HomeMy WebLinkAbout0066 CONNEMARA CIRCLE - Health F
66 Connemara Circle Hyannis
A-291-284
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TOWN OF BARNSTABLE
SEWAGE#,
VILLAGE i ASSESSOR'S MAP&PARCEL. - 2
INSTALLER' NAME&PHONE NO. ���� •
SEPTIC;TANK CAPACITY
LEACHING FACILITY:(type��/��� � �_ (size)
NO.OF BEDROOMS `
OWNER
PERMIT DATE: /n , COMPLIANCE'DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility Feet
Private Water SupplyWell and Leaching Facility f any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If ai wetlands a ist within
300 feet of leaching faciilityy) ems ' Feet
t,, FURNISHED BY l�/�0% /%UG
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No. 6 ( Fee �'V "
THE COMMONW TH OF M ACHUSETTS'' Entered in computer:
PUBLIC HEALTH DIVISION -'TO NSTABLE, MASSACHUSETTS Yes
9pplitation for ]Disposal bpotem ConstCULtion permit
Application for a Permit to Construct( ) Repair Upgrade Abandon( ) ❑Complete System � dividual Components
Local n Address or Lot No. j�h C4W11e &�� Owner's Name,Address,and Tel.No.�i�/7 QF 2l
As Map/Parcel L g
Installer's Name,Address,and.Tel.No. Z ,//�l p Designer's Name Address,and Tel.No. j
/�jn� Se9sl9� /7�/a:
Type of Building:
Dwelling No.of Bedrooms Lot Size ®,4100 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided � ,�j gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 25 -2�--'—&Wwo Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer
when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o Health.
Si Date 0
Application Approved Date
Application Disapproved by Date
for the following reasons b
Permit No. Date Issued d
_r l�
N Gg
NO
o. L J l'� Fee O "
`W Entered in computer:
THE COMMONWEALTH OF MAS'SACHU ETTS PUBLIC HEALTH DIVISION I:;TOWN-OF_-BAlkNSTABLE, MASSACHUSIk'" S Yes
applitation for b sposaf *Stem Corteitruction Perim' it T'
A �lication for a Permit to Construct
pP ( ) Repair�(ir Upgrade OAbandon.( ) ❑Complete System [t�Individual Components
Cb/�/,
Locati' Addle s or Lot No. k Owner's Name,Address,and Tel.No.l'jcii�.� QC QJI 1
it
Assess'orts�Map/Pa rc el d/ 12egl
Installer's Name,Address,and Tel No. Designer's and Tel.N
Name,Address,
�_ _>
Type of Building: v
Dwelling . .Nd.of Bedrooms Lot Size U sq.ft. Garbage Grinder( )
Other Type of Building / S' No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided Q ,�°j� gpd
; r
Plan Date _ Number of sheets Revision Date
Title
Size of Septic Tank/ � /, /,Q Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)��o.) ���� �/ ��,, n Z4
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 Certificate of
Compliance has been issued by this Board of Health. G�
Sign d Date
Application Approved&X 001 Date �� q
Application Disapproved by Date'4'
for the following reasons f f i ( Q a ,
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 Z/ (.e ✓Yrl
at / �,1'242 o 'J� 14 has been constructed in accordance
with the provision;.of Title 5 and the for Disposal System Construction Permit No. R'i—V- dated A0
Installer ��� Designer
#bedrooms �� V y Approved design flow n ��� d
gP
The issuance of this permit shall not be construed as a guarantee that the system will function as designed
Date 10 12 710 Inspector. /( l 4"'•_ Ic
- No. )Ir ' 7�7 D - ---Fee %/ --------
THE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION' BARNSTABLE,MASSACHUSETTS
�i��osaY �pste/�Construttion �errnit •
Permission is hereby granted to Construct( ) Repair(/j) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/herduty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction mu t be ompleted within three years of the date of this Permit. ;
Date Approved b,
i
Town of Barnstable
'"E Regulatory Services
Thomas F. Geller, Director
• IIAMRPABLE.
9�A Public Health Division
lFe °' Thomas NIcKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: .O Sewage Permit# L� Assessor's Map\Parcel
Designer: gNe��Installer: Z a, Q�
Address: Address:
/C as issued a permit to install a
(date) (instal ler)
septic system at �� �� based on a design drawn by
( dress) `
1!l���`�/✓� i dated
(designer}
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or am; vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow. '
yOF
R MAss9el
D ME (
(Installer's Si,natur �� '' 1140
AfGlS1E �
VV� SANITAR�P� (p�I�-- IU
DDesi�gner`s Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q: Health/Septic/Designer Certification Form 3-164doc
ti
' t
.<L'\ Commonwealth of Massachusetts
Title 5" Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Hyannis MA 02601 8-5-10
required for every y ,
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form.Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town _ State Zip Code
508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection.The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
0 0
❑ Passes ❑ Conditionally Passes ® Fails E
❑ Needs Further Eval lion by the Local Approving Authority
8-5-10 y
Inspector's Signature Date Fv a
The system inspector shall submit a copy of this inspection report to the Approving Auth4f (Beard
of Health or DEP)within 30 days of completing this inspection. If the system is a shared syster6%r
has a design flow.of 10,000 gpd or greater,-the inspector and the system owner shall.submit the
report to the appropriate regional.office of the DEP.The original should be sent to the system.owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
zt5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposa ystem•Page 1 v
r
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I 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.
I
❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
* A metal septic tank will°pass inspection if it is structurally sound,:not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
t5insp official document-03/08 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
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that,the,system is not function ing.in.a mannerwhich will protect public health,
,safety andthe,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.
- u ❑, The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
- t5insp official document-03108 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
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
i
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
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
t5insp official document•03108 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
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):.
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
❑ ❑' Area—IWPA) or a mapped Zone 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.
t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
I
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CM 15.302(5)]
t5insp official document•03108 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
66 Connemara Cir
Property Address ,
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10 .
page. CitytTown state Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry'on a separate sewage system? [if yes separate inspection required] ❑ .Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 6-2010
Date
Commerciallindustrial 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):
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
.f � .
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
'c
D. System Information (cent.)
General Information
Pumping Records:
Source of information: N/A -
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
i
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other (describe}: '
Approximate age of all components, date installed (if known) and source of information:
1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
S
6
1 �I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 36"
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Good condition.
Septic Tank (locate on site plan):
Depth below grade: 30"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: 1500 gal
Sludge depth: .
16"
Distance from top of sludge to.bottom of outlet tee or baffle
16"
Scum thickness 4'. ;
Distance from.top.of scum to.top.of outlet tee or baffle 4
' Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? Tape
, t5insp official tlocument•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
µ 66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
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.):
Tank is in good condition with baffles installed and no sign of leakage.
I
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: j
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene other(explain): !
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal i
pe g posal System•Page 10 of 15 �
0
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes . ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box had clear signs of back-up from leach field with water level above inlet invert.
Pump Chamber(locate on site plan): '
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 3-flodiffusers
❑ 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.):
Flo-diffusers have clear signs of failure with water level above inlet invert.
t5insp official document•03/08 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
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448),
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
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.
G I
ED
lid
f=�-33' 1 ,F3sEEL=
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Cir
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 8-5-10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10,
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: pate
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
USGS and town maps show groundwater at greater than 10'.
i
- t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
. I
Town of JBansta.ble. P# � 3°��
Department of Regulatory Services
• Public health Division Date
�,tnrrarest$. = I
iss¢ tee$ 200 Main Street,Hyannis MA 02601
i
Date Scheduled ;w I Timed Fee Pd. 1 U v —
I
Soil Suitability Assessment for Sewage isposal
Dal��� . �� g�S_
Performed By: ! Witnessed By:
i
LOCATION & GENERAL INFORMATION n
Location Address Owner's NameO �11Q T /47 (� /T S$Qe.,
✓1✓i 1 S '� I Address
c •D
Assessor's Map/P rcel: 2-91 /Z�Ll I Engineer's'NameA r\ren M A"u
NEW CONSIRUtiON REPAIR x Telephone# S O a 3t 2-�- 21 Z-L
Land Use t��� a-` Slopes(go) i � ' Surface Stones
Distances from: Open Water Body > zoo ft Possible Wet Area / �-6 ft Drinking Water Well ft
I
Drainage Way S y ft Property Linc 7 ft Other
ft
SKETCH:(street name,dimcnsiods'of lo4 exact locations of test holes&perc tests,locate wetlands in proximity to holes)
• � n � N V
)l 00'9Zr
1
Ln /
I cIE
l^ 0z
o LO
J LL M Lj
zo )i I N , to ' /O
d (D O (n L1J O I I I �= o
mml O X h ID '
O > O�w -�
n Li i� r / yl�l w
II %p,ti
J 1 O(V I O
/ \
f �' v
Q PAVED DRIVE WA YI
1) 00'9Zt �'.m rl. n•' n d• '
nro n „
I
l ( (L� 9 ti `W C>�S Vl ` Depth to Bedrock
Parent material(geologic) I
. I in from Plt Pace N 1 A
Depth to Groundwator. Standing Water in Hole: Wee I P g
Estimated Seasonal Mgh Groundwater N I'
DTE ATION FOR SEASONAL HIGH WATER TABLE
Method Used: I. . • ln.
in. Depth td Soil mottles:
Depth Observed standing in obs.hole: Adjustmen
Groundwater t
I in Oid
Depth toiweeping from side of obs.hole: ; _ A ,f.undw ter ctor r,� Adj.(Iroundwater Lavd.,.,,e.
Index Well# Reading Date Index Well levy -
I
PERCOLATION TEST . Date�--.�. Time
Observation I I Time at 9" --
Hole# i
Time at 6"
Depth of Perc
Zt t — -
Time(9"-6")
Start Pre-soak Time.0 t 3
End Pre-soak
at M►Nw,_,�, I
'Rate Minllnch Additional Testing Needed(YIN)
Site Suitability Assessment: Site Passed
/l Site Failed;
•
Observation Hole Data To Be Completed on Back
Original: Public l:e�lth Division —
***If percolafii6n test is to be conducted within 100' of wetland,be un must first notify the
Barnstable Conservation Division at least one (1) week prior to g
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
LAM jyA v) Olt,
DEEP OBSERVATION HOLE LOG Hole# Y
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
f!� Z
z '1-33" A: L,aaAi nc N 0-411 A/
33
''SS'' Lbaaqh cal -616
Mcct. wn 6`
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Ether
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consisten ra I
.r
I
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within]00 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perviou material exist.in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 019 (date)I have passed the soil evaluator examination approved by the
Departmen Env' nmental Protection and that the above analysis was performed by me consistent with
the required trat i g,experti e,an ex a 'ence described in 310 CMR 15.017.
Signature �►//� Al Date
I
I
Q:\.SEPTIC\PERCFORM.DOC
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
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:When filling out A. General Information
-
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor.-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC
Company Name
r� P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and thatthe
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 15.340of
Title 5(310 CMR 15.000).The system:
fV CJ'
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
r ;
3/13/2007
Inspe tor's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design.flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
66 connemara cir.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name ,
information is Hyannis Ma. 02601 3/13/2007
required for y '
every page. City/Town State Zip Code Date of Inspection
•
B. Certification (cont.)
Inspection Summary: Check.A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described f
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are .
indicated below.
Comments:
The septic system is in proper working order at the present time.
• - I a J
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. . w
❑ 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'.
V t
"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
pa"ss inspection if(with approval of Board of Health):
F ❑ broken pipe(s)are replaced '
❑ obstruction is removed #,
• 66 connemara cir.•08/06 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
66 Connemara Circle
Property Address =
Donald Dunmeyer
Owner
Owner's Name c -
information is H
required for y annis Ma. 02601 3/13/2007
'
every page. Cityrrown State Zip Code Date of Inspection
r
B.. Certification (cont.)
B) System Conditionally Passes (cont.): r
❑ 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): j
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain: S.
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) -
t determines that the system is functioning in a manner that protects the public health,
` ' t safety,and•environment: T
❑' The system has aseptic 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.
1
66 connemara cir.-08/06 + 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
M 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
.clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available'volume is less
than 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.
66 connemara cir.-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
66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code `Date of Inspection
B. Certification (cont.) "
r
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy.is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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.•
r
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of"10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
El 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.
66 connemara cir.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done.,You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
El ® 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
El ® this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility ordwelling 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.
® 0 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)]
/
66 connemara cir.•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
M 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is Hyannis Ma. 02601 3/13/2007
required for H y ".
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design):• 3 Number of bedrooms (actual): 3
1. �. R _
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? . ® Yes El No
t -
Seasonal use? ❑ Yes ❑ No
2005:115,500
Water meter readings, if available (last 2 years usage (gpd)): 2006:92,250 1 r
Sump plump? ❑ 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
1 Other(describe):. ,
66 connemara cir.•08/06. r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
41 V
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for y H annis Ma. 02601 3/13/2007
i .
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Capewide Enterprises `
a
Was system pumped as part of the inspection? ® Yes ❑ No-
1500
If yes, volume pumped:
gallons
How was quantity pumped determined? measured
Reason for pumping: Maintenance
Type of System:
® Septic tank, distribution box, soil absorption system - -
❑ Single cesspool
❑ Overflow cesspool
r
❑ 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)
El Tight tank. Attach a copy of the DEP approval.
/
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
f 10 years+
1 Were sewage'odors detected when arriving at-the site? ❑ Yes ® No T
66 connemara cir.-08/06 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 15"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction 10'+line: feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
1,
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: 10'6"x5'10"x57"
Sludge depth: none
Distance from top of sludge to bottom of outlet tee or baffle na
Scum thickness none
Distance from top of scum to top of outlet tee or baffle na
Distance from bottom of scum to bottom of outlet tee or baffle na
How were dimensions determined? tank pumped at inspection
66 connemara cir.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 66 Connemara Circle
Property Address -
Donald Dunmeyer {
Owner Owner's Name ,
information is H required for is Ma. 02,601 3/13/2007
y ann •
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendatiors, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears structurally sound.
Grease Trap (locate on site plan):
Depth below grade: . feet
Material of construction:
❑ concrete J❑ metal - ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness "
Distance from top of scum to top of outlet tee'or baffle t
i
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):
r
,
66 Connemara cir.-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1.
�M 66 Connemara Circle '
Property Address
Donald Dunmeyer
Owner Owner's Name `
information is required for Hyannis Ma. 02601 3/13/2007
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: •- r gallons
Design Flow: -
• gallons per day 1
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.):
J
... _ r R
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes' ❑ No
Distribution Box(if present must be opened) (locate on site plan):
- no j
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.):
Box is level and has two Iaterals.No evidence of solids carryover.No signs of leakage into or out of '
box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ 'Yes ❑ No
Alarms in working order: _ �: ❑ Yes ❑ No
66 connemara cir.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Circle
.Property Address
Donald Dunmeyer
Owner Owner's Name,
information is required for Hyannis Ma. 02601 3/13/2007
every page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® 'leaching chambers number:
3-flowdiffusors
❑ 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.):
Sandy soil.No signs of hydraulic failure.Vegetation appears normal.
66 connemara cir.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth=top of liquid to inlet invert
Depth of solids layer
t
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, j
etc.):
66 Connemara cir.-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
M 66 Connemara Circle
Property Address
Donald Dunmeyer.
Owner Owner's,Name
information is required for Hyannis Ma. 02601 3/13/2007
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.
66 connemara cir.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
66 Connemara Circle
Property Address
Donald Dunmeyer
Owner Owner's Name
information is required for Hyannis Ma. 02601 3/13/2007
every page. City/Town State Zip Code Date of Inspection f
I
D. System Information) (cont.)
Site Exam: II
® Check Slope
Z Surface water
® Check cellar
❑ Shallow-wells
Estimated depth to ground water: 40'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
as-built card
❑ Checked with local excavators, installers- (attach_documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used:Gaherty& Miller model 12/16/94 ground water elevations.Used:USGS observation well data
June 1992.Used:Technical bulletion 92-000-01-plate#2 annual ranges of ground water elevations:
66 connemara cir.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
t
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 66 Connemara Circle
Hyannis, MA 02601
Owner's Name: Madelyn Sheltra
Owner's Address: Same FRECEIVED
Date of Inspection: August 20, 2001
UL
J2 9 2 001
Name of Inspector:(Please Print) James M. Ford TOWN.,OF BARNSTABLE
Company Name: James M. Ford HEALTH DEPT.
Mailing Address`:' P.O.Box 49 Map:29
Osterville,MA 02655-0049 Parcel.284
Telephone:Number: (508) 862-9400
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
Con . ' nally Passes
N F er Evaluation by the Local Approving Authority
rail
Inspector's Signature: Date: August 22, 2001
The system inspector shall sub i 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)
Property Address: 66 Connemara Circle .
Hyannis, AM
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001
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
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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A '
CERTIFICATION (continued)
Property Address: 66 Connemara Circle _T _�_�_�,^,r�,•; .` r t^ �., ,��, .a�tr :
Hyannis. MA
Owner: Madelyn Sheltra 1'141
Date of Inspection: August 20, 2001
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
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:`
7 A
_ 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
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 66 Connemara Circle
Hyannis, MA
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day low
✓ 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 pricy 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 privare 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 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.
4
i
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
„ . PART B
,,CHECKLIST
Property Address: 66 Connemara Circle
Hyannis, MA
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001 '
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected;for signsaof sewage back up? ;(Owner not home) J
£ .fit t '_ .A£� i �..�J i: c ' '�� •. .` i.. , ` ~ "_ _
;.,, ✓ ;i Was the srteamspected signs for of break out ? ,
[i ...j'. ''.f f V. .i.'S ;:•J,SI+"` . e i..Ga n...r Ste• air
> ✓. 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)].
- +:..:1 .J+ ,•`ta-q a`.„ t .P:.L ti i. ...t. - .'•I . . rY,a1 s_ti;...:+LI;a$^. �:JJJ:a S? a£ ,. .. ._..=� •" •-_•. �._..r
r
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
"SYSTEM INFORMATION
Property Address: 66 Connemara Circle
Hyannis, AM
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder(yes or no): No
Is laundry on a separ to 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)): 212001 -129,000 gals.;2/2000- 147,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(geats/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: Never pumped-per owner
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 a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
August 14, 1996-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: 66 Connemara Circle _
Hyannis, AM
Owner: Madelyn Sheltra .
Date of Inspection: August 20, 2001
BUILDING SEWER(locate on site plan)
Depth below grade:
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)
i
Depth below grade: 24"
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: 1500 gal.
Sludge depth: 6"
Distance from top of sludge to bottom of outlet tee or baffle.: —
Scum thickness: 15"+
Distance from top of scum to top of outlet tee or baffle: —
Distance from bottom of scum to bottom of outlet tee or baffle: —
How were dimensions determined: 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.):
Solids were up to the top of the cover, above both tees. Recommend pumping as soon as possible.
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 baffler
Distance from bottom of scum to bottom of outlet tee or baffle: ,
Date of last pumping: - r
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 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM-INFORMATION (continued)
Property Address: 66 Connemara Circle
Hyannis, MA
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001
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 level. There were no signs of leakage or solids. There were no signs of failure or backup from the leach field.
one (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: 66 Connemara Circle
Hyannis, MA
Owner: Madelyn Sheltra
Date of Inspection: August 20, 2001
SOIL ABSORPTION SYSTEM(SAS): ✓' (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 3-flow diffusors with 3'stone(per as built card)
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 flow diffusors were located,-but not dull up: There.were no signs of-failure in the D-box: The bottom-to grade was
approximately S'. The site was approximately 8-10'higher than street elevation.
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: r.
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication 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: 66 Connemara Circle
Hyannis, AM
Owner: Madelyn Sheltra
Date of Inspection: August 20. 2001
Map:291
Parcel.284
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
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A9- 33
5H- M, - 3
AS- 1-1 S
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4y
i
10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
.,. I PART C
SYSTEM:INFORMATION (continued)
Property Address: 66 Connemara Circle
Hyannis, AM
Owner: Madelyn Sheltra
Date of Inspection: August 20,.2001 '
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
y '
Estimated depth to ground water 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&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: ; r k -
The bottom of the flow diffusors to grade was approximately 5. Using the Barnstable topographic map and the�Cape Cod
Commission water contours map, the maps were showing approximately 17'+/-to groundwater at this site. Using the Cape Cod
Commission Technical Bulletin(A1 W 230, Zone D, 7/01). the high groundwater adjustment for this site was 5.2'. '
_ - 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 will function 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.
F
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TOWN OF BARNSTABLE BAR-W Na 3963
Ordinance or Regulation
WARNING NOTICE
Name of Of fender/Manager MM-1 A CA_S T E LL/ dob
of Offender (06 00MV E/YI/¢RA ahet',JA MV/MB Reg.#
Village./State/Zip /`/WAAIAIK &A SS#
Name 380 am/ ml on l/—� / 20 G:
Business Address p �l/�v/��
' 24
Signature of Edforcing Of, cer
Village/State/Zip
Location of offense 6(a COANtMAKA C/, aE_ f�6ALTN .,0E,GT.
Enforcing Dept/Division
OffenseVI0LA'n6tJ or- l\uSAAUr1' C,ISAITR.N RFf, I RU AIR 14;44
Facts TAjt>Frt Pl1t _ 61: RV6815tj /Ta_A_5 S� 11nE00 PtV_y I AJ F20/JT of
This will will serve only -as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
TOWN OF BARNSTABLE
,'- BAR-W
Ordinance or Regulation
WARNIFIG SNOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
>;. .;l' ����; �i�%'�?S�;G; '��G'�'-'
Village/State/Zip
Business Name Si am/pm, on 20
Business Address
Signature of Enforcing Officer
Village/State/Zip
Location of Offense ''- i
L JJ Enforcing Dept/Division
0ffense'';r
Facts
Thi ��-. /C1.,, i, /gin,, ✓ � 7 ii[�\ 1) J//�"�a�% �-
s will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
TOWN OF BARNSTABLE BAR-
Ordinance or Regulation
L^ARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip / %_' % til
Business Name " am/pm; on J'( 20
Business Address
"Signature of Enforcing Officer
Village/State/Zip
Location of Offense �e
Enforcing Dept/Division
Offense'V' z-r; 1 l y H Ei. '� �� 7� �i ��)i
Facts
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GULD-ENFORCING DEPT.
Health Complaints
05-Nov-02
Time: 11:55:00 AM Date: 11/1/1902 Complaint Number: 3803
Referred To: DAVID MCKEARNEY Taken By: JOAN AGOSTINELLI
Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 66 Street: CONNEMARA CIRCLE
Village: HYANNIS Assessors Map_Parcel: 291284
Complaint Description: GARBAGE AND TRASH BEING LOADED
INTO TRAILER ON PROPERTY.
UNSANITARY CONDITIONS. ANIMALS ARE
PICKING AT THE TRASH.
i
Actions Taken/Results: Investigation of above complaint on 11-01-02.
Small utility trailer in front of residence at 66
Connemara Circle loaded with bagged trash
and assorted debris. Several trash bags torn
open with trash spilling out. Notice.to abate
issued on 11-01-02 at 3:40pm. Owners given
until 11-04 to remove and dispose of properly,
or non-criminal citiation will be issued. Re-
inspection of property conducted on 11-04-02.
All trash/rubbish removed. Voluntary
compliance achieved.
Investigation Date: 11/1/02 Investigation Time: 3:40:00 PM
1
_ ' TOWN OF BARNSTABLE
c
LsCAT:- , . SEWAGE #
VILLAGE ASSESSOR'S MAP& LOT °'RQ
` INSTALLER'S NAME&PHONE NO: A
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type). '(size) .JOK30 .;
NO.OF BEDROOMS
OR OWNER
PERMTTDATE:' t� COMPLIANCE DATE:
Separation Distance Between the:
Maximum-Adjusted Groundwater Table and Bottom of Leaching Facility NA Feet
Private Water Supply Well and Leaching Facility (If any wells exist '
on site or within 200 feet of leaching facility) Nm''. Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) LX Feet
Furnished by
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C-s = �
�.:�= 30 '
t
c � .�
,�.:-�.
TOWN OF BARNSTA.BILE
l�� / /'
_� ''1'lON ( O dt 61 Ll Y1'1 ea`�d�a � (tee-5/' SEWAGE # .
a GE 67S/�r411 i,5 ASSESSOR'S MAP& LOT
[N TktLER:S NAME&PHONE NO.
i EPTIC TANK-CAPACITY - l` —00 /�
"
EACkMG.F,A.CILITY: (type) Flo I irticr.5-e/1 (size)
rO.OF'BEDROOMS.._s�..�.
ULDER OR OWNER --
ERMITDA7E: COMPLIANCE✓ DATE:
e�aratinn Distuce Between the:
laximum Adjusted.Groundwater"fable to the Bottom of beaching Facility eet
Yivate Water Supply Well and Leaching Facility (I'any wells exist
on site or witWn 200 feet of leaching facility)
Age of Wetland and aclung T nd acility(If any wetla disc
within 300 feet a !caching f .Feet
U
C;
s,l .
s z � TOWN OF BARNSTABLE
LOCATION Co'AAC ► Arq tit- SEWAGE # 9
,If I AGE N�l/a/1✓1tS ASSESSOR'S MAP & LOTac1 r a�8 y
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY Sn 6,4)
LEACHING FACILITY: (type) 3 ��OW 1�,�F = (size) 3 STO>�
NO. OF BEDROOMS 3 I
BUILDER OR-OWNER I Steel 6
PERMITDATE: COMPLIANCE DATE: !Y b
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of eaching facility) Feet
Fuetiished by S )L Z�S/lw110r1 —� 1'O�C
d
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s
L
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cd c� c�1 �•n T T
ASSESSORS MAP N
r No. 9'a�, C- FAKEL Na Fee Z499 ddt
JHE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS
2pplication for Miq onl * 5tem Construction Permit
Application is hereby made for a Permit to Construct( ) Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. h n"e- Owner's Name,Address and Tel.No.
0440A OL Cis �, �1 Sffe/_7'If
Installer's e,Add ss,aj3d 1.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building S'E11 I �l No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 O gallons per day. Calculated daily flow gallons.
Plan Date O g6 Number of sheets �o Revision Date
Title AA
Description of Soil �`�ti c�/1�'lcly L.o*im 0L 3oi' 4o.-o-rtit ,T otgol
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Tit a En ' ode and not to place the system in operation until a Certifi-
cate of Compliance has been issued b is o f H �}
Signed Date 9 ` `►
Application Approved by
Application Disapproved for the following reasons
Permit No. Date Issued �� �`—'�
9��a6� Q
No. � �SI f� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppCtcation for �Dioonl *p5tem Cottgtructiou Permit
Application is hereby made for a Permit to Construct( or Repair( )an On-site Sewage Disposal System at:
E
1 Location Address or Lot No. 4 Owner's Name,Address and Tel.No.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
c f�1 C P �t�•+cz4
WOO
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building .S �I. No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 2 10 gallons per day. Calculated daily flow 3 50 gallons.
Plan Date(o/10&6 Number of sheets Revision Date
Title
Description of Soil u (-&*#I 1 a 4 w H
Nature of Repairs or Alterations(Answer when ap� able)
Date last inspected: •/1
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 Titl a Enviromn—entaLCode and not to place the system in operation until a Certifi-
cate of Compliance has been issued b his Bo f HH a . t
Signed \ Date v
Application Approved by
Application Disapproved for the following reasons
i
.C� Date Issued I _Permit No. � �---
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
Certificate of Compliance
THIS IS TO RTIFY,th -site Sewage Dispasal System installed( �qrrepaired/replaced( )on
4P
by L for fyJ i �r_.r✓ ,�'� I 7',G :
as .rt k as been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ,►l ,;'
Use of this system is conditioned on compliance with the provisions set forth below:
No. ✓ Fee !
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mi5po5ol *p5tem Construction Permit
Permission is here granted to
to constru (M repair( )an On-site Sewage Syste ocated at
or
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.
All construction must be completed within two years of the date below.
Date: � Approved b
S
r/ SH�-G-7-s Al
517-,67 PLC
IACATION • •!` �!9.N�ce! �a�rz�yst�4�J ,�r�A'"A
SCALE =?O. DATE . p ;..._
. • •, .. . 70.fL6 LOWAr
PLAN IiEFEnENCE ����lG LoT, ., . �' E. . L N
o. MOO
IS1Ea��
s
Lo T 471<
seQ
/ : 1
Z.p S % 1
o
6ZGsy, TDP oG Q
/ ` Fou�vD.¢ / ",.fie 26
apt( ► '`� / Zo
000
7f--VrAktCv� L
1 lot
/00
—� °oo— — 8
/oSJq
TOP OF FOUNDATION
�•' CONCRETE COVERS
": 4"CAST
�; OR SCHEDULE 40 4"SCHEDULE 40 P.V.C. (ONLY) 9'MIN .P.V.C.PIPE MIN. PIPE-MIN. 36" MAX.
�;; PITCH 1/4"PER.FT. PITCH 1/4"PER.FT. } LEACHING TRENCH (......REOUIRED)
1/8"-12 WASHEDP.3 STONE L'
INV
EL- 5
-ACe- SEPTIC TANK I DIST. IN BITS
ELg.......... BOX EL'9,,;,,. 3/4 -II/2"WASHED STON)= /t
INVERT
' EL..`Z8:8✓=. �' �� .. GAL.. INV EL. INVERT FLOWDIFFUSORS INVERT
6"CRUSHED STONE EL97.9... ( REQ.
O
or
PROFI LE OF T
!, .•.!. F- $7p4 GROUND WATER TABLE
SOIL LOG SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
'`�' ?B!y TItaE ../�.% '� NO SCALE LEACH I NG TRENCH .
DATE .. NO SCALE-
TEST HOLE 1 TEST HOLE 2
ELEV. XA?3-$}- . . ELEV. ioo-Lo .. DESIGN DATA :
9. MiN. I/8"-I/2" �
--oy'c-41.,3 -117 y NUtdBER OF BEDROOMS .-3. WS'r.ED 36 MAX.
SEr�-iY4T.Z 4�o s' .D,b+j STJNE M
7n O s/a�oY/ s 8 �e T L
TOTAL ESTIMATED FLOW ..'3'30. . . .. GALLONS/DAY .f-;��• '�•' ' • �:` •�� ••� •- 2 r
Y
Z2z•o
Q yy qNa �oo_y 80 10,M LEACHING AREA .3 .04... SQ.F T./TRENCH/G PD
Z9" yet %6 3 e :rf� r
L SIDE LEACHING AREA . . �60.0o SQ.FT./TRENCH /i8�
tZ /ay.4z GL.97,9¢ / 3/4 II/2'WASH
C,P.D.
C GARBAGE DISPOSAL .�P!y4�..(50% AREA INCREASE) - STONE
Lei ioy'c 714 C �►+�� TOTAL LEACHING AREA Orb• 00.: SQ.FT.
JAW i�y'e PERCOLATION RATE !P"! ?�`nN./PER.INCH
C Z' r LEACHING AREA PER PERCOLATION RATE'rM!�SO.FT/G,pv Nayts�vCov�s
S.r..ro
r ♦o y J YK 7/, GROUND WATER TABLE
�1.9o.Lo APPROVED .. . . . . . . . . . . . .. BOARD OF HEALTH
.•.WATER ENCOUNTERED DATE ..... ..
f
WITNESSED BY , AGENT OR• INSPECTOR • • ;-h /EDYJARD
. . !�! .. . . . .. . . . . . . . . .S . . t E. v 'C
L�• B BOARD OF HEALTH Lo7 #4C IL
S T.50!V•!'�r.�LL . . ENGINEER �L c4l""e`lllAn � C//Za/E $ 00
- crstt��°
�'Fr PETITIONER
_ s At.IC1A RD.
' r LEGEND ? �
�-- 39�p f�- SHED
f^' PROPOSED CONTOUR s
® PROPOSED SPOT GRADE;
EXISTING CONTOUR
L_O T 65 + 96.52 EXISTING SPOT GRADE � SITE BRISTOL AVE.
W— EXISTING WATER SERVICE ku t ;:
AREA — 10000 sf +— TEST PIT
LOCUS MAP N.T.S.
w w I GENERAL NOTES:
6 EXISTING 0
/ 0 1. ALL CHANCES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
I N L6 BOARD OF HEALTH AND THE DESIGN ENGINEER.
D WE L� N 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
D N OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
T F NOP OF LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
EL = 39.72+ 38 — 310 CMR 15.405 (1) (B):
�F d1q 1) A 3.00 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE
39 �Q��� sJ'�� 6.00 FT BELOW GRADE VS REQ'D 3 Fr. (H20/VENT PROVIDED)
?� N •yG 3 TOEI INSPECTION ON DISPOSALAGE AND AP APPROVAL BY BYTE BOARD OF SHALL NOT BE CHEALTEH AND THE
N EFL✓ DESIGN ENGINEER.
EX15T. 1 ,50OG — " NO. 1140 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
37 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
5EPTIC TANK 381, rt ENGINEER BEFORE CONSTRUCTION CONTINUES.
6 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
M.P.Mp vie, S01 TAR�a 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
37— ➢ � o / . 35 lc 4 �G D HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
Existing leaching (i 4 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
w _ nt 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
r e r 13 It —34 ! TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
3 0 I 1b 1 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
I -
i%:�•., / THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
I TH-2 T —1 ' v 1i .v CONSTRUCTION.
35, fr1 I ;—e 10. Existing leaching to be pumped,crushed and removed per Title 5.
FILL WITH CLEANMEDIUM SAND.
�D 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
3 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
---SO.0 ft. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING
14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) .
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
' FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
EDGEOF A EM \`
17. PROPERTY IS NOT IN ZONE II OR NITROGEN SENSITIVE AREA.
BENCH MAR CONNEMARI. /%
18. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION.
TOP OF SHUTOFF CAP ELEVATION = 33. 19CIRCLE
. 4 -
BARNSTABLE GIS _DATUM PROPOSED SEPTIC SYSTEM UPGRADE PLAN
66 CONNEMARA CIRCLE, HYANNIS, MA
MAP.291 Prepared for: Mike Dedecko
LOT.' 284 Engineering by:
.SURVEY REFERENCE:
LCP.' C 182997 DARREN M.MEYER,R.S. ECo Surveying sc DRAWN TeCb En v. 11E 20' D M M
PLAN OF LAND BY WHITNEY & BASSETT ENG. PD BOX 961
EASTSANDWICH,MA02537 (508) 364-0894 DATE: CHECKED SHEET N0.
DATED: OCTOBER 1956 508-362-2922 10/06/10 OMM 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:31.0
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S_ I
T.O.F. EL.=39.72 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER �� OF M4j,
t� OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G.
F.G. EL.=38.Ot F.G. EL.=37.5t
F.G. EL: 37.0t F.G.' EL: 37.0(MAX:) VENT � AR �E
lNo. 1140
L - 10-± 9" MIN COVER/ L = 20' TEE L = 10'(MAX INSTALL TWO INSPECTION PORTS (MIN.) A 0
EG/SfE® S=1% (MIN.) 36" MAX COVER ® Sm1% (MIN.) ® S=1% (MIN.) + NITAR�a�
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC
10" e 11.2" TO
14" INVERT l
INV.=32.92 48" LIQUID tNV.=32.67 ��6 b
IEVEL PROPOSED
OAS BAFFLE INV.=31.05 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25'/ROW
D-BOX SOIL ABSORPTION SYSTEM (PROFILE
INV.=31.25 �_ INV.=30.61
EXISTING 1,500 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75"
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �':' : :j: .;:..•,:: :
PIPE INVERTS PRIOR TO CONSTRUCTION
BREAKOUT=TOP ELEV.=31.0 � •
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 30.61 *all
GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 29.67
INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE
310 CMR 15.221(2) 2.83' MATERIAL
3) REPLACE EXISTING 1,500 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' 11.32 1 76"
TANK WITH 1500 GALLON SEPTIC TANK (7.67' PROVIDED) USE 4 ROWS OF 4-16" HIGH CAPACITY (H20)
IF FAILED, DAMAGED, OR UNDERSIZED. ADJ. GROUNDWATER EL.=22.0 - ADS BIODIFFUSER UNITS-NO STONE PROFILE
4) INSTALL INLET & OUTLET TEES AS REQUIRED -
5) PLACE SANITARY TEE IN D-BOX AS SHOWN.
SEPTIC SYSTEM PROFILE TYPICAL SECTION AN
1s°
N.T.S. e.rs 11
DESIGN CRITERIA SOIL LOG P#: 13082 t N -i j ()
NUMBER OF BEDROOMS: 3 BEDROOMS DATE: OCTOBER 5, 2010 h�34" �
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP
WITNESS: DAVE STANTON, BARNS. BOH
DESIGN PERCOLATION RATE: <2 MIN/IN TP-2 16'�" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
Elev. TP-1 Depth Elev. Depth DAILY FLOW: 330 G.P.D. �- �
DESIGN FLOW: 330 G.P.D. 35.25 FILL 0" 35.75 FILL 0"
MODEL 16" HICAP
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 33.17 22" 33.58 23"
PROPOSED SEPTIC TANK: USE EXISTING 1,500 GALLON CAPACITY A LOAMY SAND A LOAMY SAND LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
10YR 4/1 10YR 4/1 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
.LEACHING AREA REQUIRED: (330) = 445.94 S.F. 32.42 31" 32.7 33" SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
•74 B LOAMY SAND B LOAMY SAND OVERALL HEIGHT 16"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) 10YR 6/6 10YR 6/6 OVERALL WIDTH 34" 4640 TRUEMAN BLVD
PRIMARY S.A.S. 30.67 52" 30•92 55" CAPACITY 13.6 CF HILLIARD, OHIO 43026
USE 4 ROWS OF 4 - 16" ADS BIODIFFUSER H-20 UNITS-NO STONE C1 C1 (101.7 GAL) ADvANcED OMWE SYMMS, INC.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) Med. Sand Med. Sand
(BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.73 SF/LF = 473 SIF 2.5Y6/4 RPERC ®29.25 2.5Y6/4 PROPOSED SEPTIC SYSTEM SITE PLAN
DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 350.02 GPD > 330 GPD req'd 22.50 150" 23.0 150" 66 CONNEMARA CIRCLE HYANNIS MA
1� PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko
NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
I DARRENM.MEYER, R.S. Eco Tech Env. NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981
to conduct soil evaluations and that the above analysis has been performed by me consistent with the 364-0894 DATE CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam In October, 1999. 5STSANDW/CH,MAO2537 (508)
50e-362-2922 10/06/10 D.M.M. 2 of 2