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HomeMy WebLinkAbout0137 CONNEMARA CIRCLE - Health �= Connemara'GfkJT6,� Hyannis F/R A — '290 135 N. I , ca 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Connemara Circle t��5 Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the ORIGINAL computer, use 1. Inspector: only the tab key to move your David D. Flaherty Jr., R.S. cursor-do not Name of Inspector use the return key. Flaherty Environmental Services Company Name P.O. Box 81 Company Address Yarmouth Port MA 02675 mod"' City/Town State Zip Code 508-362-1657' S14713 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported.below is true, accurate and complete as of the time of the inspection. The inspection was performed based•on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to,Section 15.340 of Title 5 (310 CMR 15.000). The system: i C_ ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority < -- ' March 24, 2008 ry Inspector's Signature Date N r- � rTt The system inspector.shall submit a copy of this inspection report to the App oving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 1 f f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityfrown 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" onditional Pass" section need to be replaced or repaired. The system, upon completion the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in th for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 ye old*or the septic tank(whether metal or not) is structurally unsound, exhibits substant' I infiltration or exfiltration or tank failure is imminent. System will pass inspection if the exi ing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass i spection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that a tank is less than 20 years old is available. ND Explain: ❑ Observ/en ge backup or break out or high static water level in the distribution box due to brokted pipe(s) or due to a broken, settled or uneven distribution box. System will pass inith approval of Board of Health): I' ❑ s)are replaced s removed l5insp 137 Connemara Circle Hyannis.doc•06/06 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form °' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 imes a year due to broken or obstructed pipe(s). The system will pass inspection if(with approv I of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Re uired by the Board of Health: ❑ Conditions exist which r quire further evaluation by the Board of Health in order to determine if the system is failing to rotect public health, safety or the environment. 1. System will pass Mess Board of Health determines in accordance with 310 CMR 15.303(1)(b)that th system is not functioning in a manner which will protect public health, safety and the env ronment: ❑ Cesspoo or privy is within 50 feet of a surface water ❑ Cessp I or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System w I fail unless the Board of Health (and Public Water Supplier, if any) determines hat the system is functioning in a manner that protects the public health, safety and nvironment: ❑ T system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet f a surface water supply or tributary to a surface water supply. ❑ he 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 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Hea h (cont.): ❑ The system has a septic tank and SAS and the AS 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 alysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the pres nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no of r 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day 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 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 `r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No I ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is ithin 400 feet of a surface drinking water supply ❑ ❑ the syste is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the sys m 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 "ye " to any question in Section E the system is considered a significant threat, or answered "yes" in Se tion D above the large system has failed. The owner or operator of any large system considered a 'gnificant 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 th Department. t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Connemara Circle . Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 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 N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? - I The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] i } t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d '07: p gpd; '06: 9 ( Y 9 (gpd)): 19 gpd Sump pump? ❑ Yes E No Last date of occupancy: 2008 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to t e Title 5 system? ❑ Yes ❑ No Water meter readings, if availa e: Last date of occupancy/us Date Other(describe): l5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 , 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,.date installed (if known) and source of information: existing tank, leach trench installed 1/8/04 Were sewage odors,detected when arriving at the site? ❑ Yes ® No t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >50 feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints good, venting through house adequate, no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gallon Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 32" <1° Scum thickness 9„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? sludge judge, tape measure t5insp 137 Connemara Circle Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 t i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): inlet&outlet tees in good shape, tank seems structurally sound, liquid level appropriate, no evidence of leakage Grease Trap(locate on site plan): 'Depth below grade: feet Material of construction: . El concrete El metal El fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet. a or baffle Distance from bottom of scum to botto of outlet tee or baffle Date of last pumping: Date Comments (on pumping recom ndations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outle nvert, evidence of leakage, etc.): Tight or Holding Ta (tank must be pumped at time of inspection) (locate on site plan): Depth below grad Material of co truction: ❑ concret ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Connemara Circle . Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: /g�allons ons Design Flow: per day Alarm present: Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition o/alaand at 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.): dbox seems level, one line going out, no evidence of solids carryover, no evidence of leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: El Yes ❑ No F l5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (1)2'x56'x4' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soil &vegetation typical (lawn), no signs of breakout or hydraulic failure t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of insp ction) (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, Igns of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate /nn Materials of c Dimensions Depth of solid Comments (nf soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form , W. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .. 137 Connemara Circle _.. _... ..._.....s Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown 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. I 20 r 5� w G/s `sue ' l5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 137 Connemara Circle Property Address Michael &Jillian Ardolino Owner Owner's Name information is required for Hyannis MA 02601 March 21, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ 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: hand augered to 11', no goundwater encountered t5insp 137 Connemara Circle Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable �p 1HE A Regulatory Services BARNSrABLE, Thomas F. Geiler,.Director 1639. a�0� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. I In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:\sEP'rIC\Disclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE I.'OCATION 07 CUV..www 1,- C•t !C-e SEWAGE # VILLAGE_ A :n. i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. `O'���J �-- SEPTIC TANK CAPACITY /C�� �zC7 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS � �(�r^'i>� BUILDER OR OWNER PERMIT DATE: 1 /G I I COMPLIANCE DATE: 1 i r 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 a rku a + r I � t I i No.[J�'c� 'O/ `�— — r FEE �O COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair ` Upgrade( ) Abandon( ) - ❑Complete System Individual Components Location (' Q Owner's Name M Map/Parcel# Address A Lot# # Telephone# Installer's Name 5 Designer's Name A Address N Address 0 Telephone# coLkeS Telephone# Type of Building 0,Q�\CtCJC&Qr \ Lot Size sq.ft. Dwelling-No.of Bedrooms ')C1 � a') Garbage grinder (NIP, Other-Type of Building & p No.of persons QL Showers (►f,Cafeteria(yam Other Fixtures �U A.—b 4�1� . IC 1 ' {��5 C1L1C1� Design Flow (min.required) n gpd Calculated design flow Design flow provided 3�3 r 3�ogpd Plan: Date to `o T Number of sheets I Revision Date Title Description of Soil(s) an Soil Evaluator Form No. a Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS (a "IgTAI I ATION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN S T RICI ' ^CORDA.: CE TO PLAN, The un ersigned agrees to install the above described Individual Sewage Disposal ystem in accordance with the provisions of TITLE 5 and further a ees to of to pla ig t nj in pperation until a Certificate jljnfbiancehas been issued by the Board of Health. Sig Date Inspections .,. f -. {� i 1 �` i � , i ti %'� "'4: ,�� I t � 1 wyR FREE COMMONWEALTH OF MASSAC14USETT _ . Board of Health, �!—PDrjcc-,S-'MNENeMA. APPLICATION-,FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT ; Application for a Permit to Construct( Repair' UpgV ).Abandon(.+)t- ❑Complete System XIndividual Components Location c \Q n Owner's Name �.� Map/Parcel# ZCi i 3 Jr 1, Address Lot# $!— Telephone# Installer's Name 5VCe Designer's Name ` Address n S-� « Address O 3Q Telephone# 5 f (DJ _ .S C) Telephone# 581_Sti 13 70 O a5 24, Type of Building 4?(-\C)C� Lot Size q I S44) sq.ft. *�! +Mae•Dwelling-No.of Bedrooms Garbage grinder (NrI A Other-Type of Building n�n� No.of persons oZ Showers X Cafeteria (VI Other Fixtures Ay1 A TD sly {� �o{� i t1� lliltClC�Ct t Design Flow (min.required) gpd Calculated design flow �J��O Design flow provided 343 13(ogpd Plan: Date 1 fo o4 Number of sheets \\ Revision Date "'' Title �e - f�i tC+ 211 Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator (fit,(`t`c(,� Date of Evaluation (n o \\ `\ U P DESCRIPTION OF REPAIRS OR ALTERATIONS -�O Q �,ZA `D an f The un ersigned agrees to install the above described Individual Sewage Disposal 1System in accordance with the provisions of TITLE 5 and further a ees to of to placreae tem in •peration until a Certificate o Co p'ance has been issued by the Board of Health. Inspections �°"'•:Y^,�c:._-';s.rt;y ��.-_ -_ ••�.•.,._ _ .:- _—'.a:;-c-e,+iv-� I�:_'.�-�=:�;xp N•�r� +-•�- s. -: ..-.w.aw�- y.�... No. o o -01 D FEE (` �T 'L_.®MM � Board of Health, �� !/tI'J MA. CERTIFICATE OF COMPLIANCE Description of Work: G Individual Component(s) NI Complete System The undersigned h reby certify that the Sewage Disposal System; Constructed ( ),Repaired X Upgraded ( ),Abandoned ( ) by: at rL L f� .M a r r / KCW1 Hua 7 r has been installed in accordance with the provisions of 310 CMR 15.00�(Title ) and the approved design plans/as-built plans relating to application N . '.1.t�0"i —QJ dd to P. _. . Approved Design Flow (gpd) Installer 1) �_—\ / ; I pI Designer: Inspector: ,,,,..0 ' V'. �V t� Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. ) Z —©�� -- FEE Q COMMON OF MASSACHUSETTS 4rkN,6—, Board of Health, �\� MA. DISPOSAL SYSTEM STEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( Upgrade( ) Abandon( ) an individual sewage disposal system at l���m�x��.� Cr 2 c l� ,�Q I�/ S �^as described in the application for . I . Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the d ofThi per . 1 local conditions must be met. l � _ Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date // / y Board of Heal Sep - 20-01 13 : 62 ,. BARNSTABLE HEALTH DEPT 5087906304 N U2 -- s25roi NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AfXD SOIL EVALUATION.EXEMPTION FORM CQ_M lzv'1 hereby certify that the engineered plan signed by me urteC ����(t- , concerning the property located at _ ume�e1 Gc-CAle n\S meets all of the i;I:ow,n; criteria: . • This failed system is connected to a residential dwelling only. There are no .ommz!rzia! or business uses associated with the dwelling. -Fhe soil is ciass:,ied as CLASS I and the percolation rase is less than v equai to ri notes per inch. The applicant may use historical data to conclude th!s f3c: or may _or:duct are!irm::,afy tests ac the site without a health agent present • ;here :s no incr-,aSe in flow and/or change in use proposed • i here are no vanances requested or needed. • The bottom of the proposed leaching facility will not be located less tnan fourteen :l 'ee; aoove the maximum adjusted groundwater table elevation. ;Adjust the •nundwater table using the Fhmptor method when.applicablel Please complete the following: �:i Trip Di Grouno Surface Elevation (using GIS information) _ °�•` _ . F' G.W Elevat:on � ad;ustment for nigh G.W..2..9... = ..` + too �rR--T.RE F. BETWEE1\1 and B ye S'.G.VED _ DATE:NOTICE 3asec i on tne aGove r.fornination, a rcoair.permit will be issued for '-)edr^orns Tc,.,rt,ur No ;ddiuonal bedrooms are au(horized in the future without en,ineerec .epi c s_+stem plans. - ----- 1c:un!�:Ou PciccxmP Permit Number: Date: d Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: Lot No. �1 Owner:1 - G�� �\��� Address: A MF n Contractor: \ �,�c1c a �t'�:�v�rnc, r,�tc��Address: _�•C�: i »C L'27- , 2' i F 1Yno,.)Ak , M iA Notes: V STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date LD Ryar I-S mon /d STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... Mtn OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ............... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 28) determine water-level adjustment ..............................................:. 1 STEP .5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............................. .....................t.......................................................... Figure 13.—Reproducible computation form. . 15 TOWN OF BARNSTABLE LOCATION/3 CC� Nyt.. r° !�'� SEWAGE# VII,LAGE L� ASSESSOR'S,MAP & LOT INSTALLER'S NAME;&PHONE NO, SEPTIC TANK CAPACITY LEACHING FACILITY: (ty ) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: i • Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and-Leaching Facility(If any wetlands exist Feet within 300 feet'of leaching facility) Furnished by II ' ELI t 04/08/2014 05:57 FAX 16 002/002 CA"EN lam• SHAY - (508)-548-0796 ENVIRONMENTAL SERVICES,INC. P.O. Box 627, East Falmouth, MA 02536 January 8, 2004 RE: Certification of Title V Septic System Installation: Residential Property—137 Connemara Circle, Hyannis, Ni. A. Dear Sir or Madam: On January 7, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 137 Connemara Circle, Hyannis, MA based on a design drawn by Shay Environmental Services on January 6, 2004. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required, If you have any questions,please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARr1gElvE. SHAY ENVIRONN ENi TAL SERVICES,INC. c�yCH OF tifq�,S. C RMEN,c�G,�" E. Carmen E. Shay,R,S., President FGIsTE ' S41JITAnir���, 4 JAN-8-2004 THU 05:37PM ID: PACE:2 7 4-5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �' MAP SAILED INSPECTION PARCEL - LOT TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 137 Connemara Circle Hyannis, MA 02601 Owner's Name: Raymond Spinelli Owner's Address: Date of Inspection: November 22, 2003 -- R�CE@VD Name of Inspector: (Please Print) James M. Ford Company Name: JamesM. Ford DEC 10 2003 Mailing Address: P.O. Box 49 Osterville, MA 02655-0049 TOWN OF BARNSTABLE Telephone Number: (508) 862-9400 1 HEALTH DEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature:. Date: November 30, 2003 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will'perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 4 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well.water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: ' Raymond Spinelli Date of Inspection: November 22, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters dud to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than!/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well'water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water.supply well If you have answered`yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 I Page 5 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks?, ✓ Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? n/a Were as built plans of the system obtained and examined ?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of breakout? ✓ Were all system components, excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 137 Connemara Circle Hyannis, AM Owner: Raymond Spinelli Date of Inspection: November 22, 2003 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: I 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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2002-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool ,.. Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be t obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): s Approximate age of all components,date installed(if known)and source of information: �1 Approx. 1975-per design plan Were sewage odors detected when arriving at the site(yes or no): No 6 I t r Page 7 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. 1 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 1" Distance from top of sum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels a as related to outlet invert, evidence of leakage, etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. ' GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: ; Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels l; as related to outlet invert,evidence of leakage, etc.): 7 t. •Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow:' gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): r 4 4A r i ' Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Connemara Circle Hyannis, MA ' Owner: Raymond Spinelli Date of Inspection: November 22, 2003 SOIL,ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 - 6'x 6'(1000 ga1.) leaching chambers, number: leaching galleries, number: leaching trenches,number, length: leaching fields, number,dimensions: overflow cesspool, number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): The leach pit was full. Liquid was up to the inlet pipe. There were signs offailure. The cover was 16"below grade. The bottom to grade was 86". CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: , Depth.-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs-of hydraulic failure, level of ponding,condition of vegetation, etc.): ' 9 Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 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. C &Lk za � 3 a r /3 33 a l 8 6 1/0 c t 3 a� yo 10 Page 1 1 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Connemara Circle Hyannis, MA Owner: Raymond Spinelli Date of Inspection: November 22, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 18 +1- feet Please indicate (check) all methods used to determine the high.ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 18'+/-to ground water at this site. This report has been prepared and the system inspected and failed of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 i 137 17- /-OF c ow,c &3Z N/VH22i S - tu V/= r v/?//L J Ae v S TiZ L � 0 l5 7�Z fjT/t s 0 r j I n C w ti 4 Fas.. ............ THE COMMONWEALTH OF MASSACHUSETTS OARD O HEALTH ��/ � ...... ........... ......................OF....... ....................... 1 Appliration -for Diovoii al Morkii Cnoaaotrurtion Vaniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individ al Sewage Disposal Syst - '- --'---- -- -' '-' -- .. _ Location% dr or Lot No. ..... -'- ---------•------------------ --•-- ..........-- ----•'-•-•-- •---- •--•-•-------'------•---•-------- ••- Owner 1.` 1! Address " Install Address y U Type of Build Size Lot/�f��_. �...Sq. feet Dwelling No. of Bedrooms________________ ___ ._ _ Expansion Attic ( ) G frbage Grinder1-1 ( ) a4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria a' Other fiat d Cafeteria W Design Flow_._ -.•-.-.•-.._. .. __ ns per person per day. Total daily flow_________ ........gallons. WSeptic Tank Liquid capacit allons Length................ Width.____..._...._.. D'tmeter.......... _.__ Del�tlt................ x Disposal Tench— o_ ____________________ ��/id li .,-------- -- TV7--_----__-- 1 achin 'rea....................sq. ft. D th oSeepage Pit No._ Diameter .._ ._._._. p ____ tg area-------.--•----...sq. ft. Z Other Distribution box ( ) osing tankPercolation Test Results , Performed by------------------------------ -------------------- --- te------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit....._--------------- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch De p f Test Pit......... ......... Dep to ground water..... ................. --••------------------------------•------- "........................... ................ ----------------- -------- --------------_------ ODescription of Soil.............................. ----lie. � ..... - ---------------------... ..................... x W .................-.............................................................................................................................................................. ---------------------- UNature 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 h been issued by the board of health. / D ------------- Application Approved B Date Application Disapproved for the following reasons:............................................... ._..._._._..__..._._...__......_____._______-_______________.--_ ..........-.............................................................................................................................................................................................. Date PermitNo......................................................... Issued..........................................'.............. Date f � �^ if f r, � ( • � ` I f `. i/� ' , � •IJ / +] r � I' 1 .. f ;r _ � ' � �' ,- - _ _ P i i _ � �' � - c i 'i r .. . i �� ,. � � �_ � .� r � .. � ` ` i . - ` �`Yr 4 � t ` � i ..c {` `.,, � ` .` .� .\ �i _ /' _. �i _ c. -'" �" / -� i _. � �: i ;� t� .............. No. THE COMMONWEALTH OF MASSACHUSETTS ' "BOARD O,F; HEALTH ��� 1,3 IF .. ..................... Appliration -for 13hip at Morks Tonitrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System`at: ------------ G rJ Location•Addresf ✓/�^`r/ or Lot No. w r/ `'�- Own ��� ..�.�.r.•- Address er ..... Instal Address UType of Building�/� / Size LotU__ ..v-0___Sq. feet Dwelling—No. of Bedrooms_______________ ....................Expansion Attic ( ) Garbage Grinder ( ) pi Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria a' Other fixtces- d _- w Design Flow. ........J_.�,.t.. dlo sn per person per day. Total daily flow......... ........__--_-__.._-___..__..__.gallons. W Septic Tan Liquid capacit� � llons Length---------------- Width..____.....A iameter___....../..... Depth.._.._.___.__... x Disposal Trench—, o. _.-------'.....___. Width �_._.._./T 0_Leengtla-----j'?......... all leachin��lrca....................sq. ft. Seepage Pit No.l________________ Diameter ......._.._. Dep��b'le ow '�.� _... otaal-le�l-"ng'trea---.._.____.._____sq. fc. Z Other Distribution box ( ) Dosing tank ~" Percolation Test Results Performed by..................................... .�.`.. .... D'ate....._____._______........._______._.... a Test Pit No. 1................minutes per Inch Depth of "Pest Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch De of Test Pit........-,.......__ Dep�li to ground water----- ................. ------------•• - O Description of Soil.. --------•----•...-••••--- �� - J --•----•••--------------•-•...---------------------- w 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 ofArticle XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h been issued by the board of health. e Signed..... .�.'...� r Date --------........... Date Application Approved BY -:...... ..T :' r f�-7- Application Disapproved for the f,lowing reasons:.............................................. ------------- -•-•-•-----------------------••••----•--- ---•------------------------•----••••---•--•-•--------------•---••-•••-------------------•••--------••-••-----------•••-••------------------------•-------•••---•-•-••---------•-•---......•-----------. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH l .......I........ .... ....OF............. ........ ..:!��• 6 P► - ...... ......t,�.-Chi............................ (11prrtifirntr of Tantplittnrr THIS IS T RTIFY That e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................... c�, -d.----� . ..--------------------------- Install at--•--, ._!..(...........�--err:� -�-�-•--•-•r•--•f--�•�-�-i!==!'=,.'C•..-•�-•-�• - •--.` ........ .................................. has been installed in accordance with the provisions of Article XI of GI'he State anitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON R. ED AS A G ' ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---.......g1-/.S'�/_7-,3...-•--•------•----------------------•-•-- Inspector---• •. -•---...__ w. ��/� THE COMMONWEALTH OF MASSACHUSETTS ' BOARD O HEALTH 7d ............r/.dsl�/...OF..................................... .1es............................... No....-4?-3 FEE = Dispolitt�.. ork, trurtionrrmtt Permission is hereby granted............ _ k... ...... .........•..........................•--.......------.......__....._.........---•--... to Construct ( ) or Repair ( ) an Individual) SeA,age Disposal System at No....�?I ! ���-•---- Street as shown on the application for Disposal Works Construction Permit No..G .._........ Dated---------- ........ ---------------------------------•--•-••-----------........---------•-•-------••------•----•••-•------._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS It or 190 Z • - .- � w ' _- . /- sT1gY y�• - _- _'. ; is ... AN ems• 01 CERTtF-1ED . P-LOT P-L_ AN SC4LE_ / "M _ - DATE - ! @RERENGE° :BW/wG � T 9/ - A S S"0Wle Q A/ 4 . a n/ gr �OZZ 3 - 0 T E 1 NERE.DY CERTIFY THAT THE BUILDING REG. LAND SURVEY A' SHOWN ' ON THIS PLAN IS LOCATED ON THE GROUMD AS SHOWN HEREON AND T &AT IT .DOE-f CONFORM TO THE �OF ZONING 9'Y- LAWS OF THE TOWN OF y NS7A Bc,E-_„wHE N CONSTRUCTED. SARNSTABLE• SURVEY CONSULTANTS INC:% WEST RMOUTHf MASS . �s►;�,. :'► r � �' t�-ffi ` ''' � J � - �� i. { -i= Y �' ' � ;.: O � �. L 6 �xwTtoor,: _ "NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. VENT PIPE (® Least 24 Inches tau)----- Y --10' min. from-- tl '15 Existing Foundation house to septic tank Schedule 4 PVC w/Charcoal Odor Filte: LEACH TRENCHES CROSS—SECTION (1 TOTAL) TOF ELEV 100.00 (Assumed) Septic tank covers must be . within 6 in. of finished erode / !� - /—Grade• ovrx �t�•. rank 96.'ti �-- Dade ovm D-Dar 96.00 -- \ ' ,.,a•- FH•e ae.ao 4'-W tide •Y 11011 0 PIPE NAY HAVE TO BE RAISED S 0.02 3 HOLE N-10 �w�w 7F A`✓ BY LICENSED PLUMBER - _ HOT. 90x r t"y"I `�"" rn 10 EXIST- - S�0.10 or Greater S- 0.010' per foot 4' P rtaroted P.v L cx,7 l I�-tn"woeta Stone j~lr.r NEW PIPE---� Hp �n 1,000 GAL. OR GREATER l _ ` M" FROM FOUNDATIM as 20' - - '• SEPTIC TANK N 0 4' Invert Osv.-90.50 __ rG y 1 N ? H-10 �; 2 wost Stone 6 ;o Bottom of Leach Focllty ETay.�B3.50 � COIICRM fTAlwas a.w. rn �6e 3/4•��.ot.a rtw. Note All Nod+Mean to be -IF at and• e/PVC cape. 5 PROMCCI H'prfewoted P.YIC.p♦P• SYSTEM PROFILE 6 n of 3/4'-1 ,/2' i ; NOT TO SCALE �.. _ __ 0 o Bottom of Test Fide 1 EJw.�a7.50 lao n+W c compacted stone � o i LEACH TRENCHES - v - - m ,......., ..,: m,..,�..:«�.......�.w. Not to Scale - c ----- _------------ -- -- C C 6 In.of 3/4•-1 1/2• compacted stone NOTE; ALL COMPONENTS MUST HAVE RISERS TO 1NTHIN 6" BELOW GRADE GENERAL NOTES 1. Contractor is responsible for Digsafe notification and protection of all underground utilities and pipes. 2. The septic"tonk anq distribution box shall be set ALI OUP PtPEs FROM THE level on 6 of 3/4 -1 1/2 stone. DISTRIBUTION Fax SHALL BE 12, — CONCRETE COWR 3. Bockfill should be clean sand or gravel with no TYPICAL 1000 GALLON SEPTIC TANK SET LEVEL FOR Al L7V z rr stones over 3" in size. '� = T system is 4. This s subject to inspection during installation NOT TO SCALE i- I KNOCKOUTS by Carmen E. Shay - Environmental Services, Inc. 2-19' aAM. Access MANNOlES s - I ,Y INLET 5. The contractor shall install this system in accordance fr OUTLET with Title V of the Massachusetts state code, the approved plan \ 6• and Local Regulations. r '• I -—'S5"r 4" - SCH. 40 T` ;•�- 6. If, during installation the contractor encounters any soil conditions or site conditions that are different J E' PLAN SECTION CROSS—SECTION from those shown on the soil log or in our design installation must halt & immediate notification be wEET J OUT I T made to Carmen E. Shay - Environmental Services, Inc. 3 HOLE H-10 DISTRIBUTION BOX 7. No vehicle or heavy machinery shall drive over the r h• THE ACCESS COVERS FOR THE SEPTIC TANK, NOT TO SCALE septic system unless noted as H-20 septic components. l' SET DEEPER 11 AND LEACHING COMPONENT 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. -';�-".� _ '-"-•:T•>�-�'^-� �--."�`--_ SET DEEPER THAN 6 INCHES BELOW FINISHED ---- --.._ ----- v• `�- ~''� •�' �" .r GRADE SHALL BE RAISED TO WTHIN 6• OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. PLAN VIEW INSTALL fuF-TITS GAS BAFFLES OR FQOALS EXISTING LEACH PIT TO BE PUMPED OUT & 10. All solid piping, tees & fittings shall be 4" diameter FILLED IN PLACE. Schedule 4.0 NSF PVC pipes with water tight joints. 3-24• REMO I WE COVERS� NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 11. Municipal Water is Connected to The Residence and Abutting FROM THE EXISTING CESSPOOL TO BE DISPOSED Properties Within 200 Feet. _3` min. clearance OF AS PER BOARD OF HEALTH SPECIFICATIONS. INLET 8• min_r 2• min. in to outlet e•n'N 'r �LeT -- --- �T l)Quk1 level ILII _. . I OUTLET THE PROPERTY LINES ARE APPROXIMATE AND s r1�4 to• f4 t s r - - BAORNSTABLEMPILED ROSURVYE CONSULTANTS SURVEY NOFWN YARMOUERATED BH, MA Eo Gad Li W depth 1 ENTITLED PLAN OF LAND IN HYANNIS, MA" �' u� DATED MARCH, 1975 & THE ASSESSORS & DEED INFORMATION I L Z AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN IT SHOULD BE USED FOR NO PURPOSE OTHER THAN - a'-o• 4'--t0" Q A THE SEPTIC SYSTEM INSTALLATION. CROSS SECTION END-SECTION 7 1�� �I A 1R1°9h� of ` r� \ THERE ARE NO WETLANDS WITHIN 200' OF THE PROPERTY C LEGEND 94 _ PERCOLATION TEST �� � 42' 4°��-=�==�� � � \'�� I, `t �,� �o4x� DENOTES PROPOSED 5 75d o , ` SPOT GRADE Dote of Percolation Test: JANUARY 6, 2004 16.75' LOT #91 \ 11 DENOTES EXISTING Test Performed By. CARMEN E. SHAY - R.S., C.S.E. X 104.46 Results Witnessed By. WAIVER( Per Barnstable B.O.H.) .6 99,340 Square Feet +/- 11 SPOT GRADE EXCAVATOR: Shay Environmental Services, Inc. _4 4'I- 'E 1 Percolation Rate: Less Than 2 MPI ® 30" Below Land Surface ' --- T - A �1 1, PL PROPERTY LINE ',' 1 O Test Hole Co �E=.1 i .o -. /� r O 96P — PROPOSED CONTOUR No. 1 TEST HOLE 1 i 0D 1, a --- -- VENT PIPE-- , ti DEPTH SOILS —ELEV / raL ELEV.= 98.50 , 1 �_ — — -- — -- —97 EXISTING CONTOUR 1 1 _ Loamy E, 1 T Sand IS TING 5 1 , � � DEEP TEST HOLE & 10 YR 4/3 2 BEDROOM i �\ PERCOLATION TEST LOCATION 0"_9 A, 9/_75 5 —20.5'-- HOUSE � Say LOT #82 g o #137 �� ` �\ ✓ = --• 6 FOOT STOCKADE FENCE 10 YR 5/6 9"- 30" 8, 96.00 P. t'It yy�� ---- --------------- ----------- Sande � `P 1 �j ASSESSORS MAP 290 PARCEL. 135 10 TR Y 7/6 , - F' }� Dr f,K 30'- 132 C, CTt [yYc� EXIST. 1000 gal. , T LA N Septic Tonk %/ I �_ I �� ILV 10 Perc #1 STD BOX ; , Depth to Perc: 40" to 58" OF PROPOSED SEPTIC SYSTF M UPGRADE -- -- - - l 11 � Perc Rate= I ess Tho 2 MPI 19.6' Failed - i li 1 PREPARED FOR Groundwater Not Observed r------- Leach Pit M R . RAYM O N D J . P I N E �_ AT No Observed ESHWT � I , 1 ADJUSTED H2O Elev. = None : SHED i Approx. �\\ I 1 --- >o9.s2' 1 # 1 37 CONNEMARA CIRCLE S 84d 52' 30„ E --- - ----------- --- - ---- - _ 1 H YA N N I S MA Design Calculations - — - PROJECTco -- 1 -----------------------BENCH MARK Number of Bedrooms: 0, Equivalent to W Gal./Doy TOP OF FOUNDATION P EPARED BY: Garbage Grinder No ELEV. = 100.00 (Assumed) , c� ^^ �. Leaching Capacity Required: 330 Gal./Day Minimum per Title V. L"` jJ /��f� J�j Lj jJ Septic Tank : - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. 1 y 1""i� 1�r1r1 1 V F. —_- _1_1_ _1 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 11 ENVIRONMENTAL SERVICES, INC. p 9 Y 9 Y P # LOT #90 0 2.0 40 ` �'c . I Proposed Leaching Trench Dimensions: 4' Wide b 56' Lon b 2' Depth. LOT 83 50 � % P.O. BOX 627 Bottom Area: 0.74 gol/sq. ft. x 224 sq. ft. - 165.76 gallonsUsy7j T'-� EAST FALMOUTH, MA 02536 Sidewall Area: 0 74 got./sq. ft. x 240 sq. ft. = 177.66 gallons 17A ,\ 1 `'-::, Providing: = 343.36 gallons Vvv" `T °d TEL/FAX : 508-548-0 796 Use: 1 TRENCH - 561 by 4'W x 2'D SCALE: 1 "=20' SCALE: 1 "=20' DRAWN BY: CES DATE JANUARY 6, 2004 PROJECT#SD515 FILENAME: SD515PP.DWG SHEET 1 OF 1