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Home My WebLink About0025 COUNTY SEAT STREET - Health 25 County,Seaf:; A. A= 291 — 168 Hyannis . O i . e 0 0 �. Commonwealth of Massachusetts Title".6 Official Inspection form 4�vwy �fl a Subsurface Sew ¢lOp�� e t` ttr m Not foF,�y lu 11 As nts Property Address Phyllis Hogan. c/o Robin Ivy 37 Day St `r Owner Owners Name South Portland ME 04106 4/6/2013 information is required for.every State Zip Code Date of Inspection page. Citylfo in Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. In' Ont1en A. General"Information filling�out;forms on the computer, I use only the tab 1 Inspector. (n key to move yo11r Joe MarUng (� cursor-do not use the return Name of Inspector Acc key. . I 17 Northside Dr. Comparry Name Dennis, _ aA Company Address State Zip Code � ,,�own 3�3' �9/ * b�l � Telephone Number License Number B. Certificaticin - 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:ot osite: sewage disposal sy terns. I am a DEP approved system inspector pursuant to Section 1534d�.of:. Title 5(310 CMR Ili.000).The system: N Conditional) Passes ❑ Fails, . C= F Passes ❑ Y ,� �'J u, ❑ Needs Further Evaluation by the-Local-Approving Authority r iv e� we Date I actor's Signat The s stem.,As pector shall submit a copy of this inspection report to the Approving..Authority(Board Y,, I `s of Health or DEP),within 30 days of completing this inspection. If the system is a shared sys em om hasa design flow of 10,000 god or greater;the inspector and the system owner shalltsubmit the report to the appropriate regional office of.the DER The original should be sent to the-system owner and,cop1es self t to the buyer, if applicable, and the approving authority. ,'N I r ****This report only describes conditions at the time of inspection and under the conditions of use at that time.Tliis inspection does not address how the system will perform in the future under ` the same or different conditions of use. I . i, Title 5 Official lnspec6o Subsurface Sewage Disposal system•Page 1 of 17- t5ins•11110 , ,r 1 t " C6rnm6nwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owner's Name information is South Portland W 04106 4/6/2013 required for every page- Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes:: I have not found any information which indicates that any of the failure criteria described in 310 CMRr15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: C' De/ &Y" i B) System Conditionally Passes: ❑ One or mor( system components as described in the"Conditional Pass'section ed to be replaced or repaired.The system, upon completion of the replacement or r Ir,as approved by the Board oar Health, will pass. Check the box for"yes","no"or"not determined'(Y, N, ND)for th owing statements. If"not determined," please explain. The septic tank is metal and over 20 years old`or the tic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfikrati or tank failure is imminent. System will pass inspection if the existing tank is replaced with mplying septic tank,as approved by the Board of Health. A metal septic tank will pass insp on if it is structurally sound, not<lea&g and if a.Certificate of Compliance indicating that the t is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 00000, t5ins•11/10 TWO 5 Official Irnspecdon Form:Subsurface Sewage Disposal System•Page 2 of 17 commonwealth of IVIBSSachOsettS Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owners Name information is South Portland NM 04106 4/6/2013 required for every page. City[rown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ 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 ❑ N ❑ ND(Explain below): El obstruction is removed ❑ Y El ❑ ND(Explain below): ❑ distribution box is leveled o eplaced ❑ Y ❑ N ❑ ND(Explain below): I ❑ The system;required pumping more than 4 time year due to broken or obstructed pipe(s).The system will j�ass inspection if(with approva the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is remove ❑ Y ❑ N ❑ ND(Explain below): i I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health' er to determine if )_he system is failing to protect public health, safety or the enviro nt. 1. System will pass unless Board of Health dete es in accordance with 310 CMR :15.303(1)(b.)that the system is not function' m a manner which will protect public health, safety and the environment: ❑ Ce;;spool or privy is n 50 feet of a surface water ❑ Cesspool o vy is within 50 feet of a bordering vegetated wetland or a salt marsh t5lns-11110 Title 5 Of dal Inspection Fomr Subsurface Sewage Disposal System-Page 3 of 17 1 Comrnonweal>� of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan do Robin Ivy 37 Day St Owner Owners Name information is South Portland NM 04106 4/6/2013 required for every page Citylrown State Zip Code Date of Inspection B. Certification (cunt.) 2. Systemewill fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects ublic health, safety and:environment: ❑ The system has a septic tank and soil absorption sy (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfa ter supply. ❑ The system has a septic tank and SAS and a SAS is within a Zone 1 of a public water supply. ❑ Th6 system has a septic tank and S and the SAS is within 50 feet of a private water supply well; U The system"has a septic tank and S and the SAS is less than 100 feet but 50 feet or more from a private water suppl ell**. Method used to determine d' nce: This system jpasses if a well water analysis, performed at a DEP certified laboratory;for fecal- coliform bacteria indi es absent and the presence of ammonia nitrogen and nitrate.nittogen`is equal to or less than i pp , provided that no other failure criteria are triggered.A copy of the analysis must.. be attached to th' form. i 3. Other: I D) System Failum Criteria Applicable to All Systems: You must irtldi1,::ate"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 . ❑ ry{ Discharge or ponding of effluent to the surface of the ground or surface waters y� due to an overloaded or clogged SAS or cesspool ❑ q Static liquid level in the distribution box above outlet invert due to an overloaded X� or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6° below invert or available volume is less than 1/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Cowity Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owners Name information is South Portland ME 04106 4/6/2013 required for every page City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 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. ElAny 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 l 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 within 400 feet of a surface ' ing water supply ❑ ❑ the system is within 200 feet tributary to a surface drinking water supply Elthe system is located ' a nitrogen sensitive area(Interim Wellhead Protection El Area—IWPA)or apped Zone II of a public water supply well If you have answered'yes"to question in Section E the system is considered a significant threat, or answered`yes`in Sec i D above the large system has failed.The owner or operator of any large system considered nificant threat under Section E or failed under Section D shall upgrade the system in actor, ce with 310 CMR 15.304.The system owner should contact the appropriate regional o of the Department. t5ins•11/10 Idle 5 official Inspection Fomn:Subsurface Sewage Disposal System•Page 5 of 17 .0MMOnwe61th`of Massachdsetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Ownees Name information is South Portland ME 04106 4/6/2013 required for every page. C itY Zi frown State p 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 6[� ❑ 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? I ❑ 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. IL)IA- available note as N/A) I ' ❑ ; Was the facility or dwelling inspected for signs of sewage back up? ❑ ! Was the site inspected for signs of zg out? ❑ Were all system components, 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? El information 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: ❑ RI/ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow baked on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t51ns•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Cornmonwealtfi of Massach Wts � .._ Title 5 official Inspection Form Subsurface Sewage Disposal system Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owner's Name information is South Portland ME04106 4/6/2013 required for every Citylrown State Zip Code Date of Inspection page. D. System Information I Description: j► t! S S/Ud /f / �/ qW4- " '(OEM 61 eo Number of current residents: , i Does residence7have a garbage grinder? El Yes No Is laundry on a:separate sewage system?[if yes separate inspection required) El Yes No Laundry system inspected? A)/.4r ❑ Yes ❑ No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Z Q� 570 °I I 1 IA Sa a-D !�� moo Sump pump? ❑ Yes No " Last date of owupancy. Date CommerciaUlridustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gall r day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pr t? ElYes ❑ No Non-sanitary waste arged to the Title 5 system? ❑ Yes ❑ No Water m rE:adings, if available: TRIe 5 Officlal inspection Fomr subsurface sewage Disposal System•Page 7 of 17 t5insG 11110 Commonwealth`of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner owner's Name information is South Portland ME 04106 4/6/2013 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) Last date of occupancy/use: Date Other(describe:below): General Information Pumping Records: NO Source of information: Was system pumped as part of the inspection? Yes No If yes,volume pumped: gallons 2�j ti pumped determined? How was quantity p p . Reason for pumjping: 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/Atternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ ;Tight tank Attach a copy of the DEP approval. El ;Other(describe): t5lns•11/10 Titre 5 Of8da1 Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonalth of Massachusetts we �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owners Name information is South Portland ME 04106, 4/6/2013 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) . Approximate age of all components, date installed(if known)and source of information: 742= Were sewage odors detected when arriving at the site? ❑ Yes No Building Seweq(locate on site plan): 1 Depth below grade: feet Material of construction: ❑cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet ,O Comments(on condition of joints,venting, evidence of leakage, etc.): OILiV a �� .QV, Septic Tank(locate on site plan). Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass y polyethylene ❑other(explain) �yT P If tank is metal, list age' yeas Is age confirrr�. b Certificate of Compliance?(attach a copy of certificate) El Yes' ❑ No Dimension Sludge depth: •t5ins•1 v10 Title 5 official Inspection Form,Subsurface Sewage Disposal System•Page 9 of 17 Com h6hWi lth of Massachusetts Title 5 Official Inspection, Form Subsurface sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street .Hyannis MA Property Address Phylhs Hogan c/o Robin.Ivy 37 Day St Owner owners Name information is South Portland ME 04106 4/6/2013 required for every State Zip Code Date of Inspection page- Cityrrown D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness. Distance from tcip of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee baffle How were dimensions determined? Comments(on 11Dumping recommendation Met and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,a Bence of leakage, etc.): Gr se Trap(locate on site plan): Depth below grade: feet Material of con:;truction: ❑concrete ❑metal ❑fi rglass ❑polyethylene ❑other(explain): I Dimensions: Scum thickness Distance from top of um to top of outlet tee or baffle Distance from I om of scum to bottom of outlet tee or baffle Date of las urnping: Date 15ins•11110 TMe 5 Oflidal Inspection Form:Subsurface Se+rdge Disposal 6ystem•'Page 10 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owner's Name information is South Portland ME 04106 4/6/2013 required for every State Zip Code . Date of Inspection page. City/Town D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural i rity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at tim of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete Elmetal ❑fiberglass ❑polyethylene ❑other'(explain): i i I Dimensions: ` Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order ❑ Yes ❑ No Date of I st purinping: Date Com ents(condition of alarm and float switches, etc,)* *Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No I t5ins•11/10 Tale 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth 6f Massachusetfs Title 5 official. Inspection Fora' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address phyvis Hogan c/o Robin Ivy 37 Day St Owner Owner's Name information is South Portland ME 04106 4/6/2013 required for every Citylrown State Zip Code Date of inspection page- D. System Information (cunt.) Distribution Box(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.): P Chamber(locate on site plan): Pumps in working order. El Yes No Alarms in working order. Yes El No Comments(note condition of pump chamber, condition of ps and-.appprtertarices,•etc:): i Soil Absorption stem(SAS)(locate on site plan, excavation not required): F If SAS not t'ed, explain why: i .. I F; • "� I Title 5 official Irtspectlon For:Sub surface Sewage Disposal System•Page 12 of 17 Cwhmonwealth Hof Missac6usifts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street . Hyannis MA Property Address phyllis Hogan c/o Robin Ivy 37 Day St Owner owner's Name information is South Portland ME 04106 4/6/2013 required for every State Zip Code oate of Inspection page_ City/Town D. System Information (cunt.) Type: ❑ leaching pits number: ❑ [(,aching chambers number. ❑ Ifaching galleries number. ❑ beaching trenches number, length: ❑ beaching fields number, dimensions: overflow cesspool number. ❑ innovative/alternative system --ype/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): d lot t k4 Qh�L_�A Ped-e 7� &�- k6n Pa✓ S,61^ to 36 " 4,4v e, 2 12dWS i vn 04A sr*a & -��`f - - V lLow f/,so �� C GL�-c�,p Ce V'z esspoo" is(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 . �nn CA Indication of groundwater inflow ❑ Yes X No t5hs•t U1o' Tale 5 Official Inspection Forric Subsurface Sewage Disposal System•Page 13 of 17 CoitiMdnvmalth of Massachusetts Title 5 Official; Inspection Form Subsurface sewage Disposal Systein Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St i f Owner Owner's Name infOrmat`on is South Portland ME 04106 4/6/2013 required for every Cdy/Tovn State Zip Code Date of Inspection page. D. System Information (cost.) Comments(notecondition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): le 7— 4 Ll Wq4ex LPaki� A� mam -Toll-el— Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, lev onding, condition of vegeta ion, etc.): i 4 I - i f5ins•11It0 TNe 5 Official Inspection F*=Sfsuftw sewage Disposal System•Page 14 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County. Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner Owners Name information is South Portland ME 04106 4/6/2013 required for every pageCitylrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate atl wells within 100 feet. Locate where public waiter supply enters the building. Check one of the boxes below. and-sketch in the area below ❑ drawing attached separately w s , 32= 23 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 t5ins•11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner owners Name 04106 4/6/2013. information is South Portland ME required for every Citylrovm Mate Zip Code Date of Inspection page. D. System Information (cunt.) Site Exam: [Check Slope esurface water N/19' [Check cellar ►[Shallow wel Is VA_ N- 1 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If c',ecked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) LK Check 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: l Sr 14e, 15 7 3 s I - �• 3474n {mil APP� Z 3c�ie r �3 3. A,% A oV..e— WZ50 's � Z3 6- fi Os Before filing this Inspection Report,please see Report Completeness Checklist on next page. Title 5 official Inspection Form Subsurface Sewage Disposal system-Page 16 of V 15ins-11/10 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa a Disposal System Form-Not for Voluntary Assessments 2� County Seat Street Hyannis MA Property Address Phyllis Hogan c/o Robin Ivy 37 Day St Owner owrtet's Name information is South Portland W 04106 4/6/2013 required for every page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist inspection Summary:A, B, C, D, or E,checked R'Inspection Summary D(System Failure Criteria Applicable to All Systems)completed &System Information—Estimated depth to high groundwater [Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 TMe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17