HomeMy WebLinkAbout0101 CONNEMARA CIRCLE - Health h05K101 Connemara Circle,
Hyannis P -
n
A - 29 02
10
GL .
10
II
o Y °
u
n
Y _
TOWN.70F BARNSTABLE
LOCATION �D/ A/ - C C SEWAGE# b dJ o�
VII?MGE //1`d//1i/S ASSESSOR'S MAP&PARCEL e��" f5-2
INSTALLER'S NAME&PHONE NO. U11X,41-*,7I'I �Dl% e-e7 _ "G c ,
SEPTIC TANK CAPACITY
i LEACHING FACILITY: e 0 O size ,
NO.OF BEDROOMS
OWNER; -
PERMIT DATE: D COMPLIANCE DATE:
Separation Distance Between t :
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 L!,aching Facility(if any wetlands exist
within 300 feet of leaching:facility). feet
FURNISHED BYZ7
G
No. Z.DOA — 2ge, i Fee (� d
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB.LE, MASSACHUSETTS Yes
21pplicatlon for lotoozal *pgum Comaruaton ijCrm' it
Application for a Permit to Construct( ) Repair(Vf"Upgrade( ) Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No./O/ C0N1U0 fig Owner's Name,Address and Tel.No.
��/nnl.s /1'1'1asS' :/� � D�/fit'•
Assessor's MapMarcel AA , r
Installer's Name,Address,and Tel.No. L��n ��u� Designer's Name,Address and Tel.No0'+,UF_(� A4F e
9-6 Pv4UT/,4C AIA /1)a ®moo o gay, 9 s,4
Type of Building:
Dwelling No.of Bedrooms n Lot Size�®C) sq. ft. Garbage Grinder ( )
Other Type of Building > No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets �� Reyi&iatt•Date 64 L1
Title Lb<co. SCi��i L �'[<- 71Ati
Size of Septic Tank /lsli, Z�67 C_� Type of S.A.S.
Description of Soil 15 0 LIN Jv
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 Bo rd of alth.
i
Signed ' Date 0
Application Approved by G Date
Application Disapproved by: Date
for the following reasons
'Permit No. Date Issued '
---ni.. .. ..- r.l1 c-'a, �rr� ...ryi #'�V"'}•A�wt,`�. �+-t ,. . t tiw„A!{p; �
�o`'.
No�,ZOA)A - 23ci -,;^' h t Fee
'' Entered in computer:
.THE COMMONWEALTH OF MASSACHUSETTS ! v
PUBLIC HEALTH DIVISION.- TOWN OF BARNSTAB.LE, MASSACHUSETTS Yes' 't
1" Yication for � go�ar �pgterr� �ortgtruction Permit
Application for a Permit to Construct( ) Repair VKupgrade( ) Abandon( ) ❑.Complete System ❑Individual Components
Location Address or Lot No./O/ Ca�N��V` K Owner's Name,Address and Tel No.
Assessor's Map/Parcehy
Installer's Name,Address,and Tel.No.U�l LL� � �I NGG I Designer's Name,Address and Tel.Nol-�),¢Al:F(\)
oa -
Type of Building:
Dwelling`- No.of Bedrooms Lot Size G sq.ft. Garbage Gririder ( )
5 Other Type of Building z/y. No.of Persons Showers( ) Cafeteria( )
Other/Fixtures
Design Flow(min.required) ��n gpd Design flow provided gpd
Plan Date Number of sheets Re'yJ&i Date(0�4
Title U ti �^S -1 i C- - �' -f E v� 7 .A�..�
Size of Septic Tank Type of S.A.S.
Description of Soil !!e �u\N
Nature of Repairs or Alterations(Answer when applicable)'
a
Date last inspected:
i L!
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.
Signed / Date 0
Application Approved by L. Date
Application Disapproved bZZ
PP PP Y Date
for the following reasons
Permit No. 2C2 0�5 - 23 Gj Date Issued
------.—.—.—,----.-------•--------.----t—.--------.
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
i THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by UJ 1g-/A-o1 T l m C c: �.
at�161 C(ke,C has been constructed in accordance
with the provisions of it e 5 and the f ispos la System Construction Permit No. 2g2Q,�,-' —2 dated klar, r
Installer lov js Designer
#bedrooms Approved deqllun
' flow gpd
The issuance of th' pe its all o e construed as a guarantee that the system w do - sidesig ed. O �,
V
Date Inspector
———— "
No. /�,- Z ( Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Migpogal *pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repair (ri ) Upgrade ( ) Abandon ( )
System located at ; A91 ('01L 1/40M,4e,4, C°'JA22,i-1
a_
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions>or special conditions.
Provided: Con trucf on must be completed within three years of the date of this perm' .
Date Co G Approved by
v
� v�
Town of Barnstable
WE Regulatory Services
Thomas F. Geiler, Director
iLUMMBIZ
Public Health Division
1639.
\'F()►,�p1°' Thomas McKean, Director
200 Nlain Street, Hyannis, MA 02601
Office: 503-362-4644- Fare 503-790-6304
Installer & Designer Certification Form
Date: Sewage Permit# ��— Assessor's N1ap\ParcelC�-9/-,-3062--
Designer: ��� � � Installer: b0yi-LIAN L2')(��(�' l�
qG
Address: C) B� d b' address: I z A 4,111AC S'
,,Si9nMWlr!, MA-1( �� o
On 1,2 fit ) ,1A-M DiN6EQvas issued a permit to install a
(date) (installer)
se tic system at /,, 1
p ��� t '��'{•nus'la/4C based on a deli n drawn by
(address)
G f��l�' ( ►'"I���� dated
(designer)
l certify that the septic system referenced above was installed substantially acco.rdina to
the design, which may include minor approved changes such as lateral relocation o 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 ari 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.
OF MASs9�ti
DAR E M.
(Installers Signature) �JJo. 14(
RfGisiE
S01 TA0 �b
44& U(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUI3LIC HEALTH DIVISION. THANK YOU.
Q: Heal th/Septic!Desi;ner Certification Form 3-264doc
I
t •
P#�
Town of BArnstable. —
�� Department of Regulatory Services
i A8iJ4
Publiciealth Division Date
Asa 200 Main Street Hyannis MA 02601
• eta µ/`l /g•�-' I �� ,
Dat
e Scheduled �' V 'Time_ Fee Pd.
Soil Suitability.Assessment for Sewage Disposal ;
[ i Performed By: Witnessed By 1/"11 Yl LC / l t Dt2 AnJI�
� '
1
LOCATION & GENERAL INFORIVIATI .
location Address Owner's Name SS
Address 2S t,.t_ (c- 3f.
l �
p ��( 3� Engine
er's Name
Assessor's Ma /P�rce1: A-•��r�c..il lA/L .��!'`.
NSW CONS1RUt�'I'tON REPAIR t Telephone
��ti/ Surface Stones Owe
Land Use !\ 1 Slopes(%) d
Distances from: Open Water Body � ft Possible Wec Area y ZOft Drinking Water Well �ZSy A
' 7•, d: ft ft
Drainage Way /DL) •ft.� Property Line � Other .. . .
f
SKETCH:(Street name,dimensiods%f lot,exact locations of test holes&perc tests locate wetlands in proximity to holes)
i
• I
Parent material(gcdlogic) aG�a 107>'fW, f� ,,' I Depth to Bpdioek /t'/ -. --�
L
p g Plt Face
Depth to Groundwakdr. Standing Water in Hole :' Wee in from _
y..
C�
Estimated Seasonal Thigh Groundwater N � � X7 f
n, M
D�TERMM TION FOR SEASONAL HIGH WA1'IC'R TA-DLE
Method Used:
Depth Observed standing in obs.hole: _ In. Depth to Sol]mottles: .,•..- --- .
Depth toiweeping from side of obs.hole: in. Oroundwntet gdJuetment
Index Well# Reading Date index Well]evcl -
AdJ.factor Adj.OrnundwnterLtsvel.,,.,_
y 'x�
PERCOLATION TEST Date
Observation I Time at 91, ..
Hole#
Depth of Perc
Time:at G"
ST .-..------
me(91%61
Start Pre-soak Time.0
End Pre-soak
L M"'
Rate MinAnch '
Additional Testing Needed(YIN)
Site Suitability Assosment: Site Passed�_
Site Failed;
Original:.Public He$Ith Division Observation Hole Data To Be Completed on Back
***If ercolafii0n testis to be conducted within 100' of wetland,.-You must first notify the
•
P
'n"w"e+ahlP.rA� servation Division at least one(1)week prior to begin g
DEEP OBSERVATION HOLE LOG Hole#
. Depth from Soil Horizon Soi Texture Soil Color Soil Other
(USDA) (Mansell) Mottling (Structure,Stones,Boulders.
nsis e cGravel)
h h �6 R-V JV
Lo
371'--12C,t G Mo. . 2,sf TI
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%G el
Lvmu 10 YR,V
I
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color.. Soil Other
Surface(in.) (USDA) (Munsell) Mottling ' (Structure,Stones,Boulders.
Consistencv.%Gravel)
W L3DU A 'ay' ' ►
MOO. 2.5 �l ®1
DEEP OBSERVATION HOLE LOG Hole# ,�-
Depth from Soil Horizon Soi_Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
o it
4l
k&V2, •�1 i
Flood Insurance Rate Map:
Above 500 year flood boundary Nc•_ Yes `
Within 500 year boundary No_ Yes
Within 100 year flood boundary No— Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the
area proposed for the soil absorption system? —Y S
If not,what is the depth of naturally occurring per sous material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysii'was performed by me consistent with
the required ra'ning,expertise and experience described in 3.10 CMR 15.017.
Signature l V �' Date
Q:WF'rlC%PERCFORM.DOC
f
�.;
Town of Barnstable Barnstable
° Regulatory Services Department a mica 1
IARNSCABM
019. ,0� Public Health Division
�f0"AA�p 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
April 9, 2008-
Today Real Estate
David Holt
1533 Falmouth Road
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 102 Connemara Circle(aka 4101) was last inspected on
April 4, 2008,by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• -Backup of sewage into facility or system component due to an overloaded or
clogged SAS.
You are ordered to repair or replace the septic system within Sixty(60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDE F TH OARD OF HEALTH
.Thomas McKean, R.S.;CHO
Agent of the Board of Health r
CERTIFIED MAIL# 7006 2150 0002 1038 7169
Q:\SEPTIC\Letters Septic Inspection Failures\102 Connemara Circle.doc
Commonwealth of Massachusetts
1'it�e 5 Official-Insp ection Form .
Subsurface Sewage Disposal System Form -'Not for-Voluntary Assessments' r. }
't 102 Connemara Cir (AKA: 101'Connemara Cir ,Lot 84) map 291 parcel 302 4 7
Property Address • '
Fannie Mae (contact: David Holt Today'R.E'. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is Hyannis' MA 02601 4-4-08
required for
every page. City/Town .• State Zip Code Date of Insp tion
Inspection results must be submitted on this form. Inspection forms ma�t 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 Shawn Mcelroy
cursor-do not Name of Inspector
use the return
key. Shawn Mcelroy Enterprises
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
7Bd°" Cityrrown State Zip Code
1-508-495-0905 S13971
Telephone Number License Number
.�. . , .u. .,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 ob'my training and experience in the proper function`acid rnaihtenance of on site
sewage disposal systems. I am a DEP approved system inspector puisuant to Section 16.340 of
Title 6(310 CMR 15.000).The system: , ..;
I ,t= ❑ ,Passes .Conditionally Passes ® -Fails
❑ Needs Further Evaluation by the Local Approving Authority
4-5-08
Inspector's Signature Date
Th system inspector shall submit a copy of this inspection report to the Approving Authority (Board
a " of ealth 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
t vl ' re rt 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: ,
tiN;fir t�+�' .u��' -4., �� - •- ,_ : .-` -
•"— ;""This[eport only describes conditions at the time of inspection and under the conditions of use
u.
u + ` at that time.This inspection does not address how the system will perform in the future under
the'same or different conditions of use.
• y..,.. C\; y
t5insp;08/O6 , Title 5 Official Inspection Form:Subsurface Setirage Disposal SysbLm•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form '
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt-Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 4-4-08
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
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 exfiftration 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(sp 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-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Titre 5 Official- Inspection-Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments:. ;
102 Connemara Cir I(AKA: 101 Connemara Cir Lot 84) map 291 parcel 302,
Property Address
-_-Fannie'Mae-. (,contact:.David Holt Today R.E., 1533'Falmouth RdzCenterville, 1-800-966-2448)
Owner Owners Name 1,r..
information is „,.. ,r ,• ,
required for Hyannis s MA 02601 4-4-08
every page. City/Town State Zip Code Date of Inspection 4 r
B. Certification (cunt.)
B) System Conditionally:Passes.(cont.):,,i
❑ distribution boz is leveled or replaced '
ND Explain:
t:►
:—El,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:
. e t: f e
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:
❑ t 'Cesspool or privy is within 50 feet'of a surface water
❑ +Cesspool or priv"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: ,
7 ':. ❑ I 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.
t5insp-Oa(06 Me 5 Official Inspection Forth: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
102 Connemara Cir (AKA:1O1 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is y required for Hyannis MA 02601 4-4-08
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cunt.)
C) Further Evaluation is Required by'the Board of Health (cunt.):
❑ 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
El ® Liquid depth in cesspool is less than 6°below invert or available volume is less
than 1/2 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-Oa/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of MassachusettsVj
�Tit'le e5 Official•,'I nspection 'Forte
Subsurface Sewage Disposal System'.Form Not for Voluntary Assessments
102 Connemara Cir., 1 -^ (AKA; 101 Connemara Cir�cLot 84) . map 291 parcel'302. r. +
Property Address
Fannie'Mae ' .(contact: David Hott'Today R.E.0533 Falmouth Rd .Centenrille-�1-800-966-2448)
Owner Owner's Name , - . , +-1'0
information is H annis I.
required for Y e' * ' MA 02601 4-4-08 - r-f
every page. City/Town ' State Zip Code Date of Inspection
B. Certification (cunt.)
D).System Failure Criteria Applicable to All Systems (cunt.)::
Yes No
® Any portion of a cesspool or privy is within a Zone 1 of a.public well.
i
❑ ® 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"*itrogen is equal to or less than 5 ppm,
provided that no'othe'r failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.] ti
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1.0,000gpd.
® ❑ The•system fails. 1 have determined that one or more of the above failure
criteria exist as described in'310'CMR`15.303,therefore the system fails. The
3 system owner should contact the Board of Health to determine what will be
r ' necessary to correct the failure.
E) Large Systems': To b'e 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"non 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
t❑ ❑ 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-08108, ride 5 Official Inspection Forth: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
�y 102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 4-4-08
every page. Cityrrown 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 NIA)
® ❑ Was the'facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid,depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example,a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp•08M Trite 5 O(6dat Inspection Forth:Subsurface Sma e 1 g Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inapectionform
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
102 Connemara Cir (AKA: 101 Connemara Cir -Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Hoft-Today R.E. -1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis : MA 02601 4-4-08
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 2 Number of bedrooms (actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: _ 0
Does residence have a garbage grinder? _ : .: r• ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? El Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 2-08
Date
Commercial/industrial Flow Conditions:
Type of.Establishment:
Design flow(based on 310 CMR 15.203): canons per day(gpd)
Basis of design flow(seatslpersons/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•Oa/OB Tole 5 Official inspection Forth:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r 102 Connemara Cir (AKA: 101 Connemara Cir Lot 84). map 291 parcel 302
Property Andress
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 4-4-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
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/Altemative 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 (rf known)and source of information:
1974
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp.08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official lnspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
u,p
Property Address
Fannie Mae (contact: David Holt'Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is
required for Hyannis MA 02601 4-4-08,
every page. City/Town- State Zip Code Date of Inspection
D. System Information (cunt.)
Building Sewer(locate on site plan):
Depth below grade: 1 feet et
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: 4"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
- - - -- ----J------------------------------------------------------------
Dimensions: 1000 Gal
Sludge depth: 12'
Distance from top of sludge to bottom of outlet tee or baffle Zan'
ffl '
6"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
5"
"
Distance from bottom of scum to bottom of outlet tee or baffle 13
How were dimensions determined? Tape
t5insp•08/06 Tine 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
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 4-4-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
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 in good condition. Recommended pumpuing for solids.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
t5insp-08f06 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 ,
102 Connemara Cir (AKA: 1'01 Connemara Cir "Lot 84).F map 291 parcel 302,
Property Address Q•
Fannie Mae'. (contact: David Holt Today RE -1533 Falmouth Rd' Centerville"1-800-966-2448)
Owner Owner's Name ,•. ,' :'r
information is
required for Hyannis r , -t MA 02601 4-4-08 2 11
every page. Cityrrown _ State Zip Code Date of Inspection
D. System Information (cunt.)
Tight or Holding Tank(cunt.)
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 N/A
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.): -
Pump Chamber.(locate on site plan):
.. Pumps in working order. t ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insp-08= Tdfe 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
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for H annis MA 02601 4-4-08
y
every page. City/Town State Zip Code Date of Inspection
I
D. System Information (coat.)
I
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:
I
Type:
® leaching pits number:
1
❑ leaching chambers number.
❑ leaching galleries number.
❑ leaching trenches number,length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/aftemative system
Type/name of technology.-
Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit had clear signs of hydrolic failure being filled beyond its capacity.
t5insp-08/06 Title 5 Official Inspectim 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
102 Connemara Cir (AKA: 101 Connemara Cir Lot�84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800=966-2448)
Owner Owner's Name
information is Hyannis MA 02601 4-4-08 ,
required for y
every page. CityrFown State Zip Code Date of Inspection
D. System Information (cunt.) ,
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,
a
etc.):
t5insp-O8/O6 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
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 4-4-08
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.
: t r
i� 4 _r- 3c- 6- r= 32
vt A
t.) ♦'rr
t5insp-081W Trite 5 Official t rspecGon Fortrc Subsurface Sewage Deposal System-Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
102 Connemara Cir (AKA: 101 Connemara Cir Lot 84) map 291 parcel 302
Property Address
Fannie Mae (contact: David Holt Today R.E. 1533 Falmouth Rd Centerville 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 44-08
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
Site Exam:
❑ Check Slope
I
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to 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:
Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
I
® 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'.
.4 .
t5insp-08/O6' Title 5 Official Inspecbm Form:Subsurface Se rage Disposal System-Page 15 of 15
I '
1HE Town of Barnstable
.. �p )� '
Regulatory Services
• sARNSTABLK
Thomas F. Geiler,Director
9$. 3Mnss
Public Health Division
-Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-8624644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a-particular property would-be listed on the "Disposal
Work Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
F DEPARTMENT OF ENVIRONMENTAL PRO�T-ECTION —
I e utU 2
2003
I O„M Sve��
2 NSTABLE
V'._Ia,DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM `
PART A MAP .\..-
lob
CERTIFICATION PARCEL
Property Address: 02,CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
LOT
Owner's Name: WILKERSON
Owner's Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601
Date of Inspection: 11/4/03
Name of Inspector: (please print) JOHN GRACI,INC.
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 the inspection. The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditionally/a ses
_ Needs Furthe- valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 11/4/03
The system inspector shall submit in.'Ipf
oy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspect 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
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPINGNOW AND EVERY ONE TO TWO YEARS TO
PROLONG THE SYSTEM'S USEFUL LIFE.THERE WAS 6" OF LEACHING LEFT AT THE TIME OF THE
INSPECTION.NO ASBUILT ON FILE AS PER TOWN
****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.
Titles 5 Tncnar.tinn Fnrm 6/1 s/?nnn 1
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
I
A. System Passes:
X 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:
SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPINGNOW AND EVERY ONE TO TWO YEARS
TO PROLONG THE SYSTEM'S USEFUL LIFE.THERE WAS 6" OF LEACHING LEFT AT THE TIME OF THE
INSPECTION.NO ASBUILT ON FILE AS PER TOWN
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.
n/a 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: n/a
n/a 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
I
ND explain: n/a
n/a 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: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method used to determine distance n/a
"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: .
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z 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 NOT IN THE,LAST YEAR PER OWNER.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
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. [This system passes if the well water analysis,performed at a DEP
certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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
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.
d
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site?
X _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(3)(b))
5
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 102 CONNEMARA CIRCLE HYANNIS, MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: 2
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)):wfa-
Sump pump(yes or no): NO y` + ^ ��
Last date of occupancy: n/a
lJ Zr-ll�� ►•� i�
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
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/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: NOT IN THE LAST YEAR PER OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
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)
_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): n/a
Approximate age of all components,date installed(if known)and source of information:
1974 PER OWNER
Were sewage odors detected when arriving at the,site(yes or no): NO
Page 7 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
BUILDING SEWER(locate on site plan)
Depth below grade: 10"
Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints, venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK:X(locate on site plan)
Depth below grade: 4"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7" W 4' 1011"
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 15"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL
LIFE.
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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
NO BOX LOCATED- SNAKED THROUGH
PUMP CHAMBER: -(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required).
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a -overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF
FAILURE. PIT HAS 6" OF LEACHING LEFT IN IT. BOTTOM IS AT 7 FT.RECOMMEND PUMPING NOW.
CESSPOOLS: (cesspool must be pumped as part of inspect ion)(locate on site.plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
n/a
PRIVY: (locate on.site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a.
4
Page 10 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
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.
AC 3S
in
0age 11 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 102 CONNEMARA CIRCLE HYANNIS,MA 02601 M291 P302
Owner: WILKERSON
Date of Inspection: 11/4/03
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER- 10+FT.
tt
LO£QT10N 5EWi.GxE PERMIT UO.
IMSTALLER S 1JWAE ADDRESS'
15UILDER 5 Q &VAF- ADDRESS
DNTE PERIA T ISSUED
DATE COMPLI W-ACE ISSUED : -CL--LIZ
1
I � �
i
t�
c o d
No..... Fas..ld..................
THE COMMONWEALTH OF MASSACHUSETTS ` —
BOARDg HEA THr, 40''t. - -----*...*...OF.......... . .... . . -.. �................
ApplirFation -for Bi-qVniiFal Works 6mitrurtion Primil
Application is hereby made for a Permit to Construct (v ) or Repair ( ) an Individual Sewage Disposal
Syst t:
r . I
...---•-... .- ____• __.t_...-. "...s _...._ _.___ ._+�---•--_.� _•--------------------
•------------------
._....__ ......... .�......_.._
Locati Addressb or,Lot IVo.
A............. ..••--•--•-------....----.....-"---...
Owner Address
w � .....-----•----".....-----------------......---•----•---•---
Instal ler Address
d Type of Buildi Size Lot_._..�. �° .____Sq. feet
U Dwelling=No. of Bedrooms.._.___...... ______________Expansion Attic ( Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers (' ) — Cafeteria ( )
dOther fixtures ......................................................----=--........---.....----------------•-..._.._........---•-•-------------•---..........-•---
W Design Flow.. ....._.._._..................gallons per person per day. Total daily flow-_---._........3_o- ...............gallons.
WSeptic Tank Liquid capacity_10Ugallons- Length---_____________ Width................. Diameter................ Depth................
x Disposal Trench—No_ ____________________ Width--- ���tal Length.................... Total leaching area....................sq. ft.
Seepage Pit No..........I......... Diameter..._J______________ pt below nlet_..... .._...__._._ Total leaching " a .........sq. ft.
z Other Distribution box ( ) Dosing tank ( ) � � �-� 7� Y
'-• Percolation Test Results Performed bY.......................................................................... Date-----------------------•--••------------
,a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f3.- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.____________-.._-.._.
P; \
0 Description of Soil........
.---------------•----------•---------••------•-......---------------•-------•----•--•------------•-•---...-----------•-••-•-••••-------•-•-••••-•-----------••-•--------------•-•-------.:---------------
W •---•-------•------•----------------------------•-------•-------•----•-•--••--....__
U Nature of„Repairs or Alterations—Answer when applicable............................................________..........._____----__-_....._._-__-._..--..
----------------- -----------------------------------------••-------"--.......__...-"---"""-•--•-------•-----...------------...._....-"--------"----._.......---------------.._.....---•---•---------...
Agreement:
r; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in rl
operation until a Certificate of Compliance has be ssued by the board of health. p
Sigd -""- -"---....--• ...- -•..-.• --------------------------------
Date
Application Approved BY L�^ �� t �------- --------------------- .%�t.� ---�..
Date
Application Disapproved for the following reasons:........................... -••"...............................................................
................
........................."--•---"•----•-----•-------•----...._.."-------.........----•-•-•-•--••---------...._...........--------•--•----•------.........------..._.....----------....._....._...--.•.•--
Date
�
Permit No......................................................... Issued......... �tl-7.t/
................
Date
IP
Hl
FEI.AV.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA TH, .
#0 T j.. OF -
�Appffrtt$fun -fur Bf,ipuutt1 Warks Cnunitrurtfun Prrnift d
Application is hereby made for a Permit to Construct (I' ) or Repair ( ) an' Individual Sewage Disposal
Sys at:
IL
Lot: Addre&s Xor Lot.No.
t —'
Owner Addiess
--------., -•-------•-... ...................................................................... --------------......••----
Installer Address
UType of Buildi— Size Lot_._. .��-.----Sq. feet
a Dwelling No. of Bedrooms-"."_-__-.--3----------------"----_---.Expansion Attic (M( Garbage Grinder ( )
04 Other,—Type of Building ---------------------------- No. of persons............................. Showers Cafeteria ( )
a Other fixtures ......................................................
W Design Flow. .______._._��..................gallons per person per day. Total daily flow---------------- 0 L ..
......... ..............gallons.
WSeptic Tan' I Liquid capacity .gallons Length________________ Width---------....... Diameter---------------- Depth................
x Disposal Trench—No.--------------------- Width.......... tal Length.................... Total leaching area....................sq. ft.
Seepage Pit No........_ _ Diameter-_-_ ." below inlet.................... Total leaching •rea sq. it.
Z Other Distribution box,(.• ) Dosing,tank A
►-' Percolation Test Result's Performed by---------=----•-----....-----------------------------•-----------------' Date_....-- .........-----------------...
a
Test Pit No. 1_--_-_-- minutes per inch Depth of Test Pit.....................Depth to ground water........................
LL, Test Pit No. 2................minutes per inch Depth of Test Pit----------.......... Depth to ground.water........................
O Description of Soil...... .......l .e . '!�......._'A_p!�{.�--------.---------......----------------------- ------:..................................
x
x ----------------------------------------------------..........................................•...................................................................... ......
U Nature of Repairs or,Alterations—Answer when applicable.:.................. ...........................................................................
.....---••----------------------------------•--'•-•---------------------------------•-•--••-•--..-----
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ssued by the board of health.
Dat
Application Approved B --��//` J
Application Disapproved for the following reasons:.........................•.--------•----"----•---..............._......_..........._..__...Date.......-----_.
i ..........................................................•-•-----•------•-----••------.........---------...----......------•-- ..............--•--........------.......................................
Date
Permit No......................
.....--•--.....•..................................... Issued........................................................
Date
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
HEALTH
i
. .........OF...........�0. ,Kt . -•,..
Trrtfffra#r of Tantplianrr
THI 1 .,CERTIFY t the I dividual Sewage Disposal'.System constructed ) or Repaired
by --Jl-
cc j Instal r
at,.... 0� ! Q��'t✓l drr .�' - --- �ff
am?
' has been installed in accordance with the provisions of Article.X�I4 h S to Sanitary Coc" s des ibed in e
'+ application for Disposal Works Construction Permit No...............<. ..� ..... dated.--�'1 �'L � ......
i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS ED AS A GUARANTEE.TF9AT THE
` SYSTEM WILL IJ _CTION S ISFA TORY-----... ins ector----- ------------------------- ------------------------- =
DATE............... --- ----,----.� ... .
J
THE COMMONWEALTH'OF MASSACHUSETTS
BOARD OF 'HEALTH
..........J.... ......OF........./ZIfe' ..........................•--------...
FEE../ -•=-----•-•
:1' .: ;> k� �u trnrfuat rrmft
Permissio i ereby granted---- - d --........ -----------------
to.Const t or R r ( ) an Iidividual'Sewage Dispo ystem
at No. �-- - -aG,"-----. .... ...A....--- .. -•--
I` tree
}
as shown on the application for Disposal Works Construction Pe t o......... .. .... ......_r� 7.--......
----------- --
••- .Board of-He th
DATE------. / ---- ........... ..................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
+ , w
- , ,CDT �-� - •- _
8.3
.30'f
CERTI FIE -D PLOT 'PLAN -
L O :A T 1 O N.
SCALE � ' 3O DATE �_�/75L 4 fi
REFER E N 'C E: .BEING LOT B"F f15
3H0k/Nf ON L, G. PLAN) 27097.
D T E
; . I. H E'R EBY 'C E R'T I�,F Y T H AT-. T "H-E" B U 1 L D 1 N.G `R E G. .L A N 'D S U R v E Y O
$.H.O•W N O N : THIS'. p LAN 1 S L-O C.A T E D O N '
'THEE G R0U 'N' D ' 4S S HOWN HEREON AND
T H'A T I T n0I1=S CON"FOR. M- T O THE V.
ZONING BY LAWS O_ F T_HE TOWN OF lE• 9n,
RLgRNSTA )j_F W H E N. C O N S T R U C T E D.
IS NlNCIllY
BAR"NSTAB.LE SURVEY . CON_S,ULTANTS, .INC... u..r � ` o
WEST' YARINOUTH, MASS .
— 231
LEGEND ,�, ; 44
x;' .' . ,t a.
PROPOSED CONTOUR ,. ;co
OF Mgsf9 ® PROPOSED SPOT GRADE ;o• x, ,o,. o�.a4
G CONT ''r' Gearge 5t �•, r; Pao—— 98 —— EXISTIN OUR `�.� ,y; ,in g`1q
OZ DAW ✓' i. V` ' "'
��•
R + 96.52 EXISTING SPOT GRADE
U, 3\
NO. 1140 ' 'o! j1 'I 'V51
V W— EXISTING WATER SERVICE ;
q£C/$iE� � TEST PIT a '�1' hliccheils WAY.. __' tis+9�nk-Nd_•. ;�;o:
a•, I o..;
','�'I End•�+, `.y.iz - ..ron� t I , �-i+ .'iot. �
tit
(f
((�� �
V l/ R' ,g Ha
,Q
m: s
r`—'---•—�------'---- ,. _ LOCUS MAP N.T.S.
I T .- 34
- _ c
130.00 ft
1 -- Li GENERAL NOTES:
I
_ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
___
—— ————— 1 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
\ \ LOCAL RULES AND REGULATIONS.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT'BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
1 j 35 DESIGN ENGINEER.
/ I o / °,: PAVED DRj 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
o / // ———— VE WA Y�� I } FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
0 1 o _=z j ENGINEER BEFORE CONSTRUCTION CONTINUES.
CO I , / - \\\ I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
i / I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
J / o / C� �� j THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
/ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
34 / /?/ toll
"WATER I- 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
jt� 6, y J Z v. oPP . wote� I—� EIGATE Z 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
/ / J sefv/oq—�,-O TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
jj L- I I �, W 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
O / j_ GAS O > THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
a 11 / jo GATE t1
CONSTRUCTION.
35 _L-- / L>J Q O J / 1 O 1 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED
i ~W w 0 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
LOT 8�- _ / 1 0AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
I
35 - ......
/ AREA = 10400 sf 4— / j 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING.
-`---- _-_ _ F< W 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING.
J7 130.00 - F ' 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED)
ft
BENCH MARK
'-;----•J � -- 16. PROPOSED SEPTIC SYSTEM IS NOT LOCATED WITHIN
PP.1NT SPOT ON 37 i NITROGEN SENSITVE AREA.
BULKHEAD CORNER
ELEVATION = 38. 02 L
NBARNSTABLE GIS DATUM P A
SCALE: 1 in = 20 ft U PROPOSED SEPTIC SYSTEM UPGRADE PLAN
. t
20 0 20 40 j 101 CONNEMARA CIRCLE (aka 102 Connemara Way), HYANNIS,MA
T� 1 'r '. Prepared for: Mike Dedecko
O 10 20
t MAP: 291 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
SURVEY REFERENCE: ` LOT:302 DARRENM.MEYER,R.S. Eco-TecA Environmental 1„=20- DMM
PLAN OF LAND BY BARNSTABLE SURVEY'CONSULTANTS. LCP:#172570 PO Box981 (508) 364-0894 DATE CHECKED SHEET NO.
DATED: JULY 1972 50�2-2 22 fCr+nv�02537 06 04 08 DMM 1 of 2
ELEV. TOP •' '�
1 FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS
(Existing)
= 38.64� F.G .EL: 37.25 F.G.EL: 37.0 F.G. EL: 35.0 FINISH GRADE= 35.0
n MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX. COVER OVER LEACHING = 3.0 FT.
COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT
W/IN 6" OF FINISH GRADE
6" . 4" SC- 40 PVC r e 4" SCH 40 PVC
° ° ° ° ° ° ° ° ° ° ° °
(MIN )° 10 I 14„ S= 1% (MIN.) 6 � s= 1 (MIN.)
go
TEE'S ARE TO BE
E Y 4' SCH 40 PVC
INV.35.41 INV.33.0
r INV.32.80 ° ° ° ° ° ° ° ° ° °
GAS J PROPOSE -3 ° ° ° ° °
EXIST. OUTLET BAFFLE D DB
H-10 DISTRIBUTION BOX 25'
INV. 35.66 EXISTING 1 ,000 GALLON SEPTIC TANK '
INV. ELEV.= 31 .50
FXM?FABI% 9" MIN.
)GAS BAFFLE TO BE INSTALLED ON NOTES: 1 CONTRACTOR SHALL VERIFY ALL EXISTING OR s-OF J/"DousiE SHM STAVE PER T1 TLE 5
OUTLET TEE AS MANUFACTURED BY PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET:LEVEL AND TRUE TO BREAKOUT EL. = 32.10
TUF-TITE, ZABEL, OR EQUAL GRADE ON A MECHANICALL COMPACTED SIX
INCH CRUSHED STONE BASE, AS SPECIFIED IN INV. ELEV.= 31.50
310 CMR 15.221(2) ' 314'- T-T/a' 24" 3 p.5"
DOME WA-%W STAVE
3) REPLACE EXISTING 1,000 GALLON SEPTIC IN DER T
TANK WITH 1500 GALLON SEPTIC TANK 1
BOTTOM El.= 29.50
IF FAILED, DAMAGED, OR. UNDERSIZED. " 50" 8»
4) INSTALL INLET & OUTLET TEES AS REQUIRED
SEPTIC SYSTEM PROFILE SEPARATION 5.00 FT. 146" -'
N.T.S. BOTTOM OF TH-1 EL: 24.50 SOIL ABSORPTION SYSTEM (SECTION)
P#: 12235 SOIL LOGS DESIGN CRITERIA
t NUMBER OF BEDROOMS: 2 BR ACTUAL/3 BR DESIGN (SYSTEM NOT IN ZONE II)
DATE: JUNE 2, 2008 r SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF)
SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN
' DAILY FLOW: 110 G.P.D.
WITNESS: DONNA MIORANDI BR Bth KI T DESIGN FLOW: 330 G.P.D.
HEALTH AGENT GARBAGE GRINDER: NO (not designed for garbage grinder)
Elev. TH-1 Depth Elev. TH-2 Depth Elev. TH-3 Depth Elev. TH-4 Depth SEPTIC TANK: 330 gpd x 2 = 660 gpd USE EXISTING 1,000 GALLON SEPTIC TANK
35.75 A 0" 35.75 A 0" 35.50 0" 35.50 0" BR LI V RM 330 445.94 S.F.
LOAMY 3/1 LOOAYMRY 3/1 FILL FILL LEACHING AREA REQUIRED: ( )
.74
35.08 8" 35.08 8" 33.83 20" 33.50 24"
B B A A USE THREE 3 INFILTRATOR 3050 UNITS WITH 4 FT. STONE
LOAMY SAND LOAMY SAND LOAMY SAND LOAMY SAND
10YR 4/1 tOYR 4/1 10YR 6/8 10YR 6/8 33.00 30" 32.83 32" FIRST FLOOR ON THE SIDES & 1.3 FT. STONE ON ENDS: 25' L x 12.16' W x 2'D
B B BOTTOM AREA: 25 x 12.16 = 304 SF
32.67 _ 37" 32.75 36" LOAMY SAND LOAMY SAND
Cl Cl 10 YR 6/8 10 YR 6/8 SIDE AREA: (25 + 12.16) X 2 X 2 = 148.64 SF
f
TOTAL SQUARE FEET PROVIDED = 452.6 vs. 445.94 REQ'D
31.67 Cl 46" 31.50 Cl 48" DESIGN FLOW PROVIDED: 0.74(452.6 S.F.) = 334.95 G.P.D. vs. 330 G.P.D. req'd
.,.s� PERC ®31.50 OF d!q
MEDIUM MEDIUM MEDIUM MEDIUM ���� sX�1�10-11
PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SAND SAND SAND PERC ®30.00 SAND r /o�' DA�
2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 l �R y 271 AMES WAY, CENTERVILLE, MA
No. 1140
Prepared for: Mike Dedecko
Sl O Engineering by: Surveying by: SCALE DRAWN JOB. NO.
25.75 120" 25.75 120" 24.50 132" 24.50 '132" ClE � DARRENM.MEYER,R.S. DMM
Bco-Tech Environmental N.T.S.
PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) NIT00 PO BOX98f (508) 364-0894
NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED 1I 6g EAST SANDWICH,MA01537 DATE CHECKED SHEET NO.
`i 508-3s12911 �p/�/l08 DMM 2 of 2