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HomeMy WebLinkAbout0095 CARLOTTA AVENUE - Health 95 Carlotta Ave Hyannis AA.=238 -231 I fTOWN OF BARNSTABLE (� LOCATION J� SEWAGE # �U625 7Z VILLAG A&AA ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO.U610-'- � �� SEPTIC TANK CAPACITY JC9 LEACHING FACILITY: (type) Z C l .� , s (size) �o NO.OF BEDROOMS BtJILDER OR OWNER Mn1)1.;ICY PERMUDATE: 'COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom"of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist - within 300 feet of leaching facility) Feet`` Furnished by , \A •-- � M Nan rD 1 � G CD Commonwealth of"Massachusetts i Title 5 Official Inspection Form Subsurface Sewage-Disposal System Form -Not for Voluntary.Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owners Name information is required for every Hyannis MA 02601 September'14, 2010 page. City/Town state Zip Code Date;oflnspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, 1 use only the tab 1. Inspector: key to move your cursor-do not David.D.Coughanowr use the return Name of Inspector key. Eco-Tech Environmental r Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State. Zip Code 508 364 0894 1328 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°(390 CMR 95:000). The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority dC U. pr%- September p ber 1 4,2010 Inspector's Signature Date The system inspector shallsubmit 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.designflow,of 10,000 gpd orgreater, the inspector and the system owner shall submit the report,to the appropriate regional office of the DER The original should be sent to'th-e system owner` and.copies sent to.the buyer, if applicable, and the approving authority. #t*This report only-describes conditions'at the time.of inspection and under the conditions of.us'e at that time. This inspection does not address howthe system will perform in the future under, thersame or different conditions of use. 15ins•'09/08 Title 5'Official Inspection Form:Subsurface Sewage Disposal System-Page--t.of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owners Name information is Hyannis MA 02601 September 14, 2010 required for every j page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Removal of garbage grinder is recommended. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection'if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-02108 ride 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owners Name informatifor every yon is required Hyannis MA 02601 September 14,2010 page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09= Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name informatifor every on is required Hyannis MA 02601 September 1:4, 2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: El 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 wel[". 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 El ® 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 Ej Z 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 Y day flow i5ins•09108 Ti11e 5 Official Inspection Form:Subsurface Sewage Disposal System•PaEe 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is required for every Hyannis MA 02601 September 14, 2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10.000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins-09M Me 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is required for every Hyannis MA 02601 September 14, 2010 page. Cityrrown 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Carlotta Avenue Properly Address Albert and Joan McNulty Owner Owners Name information is required for every Hyannis MA 02601 September 14,2010. page. City/Town state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? 0 Yes ❑ No Is laundry on a separate sewage:system?[if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes Z No Water meter readings, if available last 2 ears usage d 169 gpd 9 ( y 9 (gp )): Detail: 2008-2009 Sump pump? ❑ Yes 0 No Last:date of occupancy;: current Date Commercial/Industrial Flow Conditions.: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personslsq.ft., etc.): Grease trap present? ❑ Yes `❑ No Industrial waste holding tank present? ❑ Yes ❑ ;N:o Non-sanitary waste discharged to the Title 5 system? El,'Yes. ❑ No Watermeter readings, if available-. t5ins'•09l08 Title 5 official Inspection Forrti:_Subsudace.Sowage Disposal Sysiam-Page.7<of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is required for every Hyannis MA 02601 _ September 14, 2010 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes .No 1 If yes, volume pumped: gallons How was quantity,pumped determined? Reason for pumping: Type of System: z Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy EJ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a-copy of the DEP approval. ❑ Other(describe): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pace 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner owner's Name information is required for every Hyannis MA 02601 September 14;2010 page. City/Town State. Zip Code Date of tnspbetion D. System Information (cant:) Approximate age of all components, date installed (if known) and source of information: Age 4+ years. Certificate of Compliance issued November 16, 2005 (Board of Health flies). Were sewage odors detected when arriving;at the site? ❑ Yes 0 No Building Sewer(locate on;site plan),:. Depth below'grade: feet Material of construction: Z cast iron ❑ 40,PVC ® other(explain): Distance from private water-supplywell or suction line: feet Comments(on condition of joints, venting, evidence.of leakage, etc:): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling_ Septic.Tank(locate on site-,plan)' Depth below,grade: 1feet Material of construction: 0 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. 10;5ftx6ftx.5ft Dimensions: (1500ga1) Sludge depth: 4 in t5ins-09r08 Title 5':0Hicial Inspection Form:Subsurface Sewage Disposal System•P.age:9.ofa7 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4 - , 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is required for every Hyannis annis MA 02601 September 14, 2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 3 in Distance from top of scum to top of outlet tee or baffle 9 In Distance from bottom of scum to bottcm of outlet tee or baffle 12 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural iitegrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years. Tank appears structurally sound and functioning as intended. No evidence of leakage'n or out was observed. 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Paga 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not"for Voluntary Assessments 5� 95 Carlotta Avenue Property Address Albert.and Joan McNulty- Owner Owner's Name information is required for every Hyannis MA 02601 Member 14,2010. page. Cityrrown state Zip Code Date:of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition,:structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction; ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions:- Capacity: gallons Design Flow: :gallons per day' Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working,order: ❑ Yes. ❑ No Date of last pumping:: Date Comments (condition of alarm and,floatswitches etc* "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins 091M Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page,1:1•0 17 Commonwealth of. Massachusetts Title 5 Official Inspection Form x = s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Carlotta Avenue Property Address T_�^ Albert and Joan McNulty Owner Owner's Name information is H annis MA 02601 September '14, 2010 required,for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont;) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert. at 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.): Distribution box appears structurally sound. A bucket of water was poured in and was observed to pass through in a rapid and unobstructed manner. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is required for every Hyannis annis MA 02601 September 14, 2010 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone, and no standing effluent or effluent contact staining was observed in stone or overlying soils. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09= Titre 6 Of6dal Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name_ information is September 14, 2010 Hyannis MA 02601 Se -required for every y p page. City/Town state Zip Code Date of Inspection .D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure,.level of ponding, condition of vegetation, etc.): 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.): t5ins-09108 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 14 of 17' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not-for Voluntary Assessments �.. 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owners Name information is September 14, 2010 Hyannis MA 02601 Se required for every � p page. Cityrrown State Zip Code Date3of Inspection D. System Information (cost.") Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system., including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100`feet; Locate where public water supply enters the building. Check one of°the boxes below; ® hand-sketch in the:area below ❑ drawing attached separately I 10, Cl � E- 0 4 2 3_ f- 7 d5ins.•09106 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•P.agea5 of 17 Commonwealth of Massachusetts ' -_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name- informatifor every on is required Hyannis MA 02601 September 14, 2010 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 wate.r: 25 ft+ feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 11/10/05 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: No groundwater contact mottling was observed to a depth of over 5 feet below the elevation of the bottom of the SAS in a test pit on November 7, 2005. Before filing this Inspection Report; please see Report Completeness Checklist on next page. tSIns•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Carlotta Avenue Property Address Albert and Joan McNulty Owner Owner's Name information is September Hyannis MA 02601 Se 14, 2010 required for every y p page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A, B, C', D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09108 Titles Official Inspection Form:subsurface Sewage Disposal System.Page 17.of 17 Town of Barnstable OF 1HE Tpw Regulatory Services Thomas F. Geiler, Director BARNSTABLE, '"ASS. i639• Public health Division ,0� ATED A Thomas McKean, Director 200 Main Street, llyanuis, NtA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: r Designer: Eco—Tech Installer. Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Wm E Robinson Septic was issued a permit to install a (date) (installer) septic system at 95 Carlotta Ave, Hyannis based on a design drawn by (address) E —Tech dated 1 1 —08-05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic. tank. I certify that the septic system referenced above was installed with major changes (Le. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations., Plan revision or certified as-built by designer to follow. H OF MASS9C moo`' DAVID yGm D. u COUGHANOWR N (Insta er's Signature) No. 1093 �FG/STE��O BAN!TARS Pa (Designer's re) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICA11- OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUIL.T CARD ARE RECEIN.'ED BY THE BARNSTABLE, PUBLIC ILEALTH DIVISION. T11ANK YOU. Q: Health/Septic/Designer Certification Form No. 0?co S 5 A100 .00 THE COMMONWEALTH OF MASSACHUSETTS:' Entered in computer. Yes • PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB,LEs MASSACHUSETTS 01ppitration f Or Mtopozal 6rotem C'onotrUttion VCrlttit Application for a Permit to Construct( , )Repair(X )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No: 771 —4 5 7 0 95 Carlotta Ave, Hyannis Albert McNulty Assessor'sMap/Parcel 248/231 95 Carlotta Ave, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No: 3 6 4 O 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinderro ) 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) Install a new Title '5 septic system to plans of Eco—Tech, #ETE-2228. 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 Boaz of Health. Date /0 Application Approve"byl Date Application Disapproved for the following reasons Permit No. �da <J S �--�, Date Issued110 / " Fee$10 0.0 0 ��► THE COMMONWEALTH OF MASSACHU:SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricaltion for Mie;goof *paem Construction Permit Application for a Permit to Constrict( )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 71 -4 5 7 0 95 Carlotta Ave, Hyannis Albert McNulty Assessor's Map/Parcel 248/231 95 Carlotta Ave, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3(4-0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Buildi_n g: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(nq 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 orA�terapotts(Answe whenaapplicable, Install•a new Title 5 septic ,y system to la s o Eco-tech E- 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 Health. Date ✓l/ Application Approved ` - Date O `j Application Disapproved for the following reasons Permit No. Oo �J S ---..� Date Issued 110 THE COMMONWEALTH . .._..: ,• _... OF MASSACHUSETTS (� McNulty BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( X)Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic Service at 95 Carlotta Avenue, Hyannis has been constructed •n ac ordance i with the provisions e 5 and the for Disposal System Construction Permit No. 000 S 5 7ated I D 7 Installer ) Designer - The issuance of this permit shah not a co 7stru as a uarantee that the system wil nc1b as desi red. Date Inspector No. co FJ 10 0.0 0 McNulty THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mi5po5or *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 95 Carlotta Avenue, Hyannis_ and as described in the above Application for Disposal System Construction Permit, The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mu t be completed within three years of the ate of this e i . Date:_ 1010 - _ Approved by Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, NVi 0 Q 66Z k NDA ,hereby certify that the engineered plan signed by me dated ��� �—©® , concerning the property located at qS hc--)� U6 meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering)and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ' B) G.W. Elevation M +adjustment for high G.W. "7 = 24 ` DIFFERENCE BETWEEN A and B 2 SIGNED :61"W� - i - DATE: ci�, 2-005 NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc Z PLAN REFERENCE CONTOURS . � LINDA _L ANE LL ixO- PLAN BOOK 165 PAGE 41 EXISTING - - - - 50 W ��R►-� ROAD o y n - + ASSESSOR'S MAP: 248 MINIMAL GRADING PROPOSED N Eco� o<w N LOT: 231 �c LOCVs J MOO N r CARLOTTA w vi CA r � AVENUE T , / P � / C o�p T �H �w i 53 ��N90 =H 1p op W J< ti �� F�(� HYANNIS, MA U.z o <o z `F P,q�Eiy o _H� io ENr LOCUS MAP . o , �<0 2�2 r � Z �N v cnw� t NOT TO SCALE O w !I w o o < Q <w = w w W u 3 (> J >l l Zx -� Z N ��/ e L O T 78 < w � Z n n� Vr w \���` Q� s' AREA - 10560 sf+- W = o = LEGEND 'CIC �' ° EX/ p LL t TP 2�i a-o .3 S NG 53 1500 GALLON o 0 0 W O 5 f B�� / SEPTIC TANK _ a: ~ J xw x �� / / LL� /�` D-BOX o U Q Z J o� WLZL c< o, too y v o 10-err F��'l0� ,AND G � TEST PIT u 0 53 N �i Q UO ?v zw 6P liI p EXISTING ww o< CESSPOOL • LU ' Zp J tD cn a0 W V TP-1 � 12-H UTILITY POLE $ W lw I Opo / L s TREE-o o n 53 -NUMBER REFERS TO DIAMETER Ib P 00 IN WCHES. LETTER DENOTES TYPE N n J 18-0 52 O-OAK H-HOLLY P-PINE e 24 ft x 12.5 f t x 2 ft �?3.42rr �- LEACHING GALLERY Li Nj s2' —J w J V o z BENCH MARK H J �LL C0 J � TOP OF CONC BOUND z ELEVATION - 53.85 PLAN SEWAGE DISPOSAL SYSTEM PLAN & IL U USGS DATUM ASSUMED -TO SERVE EXISTING DWELLING Z I'' N o SCALE: I in - 20 f t Q o w ALBERT & JOAN McNULTY o + a�`��SHOF DAVI MAssgCy 95 CARLOTTA AVENUE HYANNIS. MA D G� o COUGHD.ANOWR N ECO-TECH ENVIRONMENTAL LL ' No. 1093 43 TRIANGLE CIRCLE SANDWICH MA 025621 Ln a ! ISTE��° 508 364-0894 o � �- TA Is ETE-2228 NOV 8. 2005 1/2 THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT �\ 0 V S + 200 S BEARS THE STAMP AND SIGNATURE OF.THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED INBLUE AND STAMPED IN RED. SOIL TEST LOG '- DESIGN CALCULATIONS DATE OF TEST: NOVEMBER 7. 2005 SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD WITNESSED REQUIREMENT WAIVED - NO VARIANCES SOUGHT NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION - 53.50 +- PERC AT_ 62 in : 2 MIN/INCH IN C SOILS INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 f t x 12.5 f t x 2 ft LEACHING GALLERY CAN LEACH 53.50 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE Abot - ( 24 x 12.5 ) - 300 sf Asdw - ( 24 + 24 + 12.5 + 12.5 ) x 2 - 146 sf 6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE Atot - 446 of 50.50 36-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE V t 0.74 x 446 - 330.04 G P D 41.50 USE A 24 fi x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED NO GROUNDWATER TEST PIT 2 PARENT MATERIAL: EPROGLACIALDOUTWASH ELEVATION - 53.20 ._ PERC AT 56 in : 2 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER LEACHING GALLERY 500 GALLON DRYWELL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DIvENSIONS AND DETAIL 53.20 LSE �il0 uVT 0-8 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE CONSTRUCTION DETAIL �RYWELL UNIT INSTALL ONE INSPECTION 8-34 B LOAMY SAND 10 YR 4/4 NONE FRIABLE STONE RISER TO WITHIN SIX 8'-6'x 4'-10'x 2'-9- �. INCHES OF FINAL GRADE 50.36 2 N EFF. DEPTH AND INDICATE LOCATION 34-150 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 24.0 ft ON AS-BUILT PLAN 40.70 o o N 0p 33 eq o N cz]c_ o0000 �OOp� in NOTES r� 0000000000c 00 41 8.5. 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN NOT TO /42 in 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 24.0 ft SCALE 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE GROUNDWATER ADJUSTMENT 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN EXISTING GROUNDWATER LEVEL SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES BASED ON TOWN OF BARBSTABLE AND APPLIANCES, AND BIANNUAL PUMPING OF THE SEPTIC TANK GIS DEPARTMENT RECORDS. -TO SERVE EXISTING DWELLING 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT INDICATED GW 20.00 PARK OR DRIVE VEHICLES OVER SEPTIC_ SYSTEM. ZONE D INDEX WELL MIW-29 ALBERT AND JOAN McNULTY 10) INSTALLER TO OBTAIN DISPOSAL WORKS.PERMIT BEFORE STARTING WORK. READING DATE OCT. 2005 95 CARLOTTA AVENUE HYANNIS, MA II) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL READING 84.2 .2 STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ADJUSTMENT ADJUSTED GW 24.2 ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-2228 NOV 8. 2005 1 12/2. I 1 V Jam. - N i f L I I I ( _I -I---- ----- --- _- - _� - -- -- --- -_ -- _ --- - --- - -- -) ------------_ , I �,.. I ► I I I I I : I- I I I I i ! I i i I I ' i I i I i i I 1 I I I I I i i I I I I I I 71 I I I I i I I ; i • I I I I I I ! ! I I I I � I 4 � i � I I I I k I I I i I I L ..... _I j�-� I I I I I I.. I II li II ( , I ► I � I • �� ;_-� ! I j i I I __ I-- i � __ ! �- ►_ _ ICI_ I �► --I L- I - ; --- -- -' - - ;-- ; I ' i I y I \ ' I I IV , _ I......... I_ !- j I.. I � I , I 1 I ; j i ---- - k ' I - j I --P I - --- _ I - - __ __ I - - -- -�- I- - -- -- ► I ! ! _ ! _ i I ► - , i I I L ,