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HomeMy WebLinkAbout0014 ELIS DRIVE - Health 5 {14ELIS:DR r��'��HYANNIS�, �. ;, •,,�, ,.�z =.N 270-►226' R N 9 A 'I C- IO'JVN OF BARNSTABLE LOCATION 1�2LC SEWAGE # -?00I SS VILLAGE I�VAbvrvi S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. R6 6K)Sow R-fJk C 77$,-�c7 7J , SEPTIC TANK CAPACITY 1560 LEACHING FACILITY: (type) (size) i 3 e-a SA a NO. OF BEDROOMS 3 "BUILDER OR OWNER .TntiYv Q ikO l--i4S PERMITDATE: 911I /0 ( 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 C I M v lam► .a 1 r i Commonwealth of Massachusetts ip Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive I - Property Address tea Ann Ahokas s' Owner Owner's Nam information is H annis MA 02601 8/6/2019 required for every y 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:out Men en fillip out forms A. Inspector Information bj 11Yoy1 on the computer, use only the tab Patrick Rutledge key to move your Name of Inspector cursor-do not Title Five Specialists use the return key. Company Name 22 Taft st Company Address Dorchester MA 02125 City/Town State Zip Code 5082374628 S141198 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. M Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 7/10/2019 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the f 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. t5i doc•rev.7/28f2018 �P Tdle 5 Official Inspec[im Fartr Subsurface Sewage DPI System•Page 1 of 18 I_ I / Commonwealth of Massachusetts Ip Title -5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 - rage- Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary:Complete 1,2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): 6insp.doc-rev.7/W2018 Tdle 5 Official Inspection Form Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts �a ,ie Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 Inge- City/Town state Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cunt.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurfaoe D'Sevo a g �sPosal System•Page 3 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page- City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health(and Public Wafter Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: I ` ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ 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 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 must be attached to this form. c. Other: t 4) 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 dogged 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 t5insp.doc•rev.7/262018 Title 5 Official Inspectim Form SLbsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -14 Ellis Drive , Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page. City/Town state Zip Code Date of Inspection C. Inspection Summary (coat.) 4) System Failure Criteria Applicable to All Systems: (cunt.) Yes No 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 Y2 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. J Any portion of a cesspool or privy is within a Zone 1 of a public water'supply ❑ ® 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.] r " ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑s The system f i s. 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,006 gpd to 16,000 gpd. For large systems,you must indicate either"yes or"no'to each of the following, in addition to the questions in Section CA. y Yes No ❑„ ❑ the system is within 400 feet of a surface drinking water supply •,4 , 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 t5insp-doc•rev.712612018 Title 5 Official Inspection.Form Subsurface Sewage Disposal System•Page 5 of 18 f � ; y Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes'to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: t 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) Z ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. a ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rear.7@60018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Flame information required for every Hyannis MA 02601 8/6/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: . Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes X No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes Z No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): NA Detail: Sump pump? ❑ Yes No Unknown Last date of occupancy: Date } t5insp.doc•rev.726Y2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title�. � 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 - page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 2. 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 ❑ Na Water treatment unit present? ❑ Yes ❑ No If yes,discharges to: Industrial waste holding tank present? ❑ Yes ❑ No F Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No 4 If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official insp ection Farm Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): Approximate age of all components,date installed (if known)and source of information: 2001 Asbuilt Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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: >100 feet Comments(on condition of joints, venting, evidence of leakage, etc.): No leakage noted t5insp.doc-rev.7l26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owners Name information is required for every Hyannis MA 02601 8/6/2019 page- Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank(locate on site plan): Depth below grade: 1' feet Material of construction: concrete I® El ❑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: 1500 Gal Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness Orr Distance from top of scum 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? Comments(on pumping recommendations, inlet and,outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): No leakage, Baffles in place, liquid level with invert t5insp.doc-rev.7J26/2018 Me 5 Official Inspection Form Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts fi Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address f Ann Ahokas ' Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page. Cityfrdwn state Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: s feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.RMQ018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page- Citif Towm state Zip Code Date of Inspection D. System Information (cunt.) 8. Tight or Holding Tank (cont.) 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.): * 1 Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level 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.): Level, No solids, No leakage r M t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 rage- City/Town state Zip Code Date of Inspection D. System Information (cont.) 10. 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.): J *If pumps or alarms are not in working order,system is a conditional pass. 11. 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: 2 ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology. t5insp:doc:rev.7rXQG18 Title 5 Official Ins_ pection Farm Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page- Cityfrowm State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cunt.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): No hydraulic failurte,dry soil, No unusual veg 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t 1 t t5insp.doc-rev.7J2&2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 14 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page- Citylrown state Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7r4W018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 18 . II r Commonwealth of Massachusetts Ip Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 14 Ellis Drive Property Address Ann Ahokas Owner Owner's Name information is required for every Hyannis r MA 02601 8/6/2019 Page- City/Town state Zip Code Date of Inspection D. System Information (cont.) 14. 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 Tank A=34' B=24' DBox A=26' B=30' D Box Tank A B #14 Ellis Dr t5insp.doc•rev.Me/2018 Title 5 Official Insp ection Form.Subsurface sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts fi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address , Ann Ahokas Owner Owner's Name information is required for every Hyannis ' MA 02601 8/6/2019 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 9' 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 Ian reviewed: P , Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) J ❑ 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: Asbuilt at board of health J _ Before filing this Inspection Report, please see Report Completeness Checklist on next page: t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 14 Ellis Drive Property Address Ann Ahokas - Owner Owner's Name information is required for every Hyannis MA 02601 8/6/2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed&Dated and 1, 2, 3, or'4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included i t5insp.doc-rev.7128l2018 Tdle 5 Official Inspection Form Subsurface Sewage Disposal System-Page 18 of 18 r J - y �. <> LOCATION SEWAGE " 1I11 ;. WII.LAGE ti/ANIv 1 S ASSESSORS"MAP:&LOT ' y r: INSTALLER'S NAME&PHONE NO. Cla�i n)Sot-j 5c-.(J C r r HY� y r t SEPTIC.TANK.CAPACITY 1 SG O LEACHING FACILITY: (type) D2�!CSC�L S (sizej l 3 xa Sn s Sa ' NO. OF BEDROOMS . .3. V' - BUILDER OR OWNER--�T�ti.►v !� O,�}RS PERMIT DATE:_SC II'S IO 1 COMPLIANCE DATE: I o f a 3 O I a Separation Distance.Between the., Maximum Ad'usted Groundwater Table to the Bottom of Leacliin Facilrt Feet J g y Private Water Supply Well and Leaching Facility (If any wells* F ', on-site:or within 200 feet of leaching facility) Feet t Edge of.Wetland and Leaching Facility'(If any wetlands exist within;A0 feet of leaching facility)- Feet Furnished.by s h. r e No.—Zoo /J " Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pplitation for Di!6paol 6p$tem Con!Aruction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 14 Elis Dr. , Hyannis Lillian Ahokas Assessor's Map/Parcel 1 0 J ? z-6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Craig R Short P O Box 1089, Centerville P O Box 1044, S Dennis Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 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) Title-5 septic system to the plans of C R Short, consisting of a tank, D-box and 2 precast chambers with stone all around. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thisJ3,0prd Qf Healt4e-? Signed �' / Date Application Approved by 6-L, - Date Application Disapproved for the following reasons Permit No. 2-d-0 1-JI-1 Date Issued 1 " No µ ,/ Fee $5 0 , THE COMMONWEALTH OF MASSACHUSETTS Entered in com'uter.' Yves/' .PUBLIC HEALTH DIVISION - TOWN OF BAR NSTABLE.,'MASSACHUSETTS 01pplication for ]Dizpozal *potem Construction Permit Application for a Permit to Construct( .),Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 14 Elis dr. , Hyannis Lillian Ahokas Assessor's Map/Parcel v_ Z Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Craig R Short P O Box 1089, Centerville P O Box 1OA4, S Dennis Type of Building: f Dwelling No.of Bedrooms Lot Size s sq. ft. Garbage Grinder( ) Other Type of Building Ko. No. of Persons Showers( ) Cafeteri ( ) r Other Fixtures Design Flow gallons per day. Calculated daily flow g'a,llons. Plan Date Number of sheets Revision Date Title ; Size of Septic Tank Type of S.A.S. Description of Soil J Nature of Repairs or Alterations(Answer when applicable) Title-5 s_ptie system tb the plans of C R Short, consisting of ' tank, D—box and 2 precast cUlambers with stone all around. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi of Health.�'7 _ Signed l7� -Date-5 Application Approved by G• Date & Zr v / Application Disapproved for the following reasons Permit No. 7-dV/-;S_r j Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Ahokas Certificate of Compriance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded ( ) ,Abandoned( )byWm. E. Robinson Septic Service at 14 I~]_,; c Dr. , alranniS has been construct d in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No._2.40/-JT 9 dated 9; j J�Zo Installer Wm R Robinson r Designer Cry n l , ,�� nson -i. g The issuance of this permit shall not be construed as a guarantee that the syst6m will junction as designed. Date AJ ZI51 U 1 Inspector �i 6�yZ.l �J . r v N( 2 70 Fee$5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'WtZpOal *potem Construction Vermtt Permission is hereby ranted to Construct y g ( %)Repair( X)Upgrade( )Abandon Systemlocated at 14 Elis Dr. , Hyannis and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be c mpleted within three years of the date of this permit._,,,. Date: /�� Approved by OF 14-2001 09:A-R-Af,i FROH c;b!EF.lT ER EHG i HEER i HG Ti i 5087'301694 P.0 srzsio r � NOTICE- Thi&Form:Is To-Se Used For the Rep Of Failed Septic Sgswws.O PERCOLAXION VEST AiN-D SOIL.E-V-,,k U,,,j it7 F EMP'L'ION FORi't� I. p r 4C� �,.�'�o.-r`��bygn ea by me dated coccc-MT ing she Mul emy loe="t ".4� fallowing criteria: 4-- This failed syscem:is c:onn=edto a_ s,d t ti.J dwelli, g onl.�. oammemal or busiriess uses associated wi th c}te d:,vailirtg. ` The soil is classified a_s CT.kSS L and L« e-percoj 'On at is !t sc th,41, or e'.iva; t,O minutes perincst_ The applic-x1r,may usehi-storic.ai :,P a co c;1rcl.u:ry :ri$ fac: conduct prelimirtarr tests.st ttre site withoc:t a i1 :clil� W$=-r per.;-:s;t. '1`}tere is no increase in flow andlorchtu:g�;n use�rcpv�ed Thera a=no variances requested or[=decL T :V ha bottom of the Mposed.leachirg tc 1itY will OU)c l e i oca . 4 .7� t JLFi lean fc u !S yai (14) feet.sbQVC the maximurrr adjusted arou;ra water tablet nte., � s��. ��.djust ihC groundwater table using the Frirnptor-,netfio�;.w°he-n �4-7pl c,:b}e,l Pleasecarnplew the followingr A; Top of GroundStafh=G Elevatiotr(Usj;Tg, i info-- B) G-W. E1evadan 2 1_4-3ddj=rnent for high C.W. _ .Tef/y C��� .�,w r-9 is. .7 - n r n DffERENCEBETW A and$ . Z4, 7 SIGNED ; �-4d! DAM: h . I NOTICE _ $aserd upon the above info=atiorT, arepair permit wi11 be issued ,,Or -3 ber;,-Ua= maximum. No additional bedrooms areauthorizedin the future without eneineered septic system !ails. tr h" t:fUWM p=CaM TOTAL P.03 HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisholm �.;.. i. ,, Gnr : , �-+� !J; , BUSINESS: 775-1300 CHIEF •'•L� ,, w PL'.(1i�i Save ,�+..�t t"v EMERGENCY: 775-2323 l � To Town of Barnstable , Board of Health - T. McKean Town of Barnstable, Conservation Commission - From ; Fire Prevention Bureau, Hyannis Fire Department Subject ; The installation of above ground storage tanks . Date c Persuant to the applicable sections of 527 CMR - Fire Prevention Regulations , this Department has inspected the following location for above ground storage . ADDRESS 14 Ellis Drive OWNER/OCCUPANT Mrs. Ahokas PHONE 771-8063 SIZE OF TANK(S) 275 gal. Steel / Basement COMMODITY STORED • : # 2 fuel oil PURPOSE FOR STORAGE : Heating THIS INSTALLATION IS : PRE-EXISTING A REPLACEMENT X NEW This installation complies does not comply with the required installation regulation listed below. FIRE PREVENTION OFFICE For: PAUL D. CHISHOLM, CHIEF HYANNIS FIRE DEPARTMENT BENCHUM 20 FT, MINIMUM FROM CELLAR SOIL TEST TOP OF FOUNDATION DATE OF SOIL TEST tZ01101 10 FT, MINIMUM FROM SLAB OR CRAWL SPACE ELEV. = 100.00_ 10 FT, MINIMUM CLEAN SAND SOIL TEST DONE BY (ASSUMED) CONCRETE (OR FG.) WITNESSED BY _U A_______________ COVERS LOAM AND SEED OBSERVATION HOLE 1 ELEV.= 98.6 MIN. PITCH 1/8" PER FT. 2" LAYER OF _ 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE __<__?__ MIN./INCH AT 48_60 INCHES 1/8" TO 1/2" LEGEND: DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 9935 A b STONE EXISTING SPOT ELEVATION OOO 0-4" 0 FRIABLE NO UNSUITABLE 27" 4 CAST IRON PIPE . MAX.. 9t�.6 x MIN. MATERIAL EXISTING CONTOUR ----00---- (OR EQUAL) MINIMUM X z FINAL SPOT ELEVATION �.O 4-8" A LOAMY SAND 10YR4/1 NO UNSUITABLE L PITCH 1/4" PER FT. Q M FINAL' CONTOUR UNSUITABLE FLOW LINE "� 98.35 °i SOTILITY POLE OCATION� ® 8-30' B LOAMY SAND 10YR5/6 NO MATERIAL 10" ELEV. 96.1 ELEV: = 97.75_ '� MIN, ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ CI TOWN WATER �W�W §I -"""' / � 30- C MEDIUM SAND 2.5Y7/4 NO 96.50 2 0 ° ° ° CATCH BASIN `®� 132" GRAVEL ELEV. _ _ _ LEVEL ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ GAS LINE G ELEV. _ _9s 75_ BAFFLE ELEV. _ _�§�Q_ 6" SUMP ELEV. _ _96.00_ °°° ° ,° CLEAN OUT C.O. DISTRIBUTION ❑ ❑ ❑ ❑ ° 2 ° CESSPOOL C.P. Q ELEV. _ ° ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° ° ° LIQUID OUTLET BOX _fl�.6Q_ ° 00 _ ° ELEV, _ _93.60_ 4 FEET 14.INCHES DEPTH TEE (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED 2 500 GALLON DRYWELLS WITH 5 FEET 19 INCHES IF MORE THAN ONE OUTLET STONE IN AN 6 FEET 24 INCHES 1500 GALLO NO WATER ENCOUNTERED AT 1L ELEV. 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13 X 25 X 2 TRENCH FORMATION z WELL N A 8 FEET 34 INCHES SEPTIC TANK 3/4" TO 1 1/2" CLEAN REINFORCED CONCRETE SOIL ABSORPTION ;n NDEX OR FIBERGLASS FREE OF FINES &SSIILTE SYSTEM (SAS) ADJusT DESIGN CALCULATIONS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED PROBABLE WATER TABLE ELEV, _ _NLA 3 NUMBER OF BEDROOMS _ _ MIN. DESIGN WATER TABLE ( / / ) ELEV, = _ NjA _ GARBAGE DISPOSAL UNIT NOT TO SCALE BOTTOM OF TEST HOLE ELEV. = SZ$Q_ TOTAL ESTIMATED FLOW { 110 GAL./BR./DAY X 3 _ BR.) _. 4_ GAL./DAY REQUIRED SEPTIC TANK CAPACITY _16Q- GAL. ACTUAL SIZE OF SEPTIC TANK _1.500 GAL. SOIL CLASSIFICATION I__ DESIGN PERCOLATION RATE S_�`__ MIN./IN. EFFLUENT LOADING RATE _Dj_f_ GAL,/DAY/S.F. LEACHING AREA _477_ SO. FT. 4 (13X25)+(76X2) LEACHING CAPACITY (AREA X RATE) _ �2_ GAL./DAY 477 X 0.74 RESERVE LEACHING CAPACITY _�,[�_ GAL,/DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _ BARNSTABLE--__ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 33, 10 FT, OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE S.A.S. x 98.6 USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL G:6. BE MORTARED IN PLACE. 0 RFLo T' ,>y 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 20 PIT 10' DEEDED OR ZONING REGULATIONS, OWNER / APPLICANT IS TO MAN• ate' MAN OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 10' 18't 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR yr x 98.0 IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS 98.8 PRIOR TO COMMENCING WORK ON SITE. @H 8.8 GAR 7, CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 98V� SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION 2r oovnr 8,8 IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER TO�SnN of PIPE I / - IMMEDIATELY. C D 8.6 ( 8. PARCEL IS IN FLOOD ZONE ___C____. NC EC 98. 9. LOT IS SHOWN ON ASSESSORS MAP _270_ AS PARCEL _ 226 _. 98.3 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND 6 98.5 ; ' FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM X 97.8 X 98. NO GAS �yt, r ., AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255'. (3) R0 (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A,S, PIPE INVERT. 8.6 �0n �' you, '.' 1` ' 11. EXISTING CESS POOL & OVERFLOW PIT TO BE PUMPED AND REMOVED. `r t - 98.3 �- APPROVED: BOARD OF HEALTH 1 � � , 98.4 9a10 W ` � � V .- � 21 96 s8.o I �r 7`.�i DATE AGENT .9 2 97.8 PROPOSED SEPTIC DESIGN W FOR 98.2 JOHN_ AHOKAS W � 11 5 W 97.9 C DRI • t PROJECT LOCATI0i4 EIM DRI E�l J o vE 00'B6- BARNSTABLE, MA S m �BaRNSTaBLE SITE PLAN HIGH SCHOOL _ 2 O r ■ CRAIG R. SHORT J PROFESSIONAL ENGINEER r° Locus 5Q8- SOUTH DENNIS, MASS T 398-8311 02660 S. MAIN ST. � 11LTI GU ST 07, 2001 SCALE 1 " = 20' 98.4 REVISED JOB NO. 1_893 IN, X 99.3 LOCATION MAP REVISED SHEET 1 OF 1 02001 CRAIG R. SHORT, P.E.