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Home My WebLink About0035 CONNEMARA CIRCLE - Health 35. Connen-1 r rcle Hyannis A-=.291 293 i L ,a 0 'F i I I I I I I i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name ' information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address South Dennis MA 02660 Cityrrown State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addrejs and that the o information reported below is true, accurate and complete as of the time of the inspection. The.,inspe lion was performed based on my training and experience in the proper function and maintenance , on !�Ap sewage disposal systems. I am a DEP approved system inspector pursuant to-Section 1U40 of" Title 5(310 CMR 15.000).The system: ` ' — Co ® Passes ❑ Conditionally Passes ElFails w LM ElNeeds Further Evaluation by the Local Approving Authority r-- February 6, 2014 Inspector's Signatur9l 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. t5ins•3/13 i , r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 z _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 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: ® 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 meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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 statemenrs. If"not determined," please explain. The septic tank is metal and cover 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•3/13 Title 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 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): ❑ brokeri 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 i • t + , ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13• Title 5 Official Ins f pection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 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: ❑ 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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 %day flow 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. City/Town 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 pprh, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is locatedJn 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. t5ins•3113 Title 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 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 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? j 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 t5ins•3113 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 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected?' ® Yes ❑ No s. Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 13=48,000 gals. g ( y g (gp ))' 12=52,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commerciallindustrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No - e Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No t Water meter readings, if available: t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 s • T , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/ADate Other(describe below): i N/A General Information Pumping Records: Source of information: Last pumped in 2010 per info from owner. 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. ® Other(describe): pump chamber t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Pump, d-box and leaching were installed to existing tank on 2/27/06 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+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.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X9'X6 1000 gallon 4 Sludge depth: .t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 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 2' 8" Scum thickness none 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 14" probe/measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): • Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts NOR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name - information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): • Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: Capacity: N/A p ty' gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No N/A Date of last pumping: Date Comments(condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No s t5ms•3/13 1 ,� ff'r`+ - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Connemara Circle, Hyannis M -291 P=293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityrrown 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 level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order. Inlet tee was present. 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.): Pump, floats and alarm were in working order at the time of inspection. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5- infiltrators with 3.5' of stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A ". .,. N/A t , Dimensions of cesspool - 71 Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No • t5ins•3/13= ,• - Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 or 17 l . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 required for every page. Cityrrown 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.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A. t5ins•3/13 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 35 Connemara Circle, Hyannis M -291 P-293 Property Address Joan Silvera Owner Owner's Name information is' required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 r Vi LX 01 ay r !, t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owner's Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells 10.0'+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 11/17/05 If checked, date of design plan reviewed: oats ® 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: AIW 230 Zone D 21.9' (12) 1.9' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed water found at 11.0'. Hand augered 4.4' below bottom of leaching with no water found at 8.0'. Groundwater adjustment at the time of inspection was 1.9'. Bottom of leaching at 3.6'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 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 35 Connemara Circle, Hyannis M-291 P-293 Property Address Joan Silvera Owner Owners Name information is required for every 35 Connemara Circle, Hyannis MA 02601 February 6, 2014 page. City/Town 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 15ms•3,/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION , S eM<� ,� SEWAGE4006 p' VILLAGE ASSESSOR'S MAP&PARCEL 4� INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY I vmo !� ,,,, . LEACHING FACILITY: (type) , tnS (size) NO. OF BEDROOMS .' r OWNER �'1 PERMIT DATE: S' ...,.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 vz 3 No.. UD —b / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:4--' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricatiou for Migogal *pgten Cottgtruction Permit Application for a Permit to Construct ) Repair( .)Upgrade.( Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot No. � 3� 004 rW4" ur,,r( Owner's NaamTme,Addresss,--and Tel.No. Assessor'sMap/parcel C93 3- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �o gesI' �s ��X) Y� o� �� ,4 VOL Type of wilding: qz Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title , Size of Septic Tank %06-,12 Type of S.A.S. S % Description of Soil r Nature of Repairs or Alterations(Answer when applicable) G✓ / Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintena�f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co �fi not to place the system in.operation until a Certificate of Compliance has been issued by this Board ofHyalth Signe Date L Application Approved by Date 4,01/" /0G Application Disapproved by: Date for the following reasons Permit No. a0o 6—U!M Date Issued a /S ffl�..: "..'�' .:.�p '7- '0 's F7-'-n:w.,.!•-r,` =- '=`:; T. _ x r-: Y �,.._ ` Y. , 1. ... v'ti Np, . 00 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:v— PUBLIC HEALTH%DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes. • / 01pplication for �Digoni i�pftelg Con5truction.permtt ,r Application for a Pennit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components r r• Location Address or Lot No. �1 35 �0 dl/I r vu1 />' Ur-lV Owner's Name,.Address,and Tel.No. le ` Assessor's Map/parc el n Installers Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e C�'av /f C�i�rzo� iI pe of+•uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t � Design Flow(min.required) gpd Design flow provided gpd' y Plan Date Number of sheets Revision Date I • Title 1 �- Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations.(Answer when applicable) l.✓ /J 9� 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenan f the afore described on-site sewage disposal system in -� accordance#with the provisions of Title 5 of the Environmental Co d not to place the system in,operation until a Certificate of Compliance has been issued by this Board of H alth. .. Signe 'n Date Z Application Approved by r/W. Date Application Disapproved by: Date for the following reasons t Permit No. a - O�� Date Issued �- - ------- no(� ------------------ --------_--_-- ] THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , f Certificate of Compliance � . THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Upgraded ( ) Abandoned( )by a Zaeqz F1C�e2 at 1 S has been constructed in accordance with the provisio s of Title 5 ar d" e for Disposal System Construction Permit No. 2 00 G-0-5 dated 2 b s X 6 Installer Designer >l�s #bedrooms 1 Approved design flow 1? gpd The issuance of this permit sha.-lll no'be construed as a guarantee that the syste(m wil�t'ofi" e e Date N / �i _ Inspector�l t ————————————————————————————————————————— — , / S-/q — `t No. �CIOI�- � Fee /d0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migonl:i§pOteT� Construction Permit Permission is hereby granted to Construct ( ) Repair"( ) Upgrade ( ) Abandon ( ) 4 System to ated at :t. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this/ 'A roved b Date Pp y T � 9/16/03 " Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, CIRMerA F-S-Agy ,hereby certify that the engineered plan signed by me dated I 1 05 concerning the property located at O(7f�Q }� me nccr.�, 01,12ets. all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses.,associated with the.dwelling. • The soil is classified as'CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes.and percolation tests.at the site without a health agent present. • -There is no.increase in flow and/or change in use proposed • There are no variances requested or'needed. • 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 r, +adjustment for high G.W. 3 DIFFERENCE B EN A.and B SIGKD : k2yrw DATE: 0 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. lS he ercex � Q�QI — V.a q ep �P emp.doc Foci: \O 0 6 TOWN OF BARNSTABLE LOCATION ;3S— boy '1 SEWAGE �r VILLAGE' �i -y ASSESSOR'S MAP&PARCEL / � 3 INSTALLERS NAME&~PHONE NO. a� / ��'� ', G SEPTIC TANK CAPACITY 6-yZ i LEACHING FACILITY: (type) (size) NO. OF BEDROOMS ��' OWNER �- PERMIT DATE: rJ COMPLIANCE DATE: �p Separation Distance Between the: Maximum Adjusted-Groundwater Table to the Bottom'of Leaching Facility . Feet, Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i 44# 6 � stye VARIANCE REQUESTED PERCOLATION TEST 1, REQUEST A VARIANCE TO REDUCE DISTANCE FROM SAS TO A FOUNDATION FROM 20' To 16'. A 40 MIL RUBBER LINER HAS BEEN PROVIDED. Date a Percolation Test: N E. SHAY, R ., C.S.E.EB. 10, 2006 3-2+• REMOVABLE covEas-\ Test Performed By. CARMEN E. SHAY, R.S., C.S. 3-24" DIAM. ACCESS MANHOLES Results Witnessed By. WAIVER ( per BARNSTABLE B.O.H.) B' -0. •. Excavator: Shay Environmental Services, Inc. �,..;,�. , ,;.,t. ..; ; 3 min.cl cnc. "` ,r eaFT•r Percolation Rate: Less Than 2 MPI ® 30" �yi'" . ,..r •y•-` r` INLET 6• mh_T=�z•_mle. Inlet to oeuet e.min. IN t0•min QLQuTFrewl j OUTLET 1;T Note: EXISTING TANK TO BE WATER TESTED PRIOR TO INSTALLATION INLET e§ 4'uid depth Test Hole Test Hole INLET �./ ``/ a � ,, q� o.esm. ;' �• uQule d.pu, , IF TANK FAILS WATER TEST, A NEW 1500 GALLON No. 1 No. 2 • �' H-10 SEPTIC TANK TO BE INSTALL AND OLD TANK REMOVED. DEPTH SOILS ELEV. DEPTH SOILS ELEV. l ' 0 92.00 0 96.00 ;� / * N1s'-o' 5 -3. Loamy Loamy STEEL REINFORCED PRECAST CONCRETE CROSS SECTION END-SECTION Sand PLAN VIEW 10 YR 3/2 10 YR 3/2 0"-6" A. 91.50 0"-6' A, 97.50 C®NNEM,4 R.� CI1" CL.E' Loamy Loamy TYPICAL (EXIST.) 1000 GALLON SEPTIC TANK THE ACCESS COVERS FOR THE SEPTIC TANK, Sand Sand DISTRIBUTION BOX AND LEACHING COMPONENT NOT TO SCALE SHALL BE RAISED TO WITHIN 6" OF to YR s/e to YR 5/8 FINISHED GRADE. -(4O FOOT RIGHT OF WAY) 6"-30' Be 89.50 6"-30' Be 95.50 (H- 10 LOADING) INSTALL TUF-TITS GAS BAFFLES OR EQUALS ---------------------------------- -----------------------------.\ Medium Medium ON ALL OUTLET TEE ENDS Sand 7.5 YR 8/1 Sand 30"- 120 82.0 7.S YR E/t /� \\ 30"- ,38 C 86.50ALL OUTLET PIPES FROM THE 70.00' C l �\ DISTRIBUTIONS LEVELOR AT LEAST BOX SHALL 2 FT. t2' coNcaET1¢ COVER // �i'/ \\ \\\ "•tin. .• 3- 5"OUTLET •vti'•�•.c .�.., M J KNOCKOUTS •.� ASPHALT cP Note: Remove soil down to el. 95.00 & replace with • 15.a• ' 12• INLET .'' DRIVEWAY ,�� •5' tS, P a OUTLET ,") clean coarse sand w/perc. rate less than or -� '' e" '' , �� or equal to 2 min./in. before & after placement ' ' QO----------- ` i u:�t.l; tss• 4" - SCH. 4O Tee- 1.75• --------------- - \ '� \ 1fis f`x: �' `, PLAN-SECTION CROSS SECTION 9a _- � � 1 1 3 HOLE H- 10 DISTRIBUTION BOX PROJECT BENCH MARK \ `\ `\ r ,;,, 7. 5 i Perc #1l Test Hole #2) NOT TO SCALE TOP OF FOUNDATION \ \ ''' • ' r 1 Depth to Perc: 30 to 48 k;' •s:'' I I Perc Rate= Less Than 2 MPI ELEV. - 100.00 (Assumed-_-___--------- I �) \ y,, , 1 i MIW29 ZONE C - INDEX = 8.2 for 10 05 2-20"OIAM.ACCESS�0� •t • TEST HOLE #11 / / 2-20" REMOVEABLE ELEV.= 98.001 ADJUSTMENT 3.3 FEET MANHOLE COVERS WITHIN 96-_ `��\\ `� /� // ;v, / " 8' OF FINISHED GRADE. ram' 7 ` / i \ r' • OBSERVED H2O Elev. = 132 or 11' below Grade ��\ �� // '1•. gar, i ADJUSTED H2O Elev. = 92.4 Inches or 7.7" below Grade RESTORE TO FINISHED GRADE ELEV. "�� '�-' ' ' �� per Cape Cod Commission Adjustments b LOT #98 ___ e: IN3 BEDROOM s ll- ` at"�T THE ACCESS COVERS FOR THE SEPTIC TANK, - EXISTING D/Box co ;' B U 0A �/C Y CA L CUB Tl 0/�S LIFT OUT OWN !, / '1 + DIS,itIBUTON BOX AND LEACHING COMPONENT (� HOUSE __ Q� INLET INVERT 6" BELOW DECK _ F4EVr�4 OUTLET INVERT ELEV- 90.0o OR�E�sHALL BE"RAISED TO tnTHNEB' OF ��- CO / 1 - r FINISHED GRADE. 9 #3s / I 3j H CHECK VALVE rr.•r-n ►r�"1'..•.;^R-r.:.• , �; , Weight of Septic Tank(Exist): 8,240 lbs. c�RE;��PRB��`� 2" SWING CHECK VALVE-P.V.C. STEEL REINFORCED PRECAST CONCRETE Weight of Soil Above Tank 2,220 lbs. �. PLAN vlEw ,�_------ 40 POLYETHYLENE LINER FROM ELEV. Total Weight Down: 10,460 lbs. 5,• �3-24"IEM �� r 96.50 to 92.25 AND TO EXTEND 2_ r \\� LOT #97 ; TWO SIDES AS SHOWN Weight of Water Displaced: 8,870 lbs. E,4• mh.cl v gin 12,000 S uare Feet +/- i * te• R PUMP CHAMBER ELEVr Bs.oO IMu� -v nh {r,nh N� '' a"`T q\ , No Ballast Required For Septic Tank -(� --------- - : I p 1000 GALLON �1 0 20 40 50 Weight of Pump Chamber(H- 10: 8,250 lbs. t2•or 3/4•- „/2 Stene " f � �' Uw f b ------_ Pump Chamber I Weight of Soil Above Tank 2,750 lbs. TEST HOLE #2\� /1 Total Weight Down: 1 1,000 lbs. PUMP to ScaleDETAIL ►••'. r • ' ' E ' • 90 ELEV.= 92.00 \ i '� CROSS-SECTION END-SECTION 1 SCALE: 1 =20 \\ EXIST. Q Weight of Water Displaced: 8,870 lbs. PUMP NOTES & SPECIFICATIONS 1000 GALLON H-10 SEPTIC TANK USED AS PUMP CHAMBER 1000 GALLON Failed s� NOT TO SCALE SEPTIC TANK LEACH PIT I L * No Ballast Required For Pump Chamber I 1. PUMP SHALL BE INSTALLED IN STRICT COMPLIANCE NOTE: ' PUMP CHAMBER TO BE FACTORY WATERPROFFED PRIOR TO SHIPPING. )92.85' ► W/TH MANUFACTURER'S SPECIFICATIONS. CT, 2 Design s i a n Calculations 2. ALARM SHALL CONSIST OF AUDIBLE SIGNAL dt RED WARNING LIGt TO BE INSTALLED IN BUILDING AND POWERED By:'EPARATs ciRcwT FROM PUMP SPECIFICATION CAL COLA 770NS ♦i CIRCUITS TO PUMP. J. DOSING SCHEDULE• OJTO0 Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal,/Day Min. per Title V) 440 G4LLONS/4 DOSES-82.5 GALLONS/DOSE ST477C HEAD CALCULAT70N 7 O Garbage Grinder: No / Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) 95.37' - Elev of D-Box /n i Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 86.00' - Elevation of Bottom of Pump Chamber FLOAT LOCATION CALCULA T/DNS / SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 96.J7 - 86.00' - 10.37" Stoll Head I Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. ft. = 275.65 gallons 82.5 Gallon/ 7.48 GAL./Cu Ft - I Cu Ft i Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. = 58.25 gallons Area of Bottom of Chamber - 8'x 5' - 40 Sq. Ft. DYNAMIC HEAD Providing: = 333.90 gallons Height of Water,for One Dose (H) 11 Cu. Ft. /40 Sq. Ft. I _ friction Head For J'SCH 40 PVC Pipe I H - 0.28Ft. - 3.4' Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, 010 GPM - 0.005 Ft./100 Ft. LOT #96 �, TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE Pump on - 10.5' 050 GPM - 0.01 Ft/100 R. Use Gould Model 3B87(WSOSi1BF) Pump 2J0 Volt Phase l ON THE ENDS. NO STONE UNDER. Pump Off - 7.1- 0100 GPM - 0.40 Ft./100 Ft. 1/2 HP 2'Solids Handling I t.Al , V`I• Alarm - 14.0' Total Dynamic Hood - 10.77' O 100 GPM OR EQUIVALENT I � EXISTING SAS TO BE PUMPED DRY & THE PROPERTY LINES ARE APPROXIMATE AND . PUMP PLRFORMANCE DATA FILLED IN PLACE COMPILED FROM THE SURVEY PLAN ENTITLED GENERAL NOTES CERTIFIED PLOT PLAN OF LOT 97 CONNEMARA CIRCLE, 7 HYANNIS, MA, DATED SEPTEMBER 23, 1974 NOTE: THE STRIPPED OUT SOIL CONTAINING LEACHATE BY BARNSTABLE SURVEY CONSULTANTS of YARMOUTH, MA FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 40 1. Contractor is responsible for Digsafe notification IT SHOULD BE USED FOR NO PURPOSE OTHER THAN and protection of all underground utilities and pipes. OF AS PER BOARD OF HEALTH SPECIFICATIONS. THE SEPTIC SYSTEM INSTALLATION. 2. The septic tank on j distri ution box shall be set level on 6 of 3/4 -1 1p2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. Still •I i > LEGEND n 4. This system is subject to inspection during installation d n11 ! Ott si 40 by CARMEN E. SHAY - Environmental PROFILE OF SEPTIC SYSTEM - -,# i t I G 1 I 5. The contractor shall install this system in accordance DENOTES PROPOSED o with Title V of the Massachusetts state code, the approved plan 88X0 = and Local Regulations. 1' t ti i SPOT GRADE 6. If, during installation the contractor encounters any � i' t,1;n1 " 'i' DENOTES EXISTING o 20 soil conditions or site conditions that are different Ili ra""'t � F tt�� 'r� 104X46 D from those shown on the soil log or in our design • - SPOT GRADE d f (fi 4t' 1 8� installation must halt & immediate notification be 4 EL�, r I made to CARMEN E. SHAY - Environmental *NOTE: INSTALL TUF-T/TE GAS BAFFLES OR EQUALS ON ALL OUTLET TEE ENDS. Finished grade over system-29: slope away �I6� -�K' + PL PROPERTY LINE 7. No vehicle or heavy machinery shall drive over the A ! a,n �° 1 O septic system unless noted as H-20 septic components. Provide Risers if necessary t 11fad to bring D-Box cover Finished grade over system= 98.00 �. i .-"- A PROPOSED CONTOUR 8. Install Tuf-Tito gas baffles or equals on all outlet tee ends. within 6" of finished grade ' e � 10' min. from Provide Risers DBOX ►4 ` 97- - - - - -97 EXISTING CONTOUR 9. An Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes. house to septic tank Provide Risers if necessary to bring INLET Pump Chamber cover Pleasa"'"'I n 10. All solid piping, tees & fittings shall be 4" diameter EXIST. House P to brio Septic tank covers to grade and outlet cover to within �" ,P '"'mot, - � -' ' DEEP TEST HOLE & Schedule 40 NSF PVC pipes with water tight joints. within o finished grade 6" of finished rode !I g , ', 0 20 40 60 80 100 120 140 S- 1/8 per root Top OF System- Elev. -96.88 mf�''t�' � v t k .' PERCOLATION TEST LOCATION 1 1. Municipal Water is Available And All Houses Within 150 Feet • ., �,' are Connected. Level for 2' 3 Maximum wr 0" Effective Depth S` l/s• pIN o 5' i R saute I' �a. •-� STOCKADE FENCE Ca aci - US G.P.M. Per foot S- CE M r N ®2F! ibndlklk6yl,LSerppay6244>1HiLTE3 f P tY 50 rn u5 M 0.83' (10 inches) • t 1/8" per foo FOR Iq -. LO EXIST, PIPE 8 1 0. , tp i t f � FROM'EXIST, FOUNDATION o n 0 11 II X/ST. 1000 GALLO 5 In 17 4" soh 40 Pv o o cv 1000 GALLON x' soh 4o PV i > to 0) PROPOSED h. rn SEPTIC TANK In o PUMP CRAM u a, . °' REV � S0NS CONCRETE FOUNDATION b II H-1 H-1 3.5' �-- 3.5' Il PREPAREDFOR . FULL FOUNDATION c y II 11 c 3' 6" OF 3/4"-11/2" STONE 2 .1 5 5 6" Or 3/4.-11/2" STONE a0 Effective Width SUBSURFACE SEWAGE DISPOSAL SYSTEM c 6" OF 3/4•-11/2' STONE 03 0 ' ` CHAMBER c Adjusted Groundwater = Elev. 90.30 NO. DATE: DEFINITION PUMP 0 of SYSTEM PROF/LE - observed Groundwater - Elev. 87.00 Bottom of'fesF W6le -1=1ev.-66 b-®-feat Hole #2 SECTION A -A #3 5 C O N N E M A RA CIRCLE PROFILE VIEW OF ADDITION TO LEACHING SYSTEM #1 2/13/06 Revisions per BOH Comments on 2/8/06 M S . J OAN S I LVE RA HYANNIS, MA 3' of 1/8' - 1/2" Washed Peostone 3/4' to 1 1/2 Washed Crushed Stone ASSESSORS MAP - 291 PARCEL - 293 Note: Remove soil down to med - coarse sand layer & replace with 35 C 0 N N E M A RA CIRCLE elev. 95.00 Estimated & replace with clean coarse sand w erc. I PVC INSTALLED INSPECTION PORT GRADE D ." PREPARED BY: ( ) P /P INSTAu.I>) AND TO BE WITHIN 8' OF GRADE ��N OF�•� /y NOTE: PUMP CHAMBER TO BE FACTORY WATERPROFFED PRIOR TO SHIPPING. rate less than or equal to 2 min./in. before & after placement HYANNIS , MA / ,4)?H N E/ • SHAY s v1111�� ' Note: All leach lines to be capped at ends w/PVC caps. ENVIRONMENTAL SERVICES, INC. 5 Units @ 6.25' = 30, �H a' 31.25' 3' ° �o P.O. BOX 627 37.25 c' TES EAST FALMOUTH, MA 02536 Effective Length SANITAM SOIL ABSORPTION SYSTEM (SAS) TEL/FAX : 508-548-0796 INFILTATROR HIGH CAPACITY CH-20 LOADING)/ GEORGE O'BRIEN (OR EQUIVALENT) Not to Scale SCALE: 1 "=20' DRAWN BY: CES DATE: NOV. 22, 2005 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10' PROJECT#SD-834 FILENAME: SD834PP.DWG SHEET 1 OF 1