HomeMy WebLinkAbout0009 ELAINE ROAD - Health (2) Elaine Road
Hyannis
A = 248 199
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
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. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
forms on the
computer, use 1. Inspector:
only the tab key
to move your David D. Coughanowr
cursor-do not Name of Inspector
use the return
key. Eco-Tech Environmental
Company Name
"ICI 43 Triangle Circle
Company Address
Sandwich MA 02563
fe"0 City/Town State Zip Code
508 364 0894 1328
Telephone Number License Number
B. Certification
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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
June 14, 2009
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use. I
t5ins•09/08 Title 5 Official Inspection Form:Subsurfac wage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14 2009
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CrOR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if the
inspector cannot answer Yes to any of the failure criteria listed in Section D on pages 4-5 of this
report. The septic system has been evaluated according to the conditions observed on the day it was
inspected. No estimate or guarantee of system longevity is made or implied by a passing
determination.
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.
Check the box for"yes", "no" or"not determined" (Y, N, ND) 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.
❑ Y ❑ N ❑ ND (Explain below):
l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken r e o obstructedpipe(s) or due to a broken settled or uneven distribution
d stnbution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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:
I
❑ Cesspool or privy is within 50 feet of a surface water
1,7
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
I
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•09/08 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
;M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown 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.
❑ ® 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 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 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— IW A P 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.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
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 cf 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 pans 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?
The size and location of the Soil Absorption System (SAS) on the site has
4 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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 for example: 110 d x#of bedrooms): 330
( p 9P )
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sistem•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage(gpd)): 248 gpd
9 ( Y 9 (gP ))
Detail:
2007-2008
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No '
Water meter readings, if available:
l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgar Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
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) 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.
❑ Other(describe):
l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is
required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Age: 6+ years. Certificate of compliance for repair issued 5/20/2003 (Permit#03-215)
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2
feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
No evidence of leakage or backup into dwelling was observed.
Septic Tank(locate on site plan):
Depth below grade: 2
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:
8.5 ft x 6 ft x 5 ft(1000 gallon)
Sludge depth: 4 in
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 30 in
Scum thickness 2 in
Distance from top of scum to top of outlet tee or baffle 9 in
Distance from bottom of scum to bo_tom of outlet tee or baffle 13 in
How were dimensions determined? As built card
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping not required at this time but maintenance pumping is recommended within and every two
years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage
in or out was observed.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection - Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown 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.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (coat.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert at 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.):
D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
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:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GM 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
® leaching galleries number: 1
❑ 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.):
Soils above leachinggallery appeared n g ry ppe ed unsaturated. No evidence of surface ponding, breakout, lush
vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into
leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils.
No standing effluent was observed.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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 all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
vG
S�Pf�c C)
h
1 o G 2 ❑ '� .�o
Q 3 k
I �Zt/Zft �/zt
2 37 Ft
W
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
a
Commonwealth of Massachusetts
,10
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Elaine Road
G7M
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
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 high ground water: 20+
feet
Please indicate all methods used tc determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed. 5/12/2003
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 datatase-explain:
Barnstable GIS Department records
You must describe how you established the high ground water elevation:
Approved design plan on file with the Board of Health shows bottom of system to be 4.7 feet above
the bottom of a witnessed test pit in which no water or groundwater mottling was encountered.Town
of Barnstable GIS Department records indicate that the property is over 20 feet above groundwater
table.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 31 Elaine Road
Property Address
Stephen Macaleese and Jessica Morgan Macaleese
Owner Owner's Name
information is required for Hyannis MA 02601 June 14, 2009
every page. CityrTown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF B`ARNSTABLE
LOCATION _ ��,r F j za c F �bc� ►'7 SEWAGE # G3W- ,-q
VILLAGE W E 5 L A11A w we 5 ASSESSOR'S MAP & LOT� 8.0
INSTALLER'S NAME&PHONE NO. 866N_<o►-J SF l2 fi C
SEPTIC TANK CAPACITY 4 6U0
LEACHING FACILITY: (type) Z TD t2y G—)C-0 S (size) J 3 x 2 V-a S
NO.OF BEDROOMS 3
BUILDER OR OWNER G A I J 0 i'1'.A rZ 225
PERMUDATE: ��'I"�-�6�� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
Q
Z:l
r.
i a o
�f �I
i
3 TOWN OF BARNSTABLE
LOCATION -P t F 6N2-0 SEWAGE # G 3+-- Q
• VII,LAGE WC-Sj- AIJA w N45 ASSESSOR'S MAP &LOT g'� t
INSTALLER'S NAME&PHONE NO. Ro 6"-<c►j Se 12 f i C
SEPTIC TANK CAPACITY 0 Iwo
LEACHING FACILITY: (type) _Z_ (size) 13 4 Z 5c a S
NO.OF BEDROOMS 3 .
BUILDER OR OWNER &A IJ 7 iy AaG-i)-5
PERMITDATE: ��'� -"6 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
l
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
o�- #au56 .
i
3y,
a
li
nNo. - e
THE COMMONWEALTH OF MASSACHUSETTS Entered in.computerVes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Z(ppliratton for Mtopoml Opotern Congtrurtton Permit
Application for a Permit to Co struct( )Repair(X )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No.7. laine Rd, Hyannis Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 2 4 8 Q( Gail D. Marcus
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7( Designer's Name,Address and Tel.No.
W.E. Robinson Septic ECO—TECH
P.O. Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install Title 1�5 i e a Ghing system to
plans ECO—TECH
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
` in accordance with the provisions of Title 5 of the Environmet#Code and not to place the system in operation until a Certifi-
cate of Compliance has b issued by ' B d o�Health
S gned Date
Application Approved Date 51,5&/a
Application Disapproved for the following reasons
Permit No. — i Date Issued Jr
N0 ;, '• fm Fee 5
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Ves�—
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS
Rpplication for is ogal *pztem Construction Permit
Application for a Permit to Construcf�( )Repatr(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot N,71
lalrie Rd Hyannis Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel 248O7 Gail D. Marcull;
Installer's Name,Address,and RUM. 7 7 5 8 7 7 6 Designer's Name,Address and Tel.No. t
W.E. Robinson Septic ECO-TECH
P.O. Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated da%.ly�flow, gallons.
Plan Date Number of sheets i Revision Date
Title !
Size of Septic Tank Type of S.A.S.
t
Description of Soil
{•h
Nature of Repairs or Alterations(Answer when applicable) T n s a l l Title 5 leaching s y-s t m-m t;
plans ECO—TECH
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the EnvironmeDAal Code and not to place the system in operation until a Certifi-
sate of Compliance has bee, issued by thig Bykd otHealth
Signed Date
Application Approved Date a
Application Disapproved for the following reasons
Permit No. Aaoo Date Issued 5 31 0
THE COMMONWEALTH OF MASSACHUSETTS
Marcus BARNSTABLE, MASSACHUSETT§ -
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( ) s
Abandoned( )by W.E. Robinson Septic Service
at 30 Elaine Road, Hyannis has been constructecyin accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Z-CQ 3" 2-15 dated 5 2,016 3 _
Installer Designer
The issuance of ttis pe 't shall not be construed as a guarantee that the syste ' f r
s d 's ed. +
Date 03 Inspector
t
No. 's-3 ' m Fee 50.00
THE COMMONWEALTH OF MASSACHUSETTS
Marcus
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
3igpozar *p.5tem Con.5truction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 30 Elaine Road, Hyannis
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty.to
comply with Title 5 and the following local provisions or special conditions.
i
Provided: Constru tion must be completed within three years of the dat of iW es�p r��
57Mo Approved by � �` �Date: ^..
FLOW PROFILE
TOP OF FOUNDATION RAISE COVERS TO WITHIN
6 in OF FINAL GRADE '
EL SZ 2O -RAISE I COVER ON GALLERY
2- LAYER OF 1/8-
/D-BOX 1/2- STONE
�3" DROP d
FLOW LINE FIL .3/4 -1 1/4-
io- _ 4 1
PRECAST STONE
N
48" sAs r ' DRYWELL
BAFFLE :<<
BOTTOM OF
47.75 6 in SOL ABSORPTION
UEXISrINIG STONE 47.43 LEACHING SYSTEM
EXISTING BASE
EXISTING 47.60 47/5 GALLERY 5.00 ft
1000 GALLON LEND VIEW) 4s.Is
EXISTING SEPTIC TANK 4.0 rt a1 II r, 10 r►
b) 24.5 ff ESTIMATED
SEASONAL HIGH
GROUNDWATER
i
C
f — 100.00 Ft
o a Q nx
I
0 _� "�' o � r, ZO
H
yGAS
E ti
a .10 �.
CWF tm
UZI
Tj
m m
3z0 3 0° �Z ��
</)m z
cDi> � Z � 00
c Ul 3 �- /I rt
D
oo I c°O� ' m
Z PAVED DRIVEWA Y �r � • �
o m 00m m
00 m z
0
Co/VCRErE p m
— — m
— � a
• Ioo.00 ft — —
S
CpMMO/��yF
/ -r!
o �
o oz 3 X
v a wz o a
.9 F wo �s ?—
Iv �ti�o p ��a� I n
W D i
o O
z C
m2N`�' m w 0 rTl m mX m ovrTl
k
CA> —h ~o c .T �Ul � I y
mm�m 3 O m 7v — Z m
m��� � � � = vr mp ' II
- w c� m p z 0 A
CcD o -I' cnC � 3 z � O p z ^0 0 _
m v O Z �o m > 0 C/- In
I -� o
-+ fT 1 > C 17-r 3 C) .po°
v Z � Z z z -o > 3 -s
v v q
m D
SOIL TEST LOG
DESIGN CALCULATIONS
DATE OF TEST: MAY 3. 2003
SOIL EVALUATOR: DAVID D. COUGHANOWR. RS
WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD
NO
TEST PIT I PARENT MATERIAL: P OGLACIALATER DOUTWASH SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS
ELEVATION - 51.42 +- PERC AT 58 in : 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL
CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
DEPTH SOIL USDA SOIL SOIL COLOR SOL OTHER
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
0-12 Ap LOAMY SAND 10 YR 3/3 NONE FRIABLE SOIL ABSORBTI.ON SYSTEM: A 14 ft x 10 ft x 2 ft LEACHING GALLERY. CAN LEACH
12-42 B LOAMY SAND 10 YR 5/8 NONE FRIABLE A b o t - ( 14 x 10 ) - 140 s f
Asdw - ( 14 + 14 + 10 + 10 ) x 2 - 96 sf
42-132 C MEDIUM - 10 YR 6/3 NONE FRIABLE A t o t - 236 s f
COARSE SAND Vt 0.74 x 236 - 174.64 GPD
USE TWO 14 ft x 10 ft x 2 ft GALLERIES. Vt - 349.28 GPD > 330 GPD REQUIRED
GROUNDWATER
ADJUSTMENT
EXISTING GROUNDWATER LEVEL LEACHING GALLERY
BASED ON BARNSTABLE GIS
DEPARTMENT RECORDS
OBSERVED GW: 21.0 CONSTRUCTION DETAIL
INDEX WELL: MIW-29 �DRYWELL UNIT STONE
ZONE: D \ 8•-6•X 4•-10"X 2'-9'
READING: APRIL 2003 2 h EFF. DEPTH
LEVEL: 6.2 14.0 f t
ADJUSTMENT: 0.8 ft
ADJUSTED GW: 21.8
N
NOTES
O v O
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 2.75 8.5 2.75
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 14.0 ft NOT TO
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES -- SCALE
BEFORE EXCAVATING FOR SYSTEM.
5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM,
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. GAIL D. MARCUS
II) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 30 ELAINE ROAD WEST HYANNIS. MA
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 43 TRIANGLE CIRCLE SANDWICH MA 02563
ETE-1413 MAY 6. 2003 2/2