HomeMy WebLinkAbout0093 CONNEMARA CIRCLE - Health --94 RCIRCLE
HYANNIS
291 . 301
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TOWN OF'BARNSTABLE
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LOCATION `�'� (eti�v�.�av� �i 1 SEWAGE #
VILLAGE �1114 C ASSESSOR'S MAP & LOT r
INSTALLER'S NAME&PHONE NO. /19/h C/�C' CnT i C.
SEPTIC TANK CAPACITY /a0 0 !`
LEACHING FACILITY: (type) /mot/ I tZW 76 2-3 (size)�' /� :2-6
NO.OF BEDROOMS
BUILDER OR OWNER I
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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Fee " r—',.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Mig05 r 6?5tem Cow5truction Perron
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System Individual Components
Location Address or Lot N . w\--wy.r,'—CI Va_R Owner's Name,Address ano Teel.No.
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Assessor's Map/Parcel a l �d J ✓
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -
V\ktt) Of24 -S�pX'1,C_
Type of Building:
Dwelling No.of Bedrooms ✓ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ' (�I
Design Flow gallons per day. Calculated daily flow -��"k9 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ..�1 S►+ N4- �D��e Type of S.A.S. � 71 _- C,
Description of Soil C(2 a (T
Nature of Repairs or Alterations(Answer when applicably Sit-ST Af K- , ee- 41,1(
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 E uren entl Sod a�not place the system in operation until a Certifi-
cate of Compliance h en issued by this alth.
Signed Date ��7`
Application Approved by Date —i 2—
Application Disapproved for the following reasons
Permit No. ?Atop -/„ 7/T- Date Issued (a 7i
'��.'-..c. ��•,_y..7...... t yE-.wa.w. ti.--.7,�...T;�b:7 -- .....�.y_a,�ti;,.yids..�a.c�+.fr _. _ .. .
No.`� "„11CC Z ,~ Fee so
' Entered in computer: v
THE COMMONWEALTH OF MASSACHUSETTS
Yes
.PUBLIC HEALTH'•DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
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ZippYication for W5nno Y bpgtem Congtruchon Permit
Application for a Permit to Construct( , )Repair( .,)Upgrade.( )Abandon.( ) ❑Complete System kIndividual Components
Location Address or Lot N UNN E'WI✓�✓A—Ct V C Owners Name,Address an Tel.No.
` Assessor'sMap/Parcel I _ �l/
., Installer's Name,Address, d Tel.No. Designer's Name,Address and Tel.No.
(�rA _�(_11kL
l 0,-) S ST D/
i.
Type of Building: -
Lot Size sq.ft. Garbage Grinder
Dwelling No.of Bedrooms ( )
b — Other Type of Building } ,--No. of Persons Showers( ) Cafeteria( )
Other Fixtures '
Design Flow 7 / gallons per day.;'Calculated daily flow �' gallons.
Plan Date Number of sheets' Revision Date t
Title
-k Size of Septic Tank 4 Type of S.A.S. IL"
r
Description of Soil C-D 0 C
Nature of Repairs or Alterations(Answer when applicab ) -x�-`'T A(1 0' 14'S 4 DkC 'r L.(
nrCc:-ta%�
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 Titl�5of e nviro ental C-ode_and not to place the system in operation until a Certi"fi=;cate of Compliance h een issued by t ealth.
k Signed Date 40�;(�?="
' Application Approved by i Date A
Application Disapproved for the following reasons ._
U. 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 1 —C.tAp E .S r, V
at ONnl�v�n��w C�t`�. wtil has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Z4W `G Z,S dated 7 .
Installer r t Designer ./ A a
The issuan pf1hi t sh hall not be construed as a guarantee that the y'ste ,)w'.11 functi n s desiVed�1 �r
Date (� 7,! I U Inspector Xy`. �� �® 6-/,,
Ur`.. r
No. ?iC/UlJ Zf =---_—_--_-----------------Fee —0'�—
off THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH`DIVISION - BARNSTABLE, MASSACHUSETTS '
Migpogar 6pgtem �"otructton Permit
Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( )
System located at
` and as described in the above Application for Disposal.System Construction Permit.The applicant recognizes his/her duty to
Y comply with Title 5 and the following local provisions or special conditions.
Provided:Constructio must be completed within three years of the date of this pe t. p
/ 17 /
7/7.cTrrr� /Jr
Date: Approved by
I TOWN OF BA•RNSTABLE
LOCATION `141 rD 41A,'a M SEWAGE #
I VILLAGE 411 I/�d/ <'• ASSESSOR'S MAP & LOTAql— l
INSTALLER'S NAME&PHONE NO. 192/,Q C6V2l� �'. C
SEPTIC TANK CAPACITY /ab U
LEACHING FACII.ITY:.(type) �� � / T�/� (size)7 /� 2 S
NO.OF
BUILDER OR OWNER
I PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on'site or within 200 feet of leaching facility) Feet
Edge.of Wetland and Leaching.Facility(If any wetlands exist
within 300 feet of leaching faciGry) Feet
Furnished by
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• 1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
hereby certify that the application for disposal works
construction permit signed by me.dated , concerning the
property located at 93�oiv�.ee ,. 7��� a�tips meets all of the
following criteria:
tl This failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
"• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
here are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
There is no increase in flow and/or change in use proposed
X"There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the maximum
adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when
applicable]
If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation+the MAX. High G.W. Adjustment. = Z v
DIFFERENCE BETWEEN A and B 4
SIGNED :— DATE: M_ TeP
[Please Sketch pr sed plan of system on back].
NOTICE
Based upon the above information, a repair permit will be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
q:health folder:cert
00 1V
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Address of Owner: 68 GROVELAND AV.S.YARMOUTH MA.02664
Date of Inspection: 9/21100
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name:. SEPTIC INSPECTIONS
*Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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 inspection.•The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
_ Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
X Fails
Inspector's Signature: Date:nla
The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If th system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M
inspection does not imply any warranty'or guarantee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH FIELD IS PAST THE EFFECTIVE DEPTH OF LEACHING,AT THE TIME OF THE
INSPECTION THE LIQUID LEVEL WASP OVER PIPE IN DISTRIBUTION BOX.
revised 9/2/98 Paoe 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date.of Inspection: 9/21/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR.15.303 exist.Any failure criteria not
evaluated are indicated below.
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 o
the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
nta The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the
septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure
is imminent.The system will.pass inspection if the existing septic tank is replaced with a complying septic tank as approved
by the Board of Health.
n/a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o
due to a broken,settled or uneven.distribution box.The system will pass inspection.if(with approval of,the Board of Health).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
nla The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the-Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
revised 9/2/98
Paoe 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21/00
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 the public health,
safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I.-
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
_ The system has a septic,tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis 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,Method used to determine distance nta (approximation not valid).
3) OTHER
n/a
i
revised 912198 Paoe 3 of 11
iP
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21100
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
X I have determined that one or more of the following failure'conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into'facility or system component due to an overloaded or clogged SAS or cesspool.
_ X Discharge or ponding of effluedt to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n/a.
_ X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within-a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water
quality analysis.If the well has been analyzed to be acceptable,,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
•'1 I
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following: a
The following criteria apply to,large systems in addition to the criteria above:
The system serves a facility,with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health
and safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply
well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of
the Department for further information.
revised 9098 Paoe 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
`Sri
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner: MIKE DITULLIO
Date of Inspection: 9/21/00 ,
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.
X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that
period.Large volumes of water have not been introduced into the system recently or as part of this inspection.
X _ As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material
of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site
has been determined based on:
X Existing information,For example,Plan at B4O,H,
X Determined in the field(if ariy:of)the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 1 5.302(3)(b))
X _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems. :F
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• .7
revised 9/2/98 Paoe 5 of 11
r
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21/00
FLOW CONDITIONS
RESIDENTIAL
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):n/a
Total DESIGN flow: 330 gpd
Number of current residents:4
Garbage grinder(yes or no):NO
Laundry(separate 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 two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow'nla v .
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped nla gallons :,
Reason for pumping:n/a
TYPE OF SYSTEM
X 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)
_ I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
I APPROXIMATE AGE of all components,date installed(if known)and source of information:
1974
§aw§d§8daf§d§katldd wh§ii aitivllid at the Mid:(ye§6i MY N6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
revised 9/2/98 Paoe 6 of 11
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 6"
Material of construction: _ cast iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: n/a
Comments: (condition of joints,venting,evidence of leakage,etc.)
TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 0" .
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1000G L 8'6"H 5'7"W 4'10""
Sludge depth: 6"
Distance from top of sludge to bottom of outlet tee or baffle: 28"
Scum thickness: 4"
Distance from top of scum to top of outlet tee or baffle: 0"
Distance from bottom of scum to bottom of outlet tee or baffle: 0"
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.) a ,
SEPTIC TANK NEEDS A TEE,AND RECOMMEND COVER TANK WITH FILL.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a `
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.) s
n/a
revised 9/2/98 Paoe 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) '
(locate on site plan).
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order: NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
i
DISTRIBUTION.BOX:X
(locate on site plan)
Depth of liquid level above outlet invert: OVER PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments: i
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
T
revised 9/2/98 Paoe 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9121100
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
nla
Type:
leaching pits,number:(n/a)n/a '
leaching chambers,number: (nla)Wa .
leaching galleries,number: (n/a)h1a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (1)LEACH FIELD 34'X 12'
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: nla
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH FIELD IS PAST THE EFFECTIVE DEPTH OF LEACHING.THE FIELD IS SATURATED AND IN HYDRAULIC FAILURE.
i
CESSPOOLS: _
(locate on site plan)
Number and configuration: nla
Depth-top of liquid to inlet invert: nla
Depth of solids layer: -n/a
Depth of scum layer. nla
Dimensions of cesspool: n/a
j Materials of construction: nla.
Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)NO
Comments: r,
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: nla Dimensions: nla
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of pond ing,'condition of vegetation,etc.)
nla
revised 9/2/98 !'' Paae 9 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO
Date of Inspection: 9/21100
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
;Irk
Mal
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,3
revised 912/98 Paoe 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 94 CONNEMARA CIRLCE HYANNIS, MA 02601
Name of Owner MIKE DITULLIO .
Date of Inspection: 9/21/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 10 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records .
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
UGSS MAPS AND CHARTS-10+FEET
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