HomeMy WebLinkAbout0058 CONNEMARA CIRCLE - Health 58 Connemara Circle
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Hyannis
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Town of Barnstable P#
Department of Regulatory Services
s Public Health Division
- t.uas Date
200 ain Street,Hyannis MA 02601 f �F.
Date Scheduled �V f ' UI
I
Time
Fe
e Pd.
Soil Suitability Assessment for Sewa a Disposal o� 1®:
Performed By: Witnessed By: 1
LOCATION& GENERAL INFORMATION IKS
Location Address Owner's Name i ,v ,,,%
/► ice/ Address
Assessor's Map/Parcel: 'rl , t'• -a 3 Engineer's Name .,," II
e �r CA(2e j Gh
NEW CO sue,
NMUC77ON REPAIR ✓ Telephone# 361 1(29 1(C;1 •
Land Use- 1"'-S`L�-2v. •a
Slopes.(S6) Surface Stones
Distances from: Open Water Body Z� ft Possible Wet Area2f-w ft Drinking Water We117 �ft
Drainage Way 7 29>C1 ft property U ft.
ne 2 +7^ ft Other
'
SKETCH:.(Street nGme,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proxlrriity io holes)'.
-- - --
C.a n r,,. j Zc/1
Par ont material(geologic) V`!i Depth to Bedrock
Depth'to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater 3 Z`
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth t0 5011 mottles:
Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft.
Index Well#" Reading Date: index Well level Adj,factor _ Adj,Groundwhter level
PERCOLATION TEST bete .Time..
Observation.
Hole# c�' Time at 9"
Depth of Pere
ff / Time at 6"
Start Pre-soak Time @ 1.Q j lit M t'�
�,_._._--•-� Time(9"•6") ,
End Pre-soak [ f° Z� 0 c`�
• Rate MinJlnch L Z
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable.Conservation Division at least one (1) week prior to beginning.
Q:IS EPTIC%PER CFORM.DOC-
DEEP.OBSERVATION HOLE LOG Hole# -
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
n i to c ve
-13 Z
DEEP OBSERVATION HOLE LOG. Hole# ?-
Depth from Soil Horizon Soil Texture Soil Color. Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.% el
(0 .12yIt
M-C S-'j Za G/
DEEP OBSERVATION HOLE LOG Hole.#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cnite
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulders.
i
Consistcna,%
Flood Insurance Rate-Map:
Above 500 year flood boundary No_ Yes __
Within 500 year boundary N0,
o Yes
Within 100 year flood boundary No Yes .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe ious matorial?
Certification
I certify that on ` 11 t.���(date)I•have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required tr ' ' ,expertise and experience described.in 310 CMR 15.017.
Signature Date 2 24 I
Q:\S.EP'i 0PBRCFORM.DOC
f TOWN OF BARNSTABLE
LOCATION Sf! ( O✓lVl innGl YY10 SEWAGE# 2-009 •- U`-13
VILLAGE \1,ur:in n S ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. CgU,),, e �n� �A y ag
SEPTIC TANK CAPACITY ` 00( t> £y i s C .
LEACHING FACILITY: (type) KLS (size) �a) 3 X 3 1.3 _
NO.OF BEDROOMS 3
OWNER C,-(2 L-Oa y-\PERMIT DATE: Z -Z-L- Z o ocl COMPLIANCE DATE: 3 — o(o -d g
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Nv G/ 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 e01 eCG✓,'d c S-n re a er,-w-S Lc
C
r�
P
wWvJ�W C
c -c N
a�a �OL13
No. Fee��
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes.
2pplication for disposal *pstem Construction i3ermit
Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. S g Corn r7 2 wt Ala C.'r.,1 K Owner's Name,Address,and Tel.No. j [.,/n q
Assessor's Map/Parcel 2,q 1_ Z83
Installer's Name,Address,and Tel.No.CQ feLz idA E nlaQn s e5 Designer's Name,Address,and Tel.No. Cxp we,,1.. walla s
't�•o . 3�rc '! ta3 t..l w. c✓osi
eewUe vb►q �71 —5313 for->rva(e
Type of Building:
Dwelling No.of Bedrooms J Lot Size l0!D0 O t sq.ft. Garbage Grinder( )
Other •• Type of Building S i f-,� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3O gpd Design flow provided 3 (0 5. L{ gpd
Plan Date 2-Z G -Zo 0 9 Number of sheets Revision Date
Title " (0✓1n0_0y%4fA
Size of Septic Tank 10 c o Type of S.A.S.�Z) S i p n_`2)> 14 -Z.o
Description of Soil 5,te C' 3 foil
Nature of Repairs or Alterations(Answer when applicable) r_V_s"+DX bA,, Tb o 1),-
Date last inspected: ZOp�
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 Certificate of
Compliance has been issued by this Board of He
Signed Date Z"2-7 ' 2AoS
Application Approved by �^ Date 9 7 — Z aVC1
Application Disapproved by Date'
for the following reasons
Permit No. g O-0 ( Date Issued 7— 0°�
.156
No. aO-D 9 OL13 " '. Fee �v B
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN.OF BARNSTABLE, MASSACHUSETTS Yes
fppfication for M,isposal 6pstetn (Construction i9erntit
Application for a Permit to Construct( ) Repair(;,'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components 1
Location Address or Lot No. rj"8 c Q I it 2 ,nn A a C. , I r Owner's Name,Address,and Tel.No. 1- 11 e,7 4
Assessor's Map/Parcel, Zc,
Installer's Name,Address,and Tel.No.C q Designer's Name,Address,and Tel.No. r<: ,c r.,.•� ,, �,�,,
Type of Building:-
Dwelling No.of Bedrooms Lot Size 10,C C G t sq.ft. Garbage Grinder( )
Other Type of Building 7, i .e ( ,G,> �/ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
r°"•' Design Flow(min.required) 3 3 0 gpd Design flow provided 3 (0 5. gpd
e,...- Plan Date 2- Z U - 2 0°S Number of sheets Revision Date
Title Sc o>> n e vin 9I A
Size of Septic Tank I U o�� Ls(C�.k, Type of S.A.S.�?V 14
.. Description of Soil C� � ��� 3
�--
Nature of Repairs or Alterations(Answer when applicable) o R4 �j -k,)- G-0, I y
Date last inspected: Ze)p '
fr
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
1
accordance with the provisions of Title 5 of the Environmental Code and not to place thsystem in operation until a Certificate of
Compliance has been issued by this Board of Healt
Signed Date
Application Approved by U- Date a2" az)Of
Application Disapproved by Date
for the following reasons
I '
Permit No. O'dol ON Date Issued 2 ;L 7-- 01
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
a �x. Certificate of Compliance
THIS IS TO CERTIFY,that``the On-site Sewage Disposal system Constructed( ) Repaired V ) Upgraded( )
Abandoned( )by�-Ap P.�, c,� O A t-c"d i, i < L L (.
at 5 (vi i e ✓^ C, t c_j f /><~i h has been constructed in accordance.t `
with the provisions of Title 5 and the for Disposal System Construction Permit N'o�-001- 0 3 dated 2 �7-y
Installer Gn/Iful, E er o',�-eJ < Designer �•r� ��oz ..; `: i �/L Zcs"
#bedrooms 3 Approved design flow ;.gpd
The issuance of this.pe it s�all not be construed as a guarantee that the system w':l ct-"ion Gas designed. 0
Date t 1/ Inspector
a0.0� GL(3
e �V V
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( )
System located at S t (u 4 h P vi..r✓1 v w /L 4_1 n
f
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. -
Provided:Construction must becompleted within three years of the date of this permit---
Date - e'1 / - 1 Approved by
U
Town of Barnstable
4
Regulatory Services
Thomas F. Geiler,Director
-� Public Health-.,Di
Thomas McKean,Director
200.Main.S.treet,Hyannis,.MA.02601
Office: 19.8=862_4644.
Fax: 508-79.0*6304
Installer. &;Designer Certification Focm
Sewage<:Permit# Zooq- oy 3 Assessor's Ma 1Parcel 2 2 8 3
Mc.Q l� P
Des
' � G� �✓i c Installer: G���+, �e ��,-�e�p��Se S
Address �2 lam.- Tss �e`cQ Address: D• 13crx 2�.3
Ce--•f-e ,r:Ke �"1►�- U`2l�3 Z
On. a-2?-Zo�q . ev✓,rl t. �h ��was iss ued a.permit to install a
[ ).`. (installer)
septic.<syst at JC 8� n Y►e r� �^� C��c� based on a desi ,_drawn by y
dated 0
>vy that-:the septic system referenced above was installed.substanu-a. accor
V.e desist, W1u. array include minor approved changes such as .lateral.re-Deaf.-.'-
;dtsWW box and/or septic tank. _
I.certify that ,the septic system referenced above was installed with major changes
greatex than 16' lateral relocation of the SAS or any vertical relocation af.any component
of the septic system)'but 4,-accordance with State &:Local Regulations. Plan revision or
certtied.as built by designer to follow.
OF Mq�s�c
PETER T. �Gn
WEN
TEE
te)
Civet
35109 .
es
? S'$ ) (Affix Designer. Here:)p
PLEASE RIa dJIt1�T .TO BARNSTABLE PUBLIC HEAT.TH DIVISION CEBL. - ICATE OF -
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY;THE BARNSTABLE PUBLIC HEALTH DMSION THANK YOU
Q:Health/Sepdc/Designer Certification Form 3-26-04.doc
1, TOWN OF BARNSTABLE
LO:.�ION .J �'Oit!/�F/�7f��A C�� SEWAGE #
VILLAGE H / ASSESSOR'S MAP & LOT
/A/511EC7anS
NAME&P80NE NO. 29
SEPTIC TANK CAPACITY ���TL �N Sl��C /ow
LEACHING FACILITY: (type) I (size)
NO.OF BEDROOMS
BUILDER OWNER �/A�-�dPO�' i ✓i�/lj f 5
PE-R�DATE: l D rr " d COMPLIANCE DATE:
^r �r
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furbished by
lJ �
O �
O
r
TOWN OF BARNSTABLE
COAlle-MA-A Cir(,�LOO CATION '' II SEWAGE #
VILLAGE i-iy-4,1^0 ASSESSOR'S MAP & LOT a�7l 3
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I CfrV G�
LEACHING FACILITY: (type) Q,T to X G' (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER Oy T�•a►�,.a•,
PERMITDATE: 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 leac ng facility) Feet
Furnished by ,u� FO��
W
P
I
1
Z_
TOWN OF BAMSTABLE cc
LOCAT rn
ION Con�eAr,A CI rL SEWAGE #C90;L ` W7
VILLAGE 1'IT�I A✓t^IS ASSESSOR'S MAP & LOT y
INSTALLER'S NAME&PHONE NO. CEO/GOrN IJUV► QV-s
SEPTIC TANK CAPACITY ' ' QaX CeQAN r
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS 3
BUILDER OR OWNER -TAI A,(\
PERMITDATE: yla3 0AZ-- 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 (1f any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
L
I �
I � I
I D
i
w
I
7
P
W `�
Fee f
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication'for Mopogat bpfter�]Congtruction Permit
Application for a Permit to Construct( /Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. s 4NppN�07 ,1,1C!R. Owner's Name,Address and Tel.No. ���/ fA/`' %A�
w'1AMN — .�lO . y Co/V/vs I19A.RA C .� / '9
Assessor's Map/Parcel 9 /
I tall 's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
gO mpuS a 15 os-T-W,5STBA4A_rT-
508 , yd8��6y o
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
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) 12 A C Z T 30Y
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 issu by th Board of He th.
Signed Date
Application Approved by Date F4_ 0(0� __
Application Disapproved for the following reaso
Permit No. o Date Issued
-
�_ 6p� �f •
j• s'No^^��.. Fee
z' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISIONTOWN OF BARNSTABLES MASSACHUSETTS
01ppYication-for -Migpogal &pg;tem Construction Permit
Application for a Permit to Construct( Aepair( )Upgrade( )Abandon( ) ❑Complete System" ❑Individual Components
Location Address or Lot No. �8 Qit►/U'- /f7 /Zil( Ci R. Owner's*Name,Address and Tel.No.
��N 1S CSC //y/AIU AIf
Assessor's Map/Parcel Ali / w e�^ d b 1� r
A.
Installer's Name,Address,and Tel.No. ✓ Designer's Name,Address and Tel.No.
't�urr►jJ-S JL IS 65I-U) SI a & l�0
SOL?. VOt S6yo
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
y 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) 't��'�I AC f iJ '80 Y -
Date lasf 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 th• Board of Health.
Signed Date .. ,_7
Application Approved by Date Q�
Application Disapproved for the following reaso
Permit No. Date Issued
.THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by QR,46w 0M.70<
at v has men constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the syst-m will•�nctiofi as es" nedDate L1 i 1`l o'A• Inspector_- �✓ �
� �
———————————————————————————————————————
No.,_, .
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migpogal *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( (/ Upgrade( )Abandon( )
System located at C_O/u/U f I&X RA. G:R W�y ,41i s
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 t.
Date: Approved by
TOWN OF BARNSTABLE C
LOCATION Cdn�eMArA I r4 SEWAGE #o0�oZ '
`1
' C '
ASSESSOR'S MAP & LOT 'a
VILLAGE
INSTALLER'S NAME& PHONE NO. GO/ Or1 IJUY►�1i0uS
SEPTIC TANK CAPACITY' ' ' doX Ce�JA�f
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS 3
BUILDER OR OWNER �AI A,(\
PERMIT DATE: yla3 adp1�. COMPLIANCE DATE: 41 ay (go ,
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
Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility (If any wetlands exist
Feet
within 300'feet of leaching facility)
Furnished by
;
Al - a�
1 rya- as
-Ay S y
3
i
THE 'Town of Barnstable Barnstable
Regulatory Services Department ;edca j
• SPASM
Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-8624644 Thomas F.Geder,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
i
July 14, 2008
GRP Financial
c/o Jack Creaven
167 Lovell's Lane
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 58 Connemara Circle, Hyannis, MA was.last inspected on
June 20, 2008,by Patrick M. O'Connell, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
Back up of sewage into facility or system component due to overloaded or clogged SAS
or cesspool. High stain lines in pit had been full to top,pit is in hydraulic failure.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER THE BOARD OF HEALTH
_ nc,
omas McKean, R.S., CHO
Agent of the Board of Health '
CERTIFIED MAIL#7006 2150 0002 1041 7521
f
Q:\SEPTIC\Letters Septic Inspection Failures\58 Connemara Circle.doc
c� 4cly
Commonwealth of Massachusetts
Title 5 Official Inspection Form3g
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important` A. General Information
When filling out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
� 189 Cammett Road
Company Address
Marstons Mills MA 02648 -
ren,,, City/Town State Zip Code
508-428-1779 SI 12855
Telephone Number License Number
B'. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 16.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
June 20, 2008
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the 7
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.
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for t
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes: .
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in 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
08-185 GRP Fin..doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (Cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
i
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.
08-185 GRP Fin..doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is required for 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at'a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
i
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
r ❑ ® or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
El ® 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.
08-185 GRP Fin..doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
i every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
® ❑ 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.
i 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
x
_ ❑ El Area
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.
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 o115
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
every page. Citylrown 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
El ® Pumping information was provided by the owner, occupant, or Board of Health.
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® , ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
® information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation,of distance is unacceptable) [310 CMR 15.302(5)]
I
08.185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
State Zip Code Date of Inspection
every page. City/Town
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): 1330
0 -
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
I
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ® No
I
=
Water meter readings, if available(last 2 years usage (gpd)): 70,500 gal. 96gpd
Sump pump? ❑ Yes ® No
Unknown
Last date of occupancy: Date
Commercial/Industrial Flow Conditions: .
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑. Yes,❑ No
Water meter readings, if available:
Last date of occupancy/use: Date -
Other(describe):
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
State Zip Code Date of Inspection
every page. Cityrrown
D. System Information (cont.)
General Information
Pumping Records:
None
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
- Approximate age of all components, date installed (if known) and source of information` a ,
` Unknown
Were sewage odors detected when arriving at the site? ❑ Yes ® No
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate -
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
every page. City(rown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
2'
Depth below grade: 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.):
Septic Tank (locate on site plan):
2'
Depth below grade: 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: 8.5' long x 5.2'wide- 1000 gal.
5„
" Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
25
3
¢: 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
10"
How were dimensions determined? Measured
08.185 GRP FinAoc•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
informatifor on is
required 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Liquid level was found at bottom of outlet invert, solids on top of tees indicate tank had been full to
top.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): _
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is required for 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
01.
Depth'of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Previously full to top.
r A Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
F
Alarms in working order: ❑ Yes ❑ No
08-185 GRP Fin..doc-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is required for 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump.chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: One 6x6 pit.
❑ leaching chambers number:
❑ leaching galleries number:
❑ : leaching trenches number, length:
❑ leaching fields number, dimensions:
I ❑ 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.):
High stain lines in pit indicate pit had been full to top, pit is in hydraulic failure.
08-185 GRP Fin..doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is required for 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. Citylrown State Zip Code Date of Inspection
I
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
i
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
• etc.):
08-185 GRP Fin..doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal'System Form - Not for Voluntary Assessments
58 Connemara Circle, Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate -
Owner Owner's Name
information is required for 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
every page. City/town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks..Locate all wells within 100 feet.
Locate where public water supply enters the building.
* Connemara Circle
ater
ervice
S. S. N S, S./N
S. S., r r , , , , ,
16
I •
33
39
49
53
Commonwealth of Massachusetts
Amm Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
58 Connemara Circle Hyannis MA 02601
Property Address
GRP Financial C/O Jack Creaven Remax Real Estate
Owner Owner's Name
information is 167 Lovell's Lane, Marstons Mills MA 02648 June 20, 2008
required for
every page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
I
® Check cellar
® Shallow wells
N/A
Estimated depth to ground water. feet
Please indicate all methods used-to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
T-1 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:
.f
08-185 GRP FinAoc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
�FtHE T�
P` o� Regulatory Services
BARNSMBLE, : Thomas F. Geiler, Director
r Public Health Division
Thomas McKean,Director
200 Main.Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
i
QASEPTIMisclaimer Private Septic Inspections.Doc
No. y�"' 7 Fee O O
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for Migpogal �pgtem Cottgtruction Permit
Application for a Permit to Construct( . j Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components
LocatioA Ad ssS Lo��. n�Q Owner's Name,Address and Tel.No.
AAsssessor'ss Map/Parcel
Jo r
taller's Name Address,and Tel.No. �� 'j�/,/w Designer's Name,Address and Tel.No.
` e,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building�t t 0 C►� 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 ken 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 been is is B
Signed 4 Date
Application Approved by Date 0 Ito 1c)5—
Application Disapproved for the following reasons
Permit No. o2CQ 5 --CCo J Date Issued a O5
No.O�S i !�, _Feet Q Q
THE COMMONWEALTH OF MASSACHUSETTS r
t<
Entered in computer:'
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
91ppYication for 30igogal �bpgtem Congtruction Permit
Application for a Permit to Constnict( . )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
-Locati 6 Nss Lot No. ` Owner's Name,Address and Ted o.
Assessor's Map/Parcel &v rA \ c�—
Installer's Name Address,and Tel.No. q Designer's Name,Address and Tel.No.
J
h 1^_ �
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building 1. YM O 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 Aen applicable)
Date last inspected: i
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 is is B
Signed Date 1( 0
Application Approved by Date -;j Ito 10S
Application Disapproved for the following reasons
Permit No. a00 S —0& I Date Issued 5, ) 10 65
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO T1FY, thatth- - -site Sewage Disposa System Constructed ( ) Repaired( Upgraded ( )
Abandon d( )by
at has been constructed in'accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. a ddr S o 0 dated
Installer Designer
The issuance of this permt shall not be construed as a guarantee that th s�yste r, tion as designed.
Date 3 7�G 5 Inspector\�
No. PVOS —�� •` ----•---------------------Fee '— ..__
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
"I'ligPogal *p5temCoh5truction Permit
Permission is hereby granted to onstruct( )Repair(✓)�Up qde( )Abandon( )
System located at e � `L\
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 .f7thiseDate: C�J Approved by
1
3ARCEL, `Z�3
COMMONWEALTH OF MASSACHUSETTS
z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
151
s d DEPARTMENT OF ENVIRONMENTAL PROTECTION
7Cr&E-350 MAIN STREET
WEST YARMOUTH,MA04
x= 508-775-2800 TOTABLE
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP-291 PARC-283
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner's Name: WALDRON,JAMES
Owner's Address: 11 COASTLINE DRIVE
PLYMOUTH,MA 02360
Date of Inspection NOVEMBER 14,2004
Name of Inspector:(please print) JAMES D.SEARS
Company Name: A&B Canco
Mailing Address: 350 Main Street
West Yarmouth,MA 02673
Telephone Number: 508-775-2800
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 CAM 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd
or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.
The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority.
Notes and Comments
""""This report only describes conditions at the time of inspection and under the conditions of use at that time.
This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON,JAMES
Date of Inspection: OCTOBER 14,2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: N/A
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
' B. System Conditionally Passes: ,/
J' 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 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):
pipe replaced
obstruction is removed
distribution box is.leveled or replaced
ND explain: }
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health)"
obstruction is removed
ND explain,
., Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS, MA 02601
Owner: WALDRON,JAMES
Date of Inspection: OCTOBER 14,2004
C. Further Evaluation is Required by the Board of Health:N/A
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
failing to protect public health,safety,or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 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:
Title 5 Inspection Form 6/15/2000 3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON,JANIES
Date of Inspection: OCTOBER 14,2004
D. System Failure Criteria applicable to all systems: N/A
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
J 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
i
J 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
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 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 detennine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes" or"no to each of the following:
(The following criteria apply to large systems_in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a
mapped Zone H 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 is 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.
i
Title 5 Inspection Form 6/15/2000 4
I
Page 5 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON, JAMES
Date of Inspection: OCTOBER 14,2004
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?
N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
J 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?
J 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
J 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)has been determined based on:
Yes No
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 CUR 15.302(3Xb)]
3 Title 5 Inspection Form 6/15/2000 5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON,JAMES
Date of Inspection: OCTOBER 14,2004
FLOW CONDITIONS
RESIDENTIAL V
Number of Bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 330
Number of current residents: 3
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no) NO
Last date of occupancy: PRESENT
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
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: 2002
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:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system/
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank Attach copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
N/A
Were sewage odors detected when arriving at the site(yes or no): NO
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
Title 5 Inspection Form 6/15/2000 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON, JAMES
Date of Inspection: OCTOBER 14,2004
BUILDING SEWER(locate on site plan):
Depth below grade: 8
Materials of construction: Cast iron J 40 PVC other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): J
Depth below grade: III,
Material of construction: concrete metal fiberglass polyethylene
_ other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to the bottom of outlet tee or baffle: 28"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 16"
How were dimensions determined: TAPE&PROB
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
MAIN TANK AT WORKING LEVEL,INLET TEE,OUTLET TEE.
NO SIGN OF OVER LOADING OR LEAKAGE.
GREASE TRAP(located on site plan) 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.):
Title 5 Inspection Form 6/15/2000 7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON,JAMES
Date of Inspection: OCTOBER 14,2004
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: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: OVER
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.,):
D BOX IS 16"X 16"—16"BELOW GRADE,WATER LEVEL IN BOX IS OVER INLET DUE TO PROBLEM
WITH OULET LINE TO PIT,NOT DUE TO A FAILED PIT.
PUMP CHAMBER: N/A (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.):
. I
Title 5 Inspection Form 6/15/2000 8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON, JAMES
Date of Inspection: OCTOBER 14,2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number: 1
leaching chambers,number:
leaching galleries,number
leaching trenches,number,length
leaching fields, number, dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.)
LEACHING IS ONE PRE CAST PIT—12"TO COVER 30"OF WATER IN PIT,STAIN LINE AT 32".NO SIGN
OF OVER LOADING OR SOLID CARRY OVER.
CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: N/A (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.)
q ni
Title 5 Inspection Form 6/15/2000 9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: . 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON, JAMES
Date of Inspection: OCTOBER 14,2004
SKETCH OF SEWAGE'DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
i
Ij OwfiZ
i
I i
33
O
r'
Title 5 Inspection Flcrn 10
Page.1 I of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 58 CONNEMARA CIRCLE
HYANNIS,MA 02601
Owner: WALDRON, JANIES
Date of Inspection: OCTOBER 14.2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to no groundwater 12 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observation 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:
TEST HOLE 12' NO WATER
TEST HOLE 4' BELOW BOTTOM OF PIT
/3
,poi/off
Title 5 Inspection Form 6/15/2000 t 1 .
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
F
TITLE S
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM F ECEIVED
PART A
CERTIFICATION
MAY 0 3 2002
Property Address: 58 Connemara Circle
Hyannis, MA 02601 TOWN OF T
HEALTHH D DEPEPT.
.
Owner's Name: Roy Talanian
Owner's Address: 780 Waltham Street .l
Lexington, MA 02421
Date of Inspection: April 21, 2002
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49 Map:291
Osterville,MA 02655-0049 Parcel.283
Telephone Number: (508) 862-9400 Lot. 64
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was,performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Need urther Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: April28, 2002
The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
I
Property Address: 58 Connemara Circle
Hyannis, AM
Owner: Roy Talaniaria
Date of Inspection: April 21, 2002
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
i
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will i
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain-
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
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:
3
i
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
I
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 'h day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either`yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
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)
J 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:
Yes No
✓ 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(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): 2001 -7,500 gals.; 2000-4,500 gals.
Sump Pump(yes or no): No
Last date of occupancy: Weekend use
CONEWERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None on file-per treatment plant
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: Qallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner) `
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
July 10179-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
BUILDING SEWER(locate on site plan)
Depth below grade: Approx. 24"
Materials of construction: _cast iron ✓ 40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage.
I
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping: .
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels-
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was broken and dirt was caving in. A new D-box was installed(see Permit#2002-167).
PUMP CHAMBER: None (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.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: 14pri121, 2002
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 6'x 6'with 2'stone-per design plans
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
The pit was dry. The scum line was approximately T up from the bottom. There were no signs of failure. The bottom to grade
was approximately 76".
CESSPOOLS: None (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):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Connemara Circle
Hyannis, AM
Owner: Roy Talaniana
Date of Inspection: April 21, 2002
Map:291
Parcel:283
SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 64
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.
AIL
O 31
aa- as
3 A3- YO
r33- �Fl
Aq- 5y
y SH y
10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 58 Connemara Circle
Hyannis, MA
Owner: Roy Talaniana
Date of Inspection: 4pri121, 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20'+/- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
The bottom of the leach pit to grade was approximately 76". Using the Barnstable topographic map and the Cape Cod
Commission water contours map, the maps were showing approximately 20'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system willfunction properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
I
11
r Oo .q COO V*
mm Ci
L O NJ ION SEWAGE PERMIT NO.
sp 1 u�y�v�is
VILLAGE
/�-)o v\
INSTA LLER'S NAME & ADDRESS
77 -
R UI'LDE OR OWNER
DATE PERMIT ISSUED t3 7
DATE COMPLIANCE ISSUED -71f0
/72
�� T' �
c�
c i '�
S
A
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� ��'' 9 ' `'' %
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No............� ~�-�,� A a Fmc..... .5'�...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............T.QWn...................OF...................B1rnSt able.....
ApplirFa#ion for Dhipas al Works Tomitrnrtinn rumit �
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at: ,
................--..................... Qt...64:...-------•....................--.--•--- - -------Connemara Circle
Location-Ad ress or Lot No.
Owner --Address..............................•............
Installer Address 10 000
Type of Building Size Lot........---z-----_---......Sq. feet
Dwelling—No. of Bedrooms.............................._.............Expansion Attic ( ) Garbage Grinder ( ng
pa., ' Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fix res ------------------------------------------------------------•-•--••---------------------------------------••••--------•-•-••-----•--.................
d
W Design Flow...............5. 0
............ gallons per person ey �ay. Total diily flow.._....-UP_._._..___.._..__..____.__-gal�o�s. /
WSeptic Tank—Liquid capacity......_..._:gallons Length......iS'......... Width................. Diameter................ Depth................`
x Disposal Trench—No..................... WilbT----------------- Total Length...... .j......... Total leaching area..__26 _ ft.
Seepage Pit No..................... Diameter.................... Depth below.inlet.-_ .....P g 7 .. T al leaching area..................s t.
Z Other Distribution box (X ) Dosing tank ( ) �tG� .
aPercolation Test Results Performed b�ape---C-od...Surve-y...CL1x sultantsDate_.._..a,,�/.70-------------- 1
Test Pit No. 1......2........minutes per inch Depth of Test Pit......1,2t....... Depth to ground water..none-__---____.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........
a' ---•-----•------------••-•----------------•--------------•-•-••-•---------••-•--••-------------••---•--••-...............•............ R�tk1_Qf..4q,�
O Description of Soil..0 -0-•2-.0...IcLam*.& pu1Da0i.7....---2.-0-12-_Q---me-d.--.br.mm---sand--' --------------ss90
x ock-ets.--oS...cla RENWICK yG
... B. rl
Z •-••......................................................... .....__.....------------....__..._..-----.------............................ •....................... -A
U Nature of Repairs or Alterations—Answer when applicable_ __________ ______ ____ __ ____ __________________ ----p-RAP
65#o �
------•-----------------------•----------•---------------•---•--------•---.........------.........--•- -•--••-- ------------ ....I..... ----- y,.it/ ---- --6`
ST
Agreement: �'s%NAL,ENG\
The undersigned agrees to install the aforedescribed Individual Sewage Disposal' System in accor
the provisions of TLITL L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
Sig d �'- � ....._
Date
Application Approved By..........."" (,`�/1 A.............................................. ......
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
•------------------------------------------------------------••-•----------------•---........-------•--•-------------.--•----------------------------------•----------------------•-•-----••---•-•.-•---
Date
PermitNo......................................................... Issued--• ��� 1� --._....-------------------
No.._�..._2..1. ` _ r 1: Flm..... '.°.....v
V � / nTHE COMMONWEALTH OF MASSACHUSETTS
r /-` BOARD OF HEALTH
r~ ...........TOM...................OF...................flat Barnstahle...................................... '
Appliration for DispoiiFal Works Tonitrnrtioat 1hrmit
Application-is-hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at: 4 .
................_.......................Lot...64......................................... .....................Gannemara---CoAxcle............................
Location-Address or Lot No.
----•----•--._.-..._- ? '"?........ L: ;. :r----------------------------------------
Owner r Ad�ress
WIM1
r .............�� 5-.� ......
� Installer .iy-.--Address
UType of Building Size Lot....1Q.,.0.QQ......Sq. feet
Dwelling—No. of Bedrooms.... Garbage Attic ( ) Garbage Grinder (119
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fVqures ......................................................................................................................................................
� 7
W Design Flow..............)............... Q��.gallons per person geT�day. Total dailyoffow.......330.......-....................gallons.
WSeptic Tank—Liquid'capacit _.__-._..---gallons Length__._'.......... Width__�i........... Diameter________________ llepth_ ...Q..._..
x Disposal Trench-1 o. .................... Wit V*---------------- Total Length..._.b.t.___...... Total leaching area.__2�_..........sq. ft.
Seepage Pit No..................... Diameter...................... Depth below inlet.................... To 1 leaching area_...._.7_.......sq. ft.
Z Other Distribution box (x ) Dosing tank ( ) A �t,W�
'"' Percolation Test Results Performed .. -Survey Date_....-.� �f
a 1$a e- Cod-Sbt�►e ---�0�1 �1-tra.�aLs 1 ��; ?'g...............
Test Pit No. I....,2.........minutes per inch Depth of Test Pit.....12.!....... Depth to ground water.rtme............
(i Test`Pit No. 2................minutes per inch Depth of Test Pit________-..._-____-- Depth to ground water........
F Z.. OF.!yflss�
O Description of Soil.Q.Q-.Z.0...loam-A.-SubsoLl-r---2-.-Q-1-2-.0---toed....brown---sand--- - ---------------
x RENWICK J,
V gO.CkeB ( .C13jt. -
W -- -•-••--------------•-•-•-------•-....--••--•---•-••-•-•------------•------....-••--•-•-----•--•----••-•-•--•---..................--•-.......-- ------------------------ v s4 FRRF{}AN
Nature of Repairs or Alterations—Answer when a livable... �_ _%:........................... Nn..2Jft54
U P PP -.. ��
•--------•-•------•••-------------•-•--••-----•-•-•------------•--•----------••-----.........._--.--- ---•-•.•�. ---- ...........................
-----
Agreement: /ZJ / Fss/ONAL ENG
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordan stir
the provisions of TITI is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Application Approved By...... -•--•-•... -• j'� ..-----• -----------
Date
Application Disapproved for the following reasons: ----------•------•-•-------------------------------•----•-------------------•--------------•-------••-.--•--
....-•--•----••-----.......••-••-------....-••-••-•----•----••--••-•--•-----•----••---••--•-•-•--••--•--•'---------•-••-----•••--•------ ----•---•--------------------
� ! ate
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF......................................................................................
(Irrtifiratr of ToutpliFanrr
THISJS � C�/TIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( )
by.. ..... 14•-••`-•--•-••-•---•................•-....._............----•--•-••-••-•-••••-------•--••---.............•-•----•••--........_.-•--••----••••............................._•-----•-•-
Installer
atU ? Gt '�/�' �"=" 'e' ------...... V l A ltrr i i --- ----------•-------------•----------------------------•--------------
has been installed in accordance with the provisions of TI `` of
tate Sanitary e d �►ibed in the
application for Disposal Works Construction Permit No.._ 'Z dated.... ....................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GURANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
Ins etor-•-
�/
DATE........ 7 ---------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O
4� �! HE�ALT_Mto
�'
(7- ...........OF........................... .......................................................
No - "? FEE...............!.
%pasat Vvr4,5 Tonotrurtioat rrntit
Permission is hereby granted......... ,.----•--••-••=•--•••---•--•--•-:........................................................................................
:..... i.
to Construct or Repairt(„l,).,,an Indii;idual Sewag;e�Disposal System
atNo..-•--••----------•..................................•.......---•------._........----••--------••------•-------------.
Street /��.'/ Gam...._.....
as shown on the application for Disposal Works Construction Perm Dated...........................................
040
.................. -----.....--•---------•- --...-• --- ----------
Board of Health
DATE............... -----
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS
� LEGEND N
EXISTING CONTOUR
98
__ Skoting Rink Rd
CJ �
x 100.98 EXISTING SPOT GRADE s> LOCUS
U UNDERGROUND WIRES ',-
' N -eHW-- OVERHEAD WIRES v
N 1g2'55'40 E 07 04 j ( G EXISTING GAS SERVICE War
stockadesfence -
�
108.99 � 80.00 � W EXISTING WATER SERVICE
I Street
107.57 TEST PIT
T BENCHMARK
EXISTING LEACH PIT 1 I t 1 WEST MAIN STREET MAIN
TO BE PUMPED, FILLED W/
SAND & ABANDONED --107. iQ 11' aae`
O
TP-2
1_3 _ 2 LOCUS MAP
- 5.7- NOT TO SCALE
i - 106.63 x
EXISTING SEPTIC TANK y ,� __TT_ _-�_ 2.8
(TO REMAIN) o ' _1__�- i
INV.(OUT)=105.2f(VERIFY) xl ,� - TP-1 I
�( PROPOSED S.A.S. GENERAL NOTES:
21TRENCHES N to PROVIDE INSPECTION 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
Benchmark Set "I BOARD OF HEALTH AND THE DESIGN ENGINEER.
`D DECK J PORT ON EACH TRENCH
Lt. outside Cor. Bott. Step 106.30 x N p 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
cn I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
EL.=107.58 (Assumed) N r� LOCAL RULES AND REGULATIONS.
_ BH. 106.64 1
N�07.44 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFIL•LED PRIOR
DI 1 ��j I D INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
I ---- m __1061 DESIGN ENGINEER.
N /EX/STING - PAVED 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
O HOUSE 58 DRIVEWAY FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
�# ) ENGINEER BEFORE CONSTRUCTION CONTINUES.
T.0.F.=108.46.E - +
I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
106. 7 49 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
t 106.70 x HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
� I � 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
106.92 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
�1d5.61 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
i AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
1 6 x DIRECTED BY THE APPROVING AUTHORITIES.
_� "1o6 LOT 64 3 y �� 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
-104 i G CONSTRUCTION.
I APN 291 -283 �� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
10,000 S.F.t Dc _ I IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
-/02 �� OF REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
MgSs 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
-80.00102.5 ----10 .22
____ Q �P� 9�y INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
_____
104. �k -1 O o PETER T. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
S 82'S�O W ^ pavement �• McENTEE IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
o CIVIL "'
00 edge Co of rn rn 35109
9oF fcis1��N\� PROPOSED SEPTIC SYSTEM UPGRADE PLAN
Rp, CIRCLE "` 1 58 CONNEMARA CIRCLE, HYANIS, MA
CONNEMA �°\G� Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632
OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.
GRP LOAN LLC Engineering Works, Inc. 1 =20' P.T.M. 116-09
445 HAMILTON AVENUE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
WHITE PLAINS, NY 10601 (508) 477-5313 2/26/09 P.T.M. 1 Of 2
i
i NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:103.93 3 5" DOUTLETS
,( FOR A DISTANCE OF 15' AROUND THE ) IA.
PERIMETER OF THE S.A.S. 16"
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. 15.5" �.■ �2"
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE
EXISTING F.G. EL.=107.2t F.G. EL: 107.0f F.G. EL: 106.93(MAX.) u
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. 15.5" 6„
$„ 12"
INSPECTION T p T
L 15' L 6'(MAX) PORT 2„
® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC H-10 LOADING
t0•I u 6 11.3" TO
i a"
EXISTING 48" LIQUID INVERT D-BOX
LEVEL A00 N.T.S.
GAS BAFFLE INV.=104.17 PROPOSED INV.=104.00 2 TRENCHES W/5 UNITS AT 6.25'/UNIT = 31.3'
INV.=105.2E D-BOX INV.=103.54 SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING 2 OUTLETS (MIN.)
EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN SAND
(NATIVE OR PERC SAND) UNDISTURBED 75"
NOTES: GROUND
1) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). TOP EL.=BREAKOUT EL.=103.9
2) INSTALL INLET & OUTLET TEES AS REQUIRED. INV.EL.=103.54 -SHE"
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE _
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM EL.=102.6 IIIII IIIIIII II f� 76
4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE EXISTING SUITABLE 5 7'
INVERTS PRIOR TO CONSTRUCTION. SUBGRADE MATERIAL 2.83 (TWICE THE EFFECTIVE WIDTH) 2.83' PROFILE
5' MIN. ABOVE GROUNDWATER TRENCH TRENCH
2 TRENCHES WITH 5-16" (H-20) ADS BIODIFFUSER UNITS
SEPTIC SYSTEM PROFILE BOTTOM TP EL.=95.6 - MIN. REQUIRED SEPARATION = 2 x' EFFECTIVE WIDTH (5.7')
TYPICAL SECTION � 16"
cc
NTq N.ra 11 2
SOIL LOG 34" �
DESIGN CRITERIA DATE:, FEBRUARY 24, 2009 (REF#12,476) SECTION N CAP
SOIL EVALUATOR: PETER McENTEE PE
EXISTING HEALTH AGENTGENT WITNESS: DONNA DI R.S. 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
NUMBER OF BEDROOMS: 3 BEDROOMS
SOIL TEXTURAL CLASS: CLASS I HOUSE (#58) ELEv. TP- 1 DEPTH ELEv. TP-2 DEPTH
DESIGN PERCOLATION RATE: <2 MIN/IN
T.O.F.=108.46E 106.6 0�� 1os.s o" MODEL 16" HICAP
A A _.
DAILY FLOW: 330 G.P.D. SANDY LOAM SANDY LOAM LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
5,Q' 10YR 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
DESIGN FLOW: 330 G.P.D. 8H 2 106.1 B 6" 106.1 B 6 SIDE WALL HEIGHT 11 2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
GARBAGE GRINDER: NO DECK SANDY LOAM SANDY LOAM 10YR 5/8 10YR 5/8 OVERALL HEIGHT 16"
LEACHING AREA REQUIRED: (330) = 445.9 S.F. 103.6 36" 103.6 36" OVERALL WIDTH 34" N&OM
4640 TRUEMAN BLVD
.74 N `� C1 PE" C1 13.6 CF ® HILLIARD, OHIO 43026
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY WO � �� N M-C SAND 48 M-C SAND CAPACITY (101.7 GAL) ADVANCED DPAWE SYSMMS, INC.
PROPOSED D-BOX:. 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED 2.5Y 6/4 2.5Y 6/4
_ PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 2 TRENCHES WITH 5-16" (H-20) ADS BIODIFFUSER 2'[_ IF3�N�HQ1- s8.s C2 ss" ss.s C2 96" 58 CONNEMARA CIRCLE, HYANIS, MA
UNITS IN EACH TRENCH FOR A TRENCH LENGTH OF 31.3' 5.7' _ FINE SAND FINE SAND Prepared for: Copewide Enterprises, P.O. Box 763, Centerville, MA 02632
BOTTOM AND SIDEWALL AREA: 2 g'[__ TRENCH NO_.2 __ 2.5Y 7/3 2.5Y 7/3
(GENERAL USE APPROVAL FOR 7.9 SF/LF OF BIODIFFUSER) 95.6 132" 95.6 132" Engineering by: SCALE DRAWN JOB. NO.
10 UNITS x 6.25 LF x 7.9 SF/LF = 493.75 SF PERC RATE <2 MIN/IN. ("C" HORIZONS) Engineering Works, Inc. NTS P.T.M. 116-09
DESIGN FLOW PROVIDED: 0.74 x 493.75 = 365.4 GPD S.A.S. LAYOUT NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 2/26/09 P.T.M. 2 Of 2
t/
. r Y ►.
SOIL LOG
•PEAST ONE •LOAM B FILL 12•• MAx L Q, ?A
( -�� o —moo. • •� SUB 01L any /L
i Ii1M
DIST I° ° • I ME
f� ° � I
PE
►//Jt Y 100o Box IoOo GAL.
--�
IO�MIN•I GAL. I° p � ' E 24"
I° PRECAST OR , BRow t4
�i. SEPTIC I•:. • •; t ° ; ° • I NUN
TANK BLOCK ° ° 1 5A C>
SEEPAGE
L�_ _ !. WITH
C.
°
Al PIT PoCrF'TS
I �
201 MIN. �
---••�.;,. _I
FOUNDATION i 1 %211 WASHED STONE " L
I NO WAlF_ R
ELEVATION' SKETCH --- 10' — ---I PERC. RATE: uNo>wR = mtw/%uc,.A
SCALE I 4' TEST BY : L M_f? La
TOWN INSPECTOR P. C-AF.ar-,_g
° BACKHOE OPERATOR _•=UL GAR t'EN
a
TEST MADE ON
1 ... L i
1c,
v J
1
,v.
r /
rr .r f
105
�1
( \ LOT 64
101
1ol— A \ \ I
`t
/ `a
ph I 1
iT
u• �_'1" '�".••• _... ._... �•P�( I IOC q tj (7
M f a v, `yni 1 All \J I
C.)
\0 10
0
"^ ems) /rJ ,p
�r � '•` f i i C ti f'• � �^ �••
-fit,, ,_ •.�; �'J �'\.( _ r••> I r= � ��; •�'� ,_. I � � �,., C
101
99
1
�• ( {1-� vt t L7 E �
1 �; C� Imo± _ ___ c�►= --- BA'✓ Ern
. A
ELEVATION SCHEDULE
PROPOSED SITE PLAN
I INV. AT FOUNDATION a
2. INV. INTO SEPTIC TANK i�� J SEWAGE SYSTEM DESIGN
IN
3 I NV. OUT OF SEPTIC TANK 1 i r rrt 1, E:;.iA5=;A
4 INV. INTO DISTRIBUTION BOX = 1 -' r"1 ; G r " '., Ivi c
SCALE : I ? r= E [� 197.9
S INV. OUT OF DISTRIBUTION BOX C
r:
6 INV. INTO SEEPAGE PIT CAPE COD SURVEY CONSULTANTS
7 ROUTE 132 BOTTOM OF PIT = -f7 ��:�
HYANNIS ,MASS.