Disapproved for the following reasons----------------------------•-'-•----------------....--•---------------•--•--------•------'----••_..._.....•-'-•- -------------•--..._.........••-•--'--......••-"-'...--•--••••-•••-•-•••--•--•---••......'----"'-'...--•---••--._.............-'--•'••'--'-'-----•-•-••'-'---'-'---_....----"---------••--•-----'---- Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS ,,. BOARD OF HEALTH ...........................................;.', OF }...... . f".y 1 �J �' :. �ertifirate of Tuutpliattrr THI,S-hS TO GER�TIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired Installer at.......................... r7:'_: -- ' ' - has been installed in accordance with the provisions of T E 5pJ�f The State Sanitary Code as desc lbed in the application for Disposal Works Construction Permit No Z�r.f........... dated_..._ :. ?' • ".................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �7 DATE---...... .. Inspector... ------------------ -•---- ------ .......... ._..------•----.----- THE COMMONWEALTH OF MASSACHUSETTS --- BOARD OF -HEALTH .............................................. ............. " No:........ .......... FEE .1....... _...--.... - �i��o��1� arku �ufn�trttrt�uan �erutit Permission is hereby granted__.._..,..:_.._ .............._...?%__._.. :-.�!-_ ------------------------ __ to Construct ( ) ..oT Repair ( an Individual ewage Disposal Slystem at'No....- = ..�...........1 ....... -------•--------------------•---•-•------------ ------. •---...---•-- = ?` Street ,�/ as shown on the application for Disposal Works Construction Pe it N 1...._._ Dated.._."I`_ _ ...__-............. sv � •'•---------'-•-----...-•----...... ----- Board of Heat DATE.. t ......../-•- -•t------------•--...... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _ TOWN OF B RNSTABLE ^��Ste( I SEWAGE # OCATION ` - - _-- LAGE tj G�1111 ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE N O - SEPTIC TANK CAPACrrY LEACHING FACILITY: (typo) � ° e� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COWLIANCE 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) f Feet Edge of Weiland and Leaching Facility(If any',elands exist within 300 feet of leaching facility) � Feet Furnishedb � 4w� =f�jy L"r �1� 0 P , � r o G1 i LOCUS 0 LEGEND U Pus Ro a CHESTNUT ST 9 PROPOSED CONTOUR $ � CHERRY ST ' 99 PROPOSED SPOT GRADE 4 EXISTING CONTOUR x 101.70 EXISTING SPOT GRADE 03 TP fn EXISTING LEACH PIT EXISTING CESSPOOL ; ® TEST PIT TO BE PUMPED & FILLED TO BE PUMPED & FILLED [ ------------ W EXISTING WATER SERVICE z WITH SAND WITH SAND BENCHMARK: �i 5ULKt1EAD CORNER No`xcN 51 '"p, ELEV.— 100.00' (A55UMED DATUM)-', N74058'00"E i ,9 0 - c r1 x 1-00-AO' ,. x x ----PROP. x --- -� LOCUS MAP N.T.S. 9 w,. G.41_ 34 TEA�NK �TP 1 GENERAL NOTES: QL . �'�j 4 �y `� X s� Q I ii II I .i 1- ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �/�r / r DECK _ ��'lI BOARD OF HEALTH AND THE DESIGN ENGINEER. ELI2.�' - ! ,i TP-2 _9 IQ�I t . ALL WORK AND MATERIALS SHALL Z CONFORM TO THE REQUIREMENTS / �� ;� OF THE.STATE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE t IlUjll # LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: Ln r11 I O N -� ' f f' / r hail C�71 �'I —310 CMR 15.405(1)(b): N r' r`/ f I u0ICO N j 1) A 1 3' variance, S.A.S. to cellar wall, for a 7' setback. z . /NO. 38' i/ H-Ila,'l 2) A 5' variance, Septic Tank to cellar wall (bulkhead), for o 5' O IL� �XS x-�------ / �li STY./j I- `r vsetback. O1r ' I' II I nj 3. THE SEWAGE DISPOSAL SYSTEM SHALL NO7 BE BACKFILLED PRIOR OCI- c %f • D. FRJ�II;,' /f' r I EXISTING SHED TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE f T.O.F. 100.75.^ �L 70 BE REMOVED & RELOCATED DESIGN ENGINEER. Q lX O ;` / / / / I u u 1 4W I ' / � EXISTING FENCE 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING f "r_ SEE NOTE 9 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN t rc I xu a ENGINEER BEFORE CONSTRUCTION CONTINUES. LJLJL i'1 1 0'� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. > `\ o I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �• r+ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 80.Oa � y `� i HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. b 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 574058'00%V 40 MIL POLY LINER 8. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. BETWEEN HOUSE AND S.A:S., AS 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED �___ SHOWN, SET Et_. 94.0 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. x EDGE Of PAVEMIrNT I 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY c5' THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ts ' CONSTRUCTION. r OAD i Y 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS BUMPU5 R ! IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. OF 414SS� AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PETER T. 9�G� AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. -� McENTEE o CIVIL PROPOSED SEPTIC SYSTEM UPGRADE N. 351Io9(9 38 BUMPUS ROAD., HYANNIS, MA F ? Prepared for: Mary Samuel, 38 Bumpus Road, Hyannis, MA 02601 & Engineering by: Surveying by.: SCALE DRAWN JOB, NO. t� dG EngineeringWorb HOOD SURVEY GROUP 1, =20' P.T.M. 213-06 1 ` l 12 West Crossfield Rood P.O. Box 1724 Forestdole, MA 02644 Mashpee, MA 02649 DATE CHECKED SHEET NO. (508) 477-5313 (50B) 539-7799 9/23/06 P.T.M. 1 of 2 t rtt ii r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.96.5 FOR A DISTANCE OF 15' AROUND THE ELEV. TOP FINISH GRADE: 99.9t PERIMETER OF THE S.A.S. FOUNDATION (Existing) EXISTING F.G. EL.99.9t F.G. EL.99.9t MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 36" MAXIMUM COVER u a. INSPECTION RISER PIPE e L=10" L = 18' a L =4' 4" SCH 40 PVC 6, "' 4" SCH 40 PVC 4' SCH 4' PVC alil I a ® S= 2% (MIN.) 10" 14" 0 S= 1% (MIN.) 6 ® S= 1% (MIN.) INVERT" TOe ;9 a � so 48" LIQUID e LEVEL �INV.=97.50ml " < GAS PROPOSED INV.ELEV.=96.67 INV.=97.75 BAFFLE D-BOX 3 ROWS OF 10 UNITS AT 4'/UNIT + 2'(END CAPS)= 42.00' CONNECT TO EXIST. INV.=97.17 INV.=97.00 4" C.I. SEWER SOIL ABSORPTION SYSTEM (PROFILE) INVERT= 98.12 PROPOSED 1500 GALLON SEPTIC TANK N.T.S. PROPOSED SEPTIC TANK SHALL BE AN NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ESTABLISH VEGETATIVE COVER PROPOSED RIBBED POLYETHYLENE OR PIPE INVERTS PRIOR TO CONSTRUCTION. 2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL BA(NATIV WITH CLEAN SAND EQUAL. AND TRUE TO GRADE ON A MECHANICALLY COMPACTED (NATIVE OR PERC SAND) I SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 3) INSTALL INLET & OUTLET TEES AS REQUIRED, TOP ELEV.=97.0 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE INV.ELEV.=96.67 BREAKOUT ELEV.=96.0 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM ELEV.=96.00 r � 2 8' -I0.5'i EXISTING SUITABLE 0.5' MATERIAL (3) 5" DIA.OUTLETS 5' MIN. ABOVE BOTTOM G.W. EFFECTIVE WIDTH=9,4' 1I--5.5�'•I 1 � �2" SEPTIC SYSTEM PROFILE T.P. EXCAVATION OR G.WW. USE 3 ROWS OF 10-QUICK4 STANDARD INFILTRATOR CHAMBERS NO G.W. AT EL: 88.9 WITH 6" SEPARATION BETWEEN EACH ROW & NO STONE y it N.T.S. SOIL ABSORPTION SYSTEM (SECTION) 15.5" 6„ 1 O N.T.S. H-10 LOADING 2" DESIGN CRITERIA D�BOX NUMBER OF BEDROOMS: 4 BEDROOMS t. SOIL TEXTURAL CLASS: CLASS I \ ff DESIGN PERCOLATION RATE: <5 MIN/IN 16" DAILY FLOW: 440 G.P.D. DESIGN FLOW: 440 G.P.D. 0PINSPE111.11 SOIL LOG GARBAGE GRINDER: NO DATE: !SEPTEMBER 22, 2006 (P-11443) PROPOSED SEPTIC TANK: 1500 GAL. CAPACITY o (3 I4 C7 I�O SOIL EVALUATOR: PETER T. MCENTEE P.E. LEACHING AREA REQUIRED: (440) = 594.6 S.F. jK WITNESS: DON DESMARAIS-HEALTH AGENT74 _ ''� p C -- --- USE 3 ROWS OF 10 QUICK4 STANDARD CHAMBER UNITS WITH NO 5 oo �_ -�,cn.0 Elev. TP 1 Depth EIeV. TP—2 Depth oP VIE w p I 0„ STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 9.4 34" O Ln 99.9 A O 99.9 A SANDY LOAM 8" INVERT SANDY�LOAM BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) 48" — E D CAP, 'J`• \ \, n? 101'R 3/3 10YR 3/3 EFFECTIVE LENGTH) P�: Q4STDE :�L" \ 99.2 8" 99.2 8" 10 UNITS + 2 END CAPS PER ROW = 42.0 FT e ® END VIEW B SANDY;LOAM B SANDY LOAM 3 ROWS x 42.0' x 4.72 SF/LF = 594.7 SF MULTIPORT END CAP \\ 96 9 10YR,5/8 �6„ 96 9 Cl 10YR 5/8 36" DESIGN FLOW PROVIDED: 0.74(594.7 S.F.) = 440.1 G.P.D. Cl M-C 5AND M-C SAND PERC SIDEVIE NOMINAL CHAMBER SPECIFICATIONS 10YR 5/4 48" 2a.a �6�, >201%GR VE W/ PROPOSED SEPTIC SYSTEM UPGRADE SIZE (W x L x H)..........••................34" x 48"x i2" >20%GRAVEL W/ EFFECTIVE LEACHING AREA: o) COBBLES,BOULDERS COBBLES,BOULDERS 93.4 - 78" 93.9 C2 76" BED.......................................................PER CODE ,--I--rL `—L—J.—J.—J_J_—J C2 38 BUMPUS ROAD., HYANNIS, MA L J_-1 TRENCH......................................... PER CODE (0 r=-1- T--'�----------r'--1 M-C SAND M-C SAND 34" INVERT ELEVATION........................:.........................8' �` L-- —I--L-1 PROP.-S.A_S.I--j 2.5Y 6 4 r- --r--r-r-r-F=-1-,_-I--� 2.5Y•s/4 / Prepared for: Mary Somuel, 38 Bumpus Road, Hyannis, MA 02601 FRONT ylEw STORAGE CAPACITY PER UNIT....................44.4 GAL _—I_—L—L—L-1-1—J_J_—I—.—J <5%GRAVEL <5%GRAVEL 42.0' Engineering by: Surveying by: SCALE DRAWN JOB. NO. QUICK 4 STANDARD INFILTRATOR CHAMBER -' 39.9 1 120" 89.9 120" EngineeringWorkr HOOD SURVEY GROUP N.T.S. P.T.M. 213-06 INFILTRATOR CHAMBERS S.A.S. LAYOUT y NO GROUNDWATER OBSERVED 12 West Crossfie0 Road P.O. Box 1724 PERC RATE <2 MIN/IN. Forestdale, MA 02644 Mashpee, MA 02649 DATE CHECKED SHEET N0. (508) 477-5313 (508) 539-7799 9/23/06 P.T.M. 2 of 2 N.T.S. g