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Home My WebLink About0074 CEDAR STREET - Health 4 cedar Street Hyannis P �. A = 343 009 e: IQ �I i � y � n r l II r �I r I� 1 l� o � i. 3 C l w�R COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 7 r,1 E;,:,* IS 17k B L E f o DEPART=NT OF ENVIRONMENTAL PROTECTION t David B.Mason,ILS,Certified Title V Inspector,50"33-2177 p TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:74 Cedar Street,Hyannis,MA Owner's:McMur 7 Owner's Address:74 Cedar Street,Hyannis,MA Date of Inspection:January 16,2006 Name of Inspector:(please prime)David B Mason Company Name:—N.A. Mailing Address:4 Glacier Path East Sandwich,MA 02537 Telephone Number:508-833-2177 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 F Inspector's Signa Date: The system inspector shall submit a copy of this inspection report to the Approving A ority oard of Health`or DEP)within 30 days of completing this inspection.If the system is a shared system or gn 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: System as inspected appears to have operated based on occupancy level. Increase in occupancy may cause hydraulic failure.The information as identified represents only the condition of the system on January 16,2006 at 9:30 AM. Maintenance pumping is required ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 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 CUR 15.303 or Fa-3 10 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 (THIS IS REQUIRED TO BE COMPLETED) 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: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 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:The primary cesspool is not a typical configuration for a cesspool. It appears to be a pipe cylinder with an inlet pipe and outlet pipe with tee connected to a pre-cast 4'deepx6'diameter leach pit with stone. Permit on file with the BOH for the pre-cast leach pit. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS C1rTRCTTR1FAr1F CFWArF MRPnCAT.4V1.qT1FM TNRPF('TF0N FORM Page 4 of 11 PART A CERTIFICATION(continued) Property Address:74 Cedar Street Owner.McMur Date of Inspection:January 16,2006 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for g 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 6"below invert or available volume is less than%s 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. 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. (Tie following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply _ — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone Il of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 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 m 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 scam? 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 CUR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74 Cedar Street Owner:McMur Date of Inspection:Janaury 16,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3(per assessors records Number of bedrooms(actual):3 DESIGN flow based on 310 C_M .15.203 (for example: 110 gpd x#of bedrooms):(330 gpd capacity) Number of current residents:_3 Does residence.have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no):NA Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2005:87,750 gal. 2004:95,250gal. Sump pump(yes or no):No Last.date of occupancy:(current) COMM 11CIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203): apd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Barnstable Health Department Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: Requires maintenance pumping TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system(2-500 gallon chambers with 4'stone) —Single cesspool Overflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:Installed 11/25/03 Were sewage odors detected when arriving at the site(yes or no):NO Page 7 of l l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:74 Cedar Street Owner.Mchfur Date of Inspection:January 16,2006 BUILDING SEWER(locate on site plan) Depth below grade:Approximate; 14 Inches Materials of construction:_cast iron _X 40 PVC_other(explain): Distance from private water supply well or suction line: NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. SEPTIC TANK: N.A.(locate on site plan) Depth below grade: 10" Material of construction X 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: Typical 1500 gallon tank Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness:2.5 inches Distance from top of scum to top of outlet tee or bale: 15" Distance from bottom of scum to bottom of outlet tee or baffle: 12.5" How were dimensions determined: Actual measurements with tape and scour stick. Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) PVC outlet tee in good condition,PVC inlet tee in good condition,Fluent level with outlet pipe. GREASE TRAP: N.A. Depth below grade:_ Material of construction:_concrete metal fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 TIGHT or HOLDING TANK: N.A._(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: X (if present must be opened)(locate on site plan) Depth of liquid level even with outlet invert:liquid level even with outlet pipe 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.): no indication of solids carryover. D-box 19 inches below grade._Effluent is level with outlet pipes. PUMP CHAMBER_(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 ASSS FORM SSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION SYSTEM INFORMATION(continued) Property Address:74 Cedar Street Owner:McMur Date of Inspection:January.16,2006 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number X leaching chambers,number:2 500 gallon chambers with 4 feet stone. —_leaching galleries,number: _ leaching trenches,number,length: leaching fields,number,dimensions; overflow cesspool,number: innovative/alternative system Type/name of technology: condition of vegetation, Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp il, etc), Probed stone area No sign of hydraulic failure. No damp soil.No excessive vegetation growth. 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 or no): failure,level of ponding,condition of vegetation,etc.): Comments(note condition of soil,signs of hydraulic PRIVY: N.A._(locate on site plan) Materials of construction: Dimensions: Depth of solids: h diaulic failure,level of ponding,condition of vegetation,etc.): Comments(note condition of soil,signs y Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continual) Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 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. -� 27 341 VA . �Z A-F' 3� A-�r I i5- F Al f ME 4 t ; Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16�2006 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_15_feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: _X Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explaim Recent Test Holes. Existing engineer records with BOH X Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the!nigh ground water elevation: Utilized existing site design information on file with the Board of Health Additionally,existing site and abutting site topography does not indicate ground water to be within 5 fat of bottom of leaching facility. e , - Page 11 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Cedar Street Owner:McMur Date of Inspection:January 16,2006 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_15_feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: X Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain:Recent Test Holes, Existing engineer records with BOH X Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography does not indicate ground water to be within 5 feet of bottom of leaching facility. TOWN OF BARNSTABLE LOCATION �T � � � SEWAGE # VILLAGE /_�y�4/j'�lJ" ASSESSOR'S MAP & LOT INST'ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY „ LEACHING FACILITY: (type) (size)��X'� NO. OF BEDROOMS ,,`BUILDER OR OWNS$ ERMIT DATE: COMPLIANCE DATE: eparation 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(Ifany wetlands exist / within 300 feet of leaching facility) Feet Furnished by Cr-I" Ze-_1CVL--&4*f Q y n `� Ob q Ctaox- 5 '7 N No. 5_✓.<J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Migozar *p6tem Construction Permit Application for a Permit to Construct( . )Repair{,6 Upgrade f )Abandon( ) El Complete System O Individual Components Location Address or Lot No. ,r'J" Owner's Name, ddress and Tel.No. Assessor's Map/Parcel J!!//j 0�� 7_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: -5 Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building '-p No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow zi �� : gallons per day. Calculated daily flow - gallons. Plan Date ///� —® Number of sheets Revision Date Title _ Size of Septic Tank �`�"® e Xe Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b - 'ssue and of Health. Si ned Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued IG Fee' f - / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTSm Yes �F Z ricatiort for tg- o0al 0tem �Con!6t uct" �< �� p r tort Permit Application for a Permit to Construct( )Repair(5 Upgrade O Abandon( ) ❑Complete System ❑Individual Components r Location Address or Lot No. ,G ��(� f'T ffy Owner's Name, ddress and Tel.No. !/J ?CA- IF lov 1 C.'NA Assessor's Map/Parcel7 J 470 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ,3 Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow C . 5� f gallons per day. Calculated daily flow 3�a gallons.a Plan Date /-/ —p3 Number of sheets Revision Date 4, Title _ Size of Septic Tank /3o v ,9AZ Type of S.A.S. /A"/eeG-J /-1,>0 Description of Soil o� —1-,00(fAZ CG.vcoeW-,ee t Z. Nature of Repairs or Alterations(Answer when applicable) k t- . t 9 ` r Date last inspected: Agreement: The.undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee 'ssued by this-Board of Health. Signed Date Application Approved by Date 11 113to Application Disapproved for the following reasons Permit No. 3 SS Date Issued G _.... ----------------------------------- ---- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa a Disposal System Constructed( )Repaired(�')Upgraded( ) Abandoned( )by L�!3`Ofry at has been cens�zcted in Accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7�3-5-5? dated 1I h�%o 3 Installer // Z40 t!? Z P",X Designer ,^4 lvi� �- il��,/',e{/�,1 Pp The issuance of thil permit shall not be construed as a guarantee that the system . ilhfu c ron as e ed� Date It 12-5f co Inspector � /C .No. CJ'�•-�-' 7j --��. �jQJ------------------------Fee_ v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS mig;pogal bpztetu Cong1ructiort Perron Permission is hereby granted to Construct( )Repair(,;�)Upgrade(,Pg�)Abandon( ) System located at -152401 lw1/< and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three ears of the date of this e P Y P Date: O Approved by • TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE IJO. SEPTIC TANK CAPAC /ram Ly-"-e '4K�® LEACHING FACIL=: (type) (size) NO. OF BEDROOMS -? -� �i' BUILDER OR OWNER PERMIT DATE: —COMPLIANCE DATE: Separation Distance Between the: f 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 6 DATE: _ 11 /5/96 . PROPERTY ADDRESS: .74 C-edar Street , Hyannis ,Mass . 02601 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 3-Block cesspools . Based bn my Insoectlon, I certify the following conditions: 1 . This is not a title five -septic system. . 2. This .is a sewage system. 3 . The sewage system is in proper working order at the present time. 4.. Main. cesspool only two thirds full. The two overflows are dry. House is occupied. SIGNATURE: . . I I . . C 10 -- Name:—J. P .Macomber Jr..---- . i 'P IN -1 'd Company.* om any J. P_Macomber & Son- •Inc . �Y — ------ c� =3-- -- ' NOS Address j f/ ® --Be-x-,6g----- 3 Centerville . Mass__02632 , t • Phone:---S08�Z7S�3338------- p THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY L'H=P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped L Installed Town Sewer Connections x 66' Centerville, MA 02632-0066 775-3338 775-b412 r Commonwealth of Massachusetts i Executive Office of Environmental Affairs 1 Department of �aKva ironmental Protection Trudy Cox* sec-. David B.Struhs U.Oo..r,.,4 CiommW4orwr • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P,pertyAddresa: 74 Cedar Street Hyannis ,Mass . AddreasofOwner. Date of Inspection:11 /5/96 (If dlfferent) Name of Inspector.Joseph P. Macomber Jr. Company Name,Address and Telephone Number. J.P.Macomber & Son Inc. &QRgrlA& g*�fajA;q,Mass. 02632 508-775-3338 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate amd 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 sew disposal systems. The system: Passes Conditionally Passes — Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: 141 GAG'/��Gyt� Date: The System Inspector&hall 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.rwd copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) 9Y9 PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bi SYSTEM CONDITIONALLY PASSES: —,d._SL One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) /(fLM� The septic ianli is metal,cra:ked, structurally unsound, shows substantial infiltration or exfiltratiom,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street * Boston,Mastachusetts 02108 * FAX(617) $545 10d9 • Telephone(617)292-5500 C� Printed on k"Ied Paper t ` 1 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) PropertyAddresu 74 Cedar Street Hyannis ,Mass . 02601 Owner. Margaret McCulloch Date of.Inspeotlon: 1 1 /5/9 6 B) SYSTEM CONDITIONALLY PASSES(oontinued) Nedj(� Sewage backup or breakout or bo static wale level observed in the distribution box is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced , obstruction is removed distribution box is levelled or replaced The system requite pumper 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A,)O 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: _4,0 Cesspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt mare) 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: /1JD The system has a septic tank and soil absorption system and 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 systsm and is within a Zone I of a public water supply well. ,J2D The system has a septic tank and soil absorption system and is within 60 foot of a private water supply well The system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,ualeu a well water analysis for conform bacteria and volatile orpnic 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 6 ppm. 9) OTHER The: .s_ystem has three block cesspools. Main cesspool acts as a se tin tank SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) PropeetyAddreaa 74 Cedar Street Hyannis ,Mass . 02601 Owner. Margaret McCulloch Date of Inspeotion: 1 1 /5/96 D) SYSTEM FAILS: • I have determined that the system violater one or more of the following failure criteria as defined in 310 CMR 16.303, The basis for this determination is identified below. The Board of Health should be contacted to determine what will be neosssary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or oesspool. Discharge or ponding of effluent to the surface cf the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution boi above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool-is Is" than 6"below invert or available volume is less than 0 day flow. &D 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. IM Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of•oesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design now 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: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such sywum shall bring the system and facility into full compliance yr th the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for ftuther information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddress: 74 Cedar Street Hyannis ,Mass . 02601 Owner. Margaret McCulloch Date of Inspection: 1 1 /5/9 6 • Check if the following have been done: ` ,Pumping information was requested of the owner, occupant,and Board of Health. Y 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. ,d2AAs built plans have been obtained and examined. Note if they are not available with N/A ZThe facility or dwelling was inspected for signs of sewage back-up. , The system does not receive uon-aanitary or industrial waste flow , The site was inspected for signs of breakout. r. All fystem components,Zuding`the Soil Absorption System,have been located on the site. wd,tL—The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baMes or tees,material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. , The site and location of the Soil Absorption System on the site has been determined based on existing information or app ted by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information P on the proper maintenance of Sub- surface Disposal System. (revised 11/03/95) 4 �5 SUIISUIWACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAc1dtcsa: 74 Cedar Street Hyannis ,Mass . 02601 Owner. Margaret McCulloch Date of In►peuti—I 1 /5/96 FLOW CONDITIONS RFS I D ENTIAL- Deaip now: D Ur per 01►4-y Number of bedroom,: r Number of currant residents: Garbaep p-index(yes or no):, /1 Laundry connected to ryrtem (yes or no): � SeasouJ use (yes or no):— Water meter readings, if available: — �v (tee! . -Aele �Grs�rl i�7�� 15�i�i(�/YS =lOt7��7 1 h mom, Last data of occupancy: COMMERCIAL NDUSTRIAL- Type of establishment: Desiz.n flow: 4)4 gallons/day Grease trap present: (yes or no)hz�� lndustrial Waste Holding Task present: (yes or no) W Non-"Lary wasw discharged to the Title 5 eystem: (yes or no) Water meter reading, U available:_ A)4 AA _ Last date of occupancy: OTEER (Describe) Last date of oocupancy: - GENERAL INFORMATION PUMPING ORDS d ao of ortnauon: &tee �v��.4"g System pumped as part of inspectio)� on. lyes or n if yea, volume pranged: ocu Reason for primping TYPE OF SYSTEM Septic taukJdistribulion box/soil absorption s)at.em S tr.,�le 06�_;441 _ Ovornow cU:spwl� Privy Shared ry"m (yes or no) (if yew, attach previous inspection records, if any) Other(eiplt..in) s APPROXIMATE AGE of all oomponents, date u:n4LUtJ (if known) and source of information: 3oware odor~ r.WA tal Wtio t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: Margaret McCulloch Owner: 74 Cedar Street Hyannis ,Mass . 02601 Date of Inspection: 11 /5/96 SEPTIC TANK:J1P4V1 e (locate on site plan) Depth below grade: .( Material of construction: i oncrete _metal _FRP —other(explain) Dimensions:_ 444 Sludge depth:_ Distance from top of,slu�dge to bottom of outlet tee or baffle:k/ 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._ s— Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid level in relation to outlet invert, structural city' evidence of leakage, etc.) Sancti P. txqnk i g not :present GREASE TRAP. if&Kle— (locate on site plan) Depth below grade:,'"V o Material of conslri.jni6n•;f/Xzoncrete _metal _FRP _other(explain) AIA Dimensions-, Scum thickness: Distance from top vi scum to top of outlet tee or baffle: 'Vd Distance from bottom nl from In honom o) outlet lee or 6ftle'_/fJ� Comments: (recommendation for pumping, condil—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et�j Q ea_ sus a tga-p is not present. I V' (revised 9/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontiaued) Property Address: 74 Cedar Street Hyannis ,Mass. 02601 Owner. Margaret McCulloch Date of Inspectlon:11 /5/9 6 TIGHT OR HOLDING TANK2ZbAt, (locate on site plan) • Depth below grads:A' Material of coastrvction1 ooacrate_metal_FRP_other(e:plain) - AN Dimensions: Capacity ons Design flow: ona/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) Tight or holding tank is not needed at this address . ' DISTRIBUTION BOX:j)pye_ (locate on site plan) Depth of liquid level above outlet invert: A.IA Comments: (note if level and distribution is eq evidence of solids carryover,evidence of leakage into or out of boa,etc.)_. Distribution box is not present PUMP CHAMBER:IlLye, (locate on site plan) Pump+in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenaaoes,etc.) Pum-p chamber not present. Pump chamber is not needed at tftis iocaTTon. 4 (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrees: 74 Cedar Street Hyannis ,Mass . 02601 Owner. Margaret McCulloch Date of Inspection: 1 1 /5/9 6 SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if pool ;excavation not required,but may be approximated by non-intrusive methods) e If not determined to be preeeat,explain: Type: 1"Aling pits,number: Lachin Chambers,num leaching galleries,number leachiag trenches,number,length: leaching fields, number,dimenaions•— overflow cesspool, number• Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of ve etc.) Medium dand to fine sand;No signs of Hydraulic faiTure or pan i , _All VPgntation is normal_. No repairs needed at fFe—presenttime . CESSPOOLS: (locate on site plan) 2 Number and configuration: 3 Depth-top of liquid to inlet invert: Depth of solids layer. r— Depth of scum layer. ! Dimensions of cesspool Materials of constriction: Indication of groundwater: if/BiU inflow(cesspool mygrt bep�un ped as part of' n) Lye 4 S jdd.�S ll)A .1..v Ai C 7- Liw)C o•F- )A-'M1- �4 Comments: (note condition of soil,signs of hydraulic failure, level of pondit4L, oonditloa of vetation,etc.) Maciiirm sand to fin nd•No si ns of h draulic ailure or onding; . trogo+.a+.inn is nnrmnl _ Nn ranAirs needed at the present time . PRIVY:ZZ,�.V e, (locate an site plan) Materials of oonstruction. N/A Dimensions: N/A Depth of solids: N f A Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)_ N I A --- p.aPfy-I s H e t-� (revised 11/03/95). g U J�d jU1UACE SEWAGE DISPOSAL SYSTEM INSPECTI0N .1'u1tr1 PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE E :SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Hyannis Water Company 775-0063 S -�aprar� h DEPTH TO GROUNDWATER 201 + depth to groundwater r+ thod of determine$ion or approximati,on: nsta Y*ed,h6V6 es -. o "the�::�om�on s r. on. .C-edar street hyannis . No water t -1 -T `t o ouaes wa f om• the common sewer. e- er 1= e-'• • in : i '1` b b ila "le :at som time . z _ w f ssbyv ��1~ THE COMMONWEALTH .OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ion of Water Pollution Control 'I'UHN OF Barnstable WARD OF HEALTH SONSl1RFACF ,SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION 1 �...._....r......--.::-^---+.r-t•ra:-s.—v...�'�..-....-..�_.�—.-s—nir rr.-rs:rr.ss • .. ...• ... .. .. i:n r.TT*t+'*t�irr+rr•r.-.rrrr•: ._.. -TYPE OR PRINT CLEARLY'- PIWERTY INSPECTED STREET ADDRESS 74 Cedar Street Hyannis ,Mass . 02601 ASSESSORS MAP , BLOCK AND PARCEL # OWNER' S NAME Margaret McCulloch PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. . COMPANY NAME J.P.Macomber & Sori INc. COMPANY ADDRESS Box 66 Centerville .Mass . 02632 Street Town or City Stat• CIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one : XXXXXXXXX System PASSED Tile inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 11 /6/96 Inspector Signature Date One copy of this certification must be Drovideri t.n the nwUrn 4.1.., n,rvr.n ASSESSORS MAP: __.� TEST HOLE LOGS PARCEL: 4 M _. _. _ . __ _ . _ SO i L EVALUA OR : l_ FLOOD ZONE: _IP(�l(,- 1 -- -- `I� �+ v NOTES: W 1 THE S S 3 0 REFERENCE: DATE: OIN! r' -� u) PERCOLAT 1 ,� N RATE: .. 1 + 1) The installation shall comply with Title V and Town of Barnstable Board of V Aer'�,, Health Regulations. TH- I TH-2 2) The installer shall verify the location of utilities, sewer inverts and septic t o ` components prior to installation. ll �cw� d 3) All septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. 1 4) This plan is not to be utilized for property line determination nor any other 2, 1 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. � �( p s. LOCATION MAP T',5• /, 1__ _ 6) Parking shall not be constructed over H10 s C � eptic components. 7) The property is bounded by property corners and property lines as depicted. 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the number of (O �a bedrooms. 12►� 9) The existing cesspools shall be pumped and backfilled per Title V Abandonment / r \ Procedures. 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut grade as permitted by the Board of Health. SEPT i C S Y'S T E M DES 1 G N FLOW ESTIMATE BEDIOOMS AT '10 GAL/DAY/BEDROOM • 72�*')70 GAL/DAY EPTIC TA K `,r' Z 2 910 GA./DAY x 2 DAYS - GAL USE GALLON SEPT I C TANK � i { OIL AESORPTION SYSTEM c� SIDE AREA: Z7C Zzj - - `3' X Z'� ,� : o ! BOTTOM AREA: 1 G- 230, h ---- SEPTIC SYSTEM SECTION `ile AA ID ySC-(v ►Z Ma, , , I {Y Q O M�1, 1C()D GAL � y, -.l I SEPT I C TANK % ! _. 7�7 fir � dd w ' l a y ------------ SITE AND AGE LAN W P SE LOCATION . ,// PREPARED FOR 01", rC� L o � o SCALE: Z DAV I D B . MASON R5 DATE: 1 17 A�j o Z DBC ENVIRONMENtAL DESIGNS j DATE HEALTH AGENT EAST SANDWICH . MA W ( 508 ) °833- 2177