HomeMy WebLinkAbout0062 FAWCETT LANE - Health 62 Fawcett Lane
Hyannis
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LOCATION.16 t 6u ee t}- h.��, SEWAGE#
VILLAGE 44,117 ASSESSOR'S MAP&PARCEL.;-2.q 6 U f-1_
INSTALLER'S NAME&PHONE NOegi & adsf ��SJ—
SEPTIC TANK CAPACITY /000 �F4I16A-�
Of
L/G ff`
LEACHING FACILITY:(type)�,/ /e0(sUS DF V (size)
NO.OF BEDROOMS 3
OWNER EJCM J 19/
PERMIT DATE: 2h y// s- 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
Fo---61
5
10
TOWN OF BARNSTABLE
LOCATION 1� ^ V:: JL iC 4 LOA P_ SEWAGE
IV
r `'ILLAGE ASSESSOR'S MAP&PARCEL �G' O/
INSTALLERS NAME&PHONE.NO.
SEPTIC TANK CAPACITY I`DO O
LEACHING FACILITY: (type)' r (size) (P
NO. OF BEDROOMS
OWNER
PERMIT DATE: 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) r Feet
FURNISHED BY
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' 7-7- c�
LOCATION SEWAGE PERMIT NO.
° e�7- /a3
VILLAGE
/'s(-,/V-,
INSTALLER'S NAME i ADDRESS
r�
eU4,lDER ON OWNER
DATE PERMIT ISSUED k
DAT E C 0 M P L I A N C E ISSUED
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No. v� � \` (/Cee lV a 1
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes `=- '
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pphCation for Misposa1 6pstrm Construction 3pPrmit
Application for a Permit to Construct( ) Repair(�pgrade( ) Abandon( ) ❑Complete System Kindividual Components
Location Address or Lot No. 2 fQ,y L!� 1� Owner's Name,Address,,and Tel.No.
Assessor's Map/Parcel 0 — v �J 40Wry 2 V'C, Z
Installer's Name,Address,and Tel.No. ( Designer's Name,Address,and Tel.No.
D
77y—Z;?—I rI
Type of Building:
Dwelling No.of Bedrooms Lot Size 2 1 z 7 Y Al sq.ft. Garbage Grinder( )
Other Type of Building ��'/� No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 a gpd Design flow provided ? gpd ,
Plan Date ?--� Sy L 2-'V/S'� Number of sheets Revision Date
Title n ) 1
Size of Septic Tank A6�fi /0-00 Type of S.A.S. c
Description of Soil je /y 77 y
Nature of Repairs or Alterations(Answer when applicable) ✓ (9 Ge (p 24'.X//-4
x 6 e S " IA-rvc-6 4.elg elm A�,
Date last inspected:
Agreement:
The undersigned agrees to ensure t construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 o Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Bo f ealth.
i e ' - JCS .� l� 1�°XY Date
Application Approved by Date y
Application Disapproved by Date
for the following reasons
Permit No. '—� Date Issued
Entered in comgutef. C
• `NO. An 10i
THE COMMONVIIE g Tf� (�F MAS$ACHUSETTS Yes .-Pe_.-
PUBLIC HEALTH DIVISION -�TOW1 OP,,BARNSTABLE, MASSACHUSETTS
4plicatlon for Disposal *pstrm Construction 3perm t
Application for a Permit to Construct( ) -Repair( pgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. Z f-a y, / L r^� 1d -Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel V C Z
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
741
Type of Building: j
Dwelling No.'of Bedrooms Lot Size Z y` 3 y Ll sq.ft. Garbage Grinder( )
Other Type of Building S No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 a gpd Design flow provided ' 9-7 gpd
Plan Date Z SV L ZSo� Number of sheets Revision Date °r
'Title•.._. ""'-;"�
Size of Septic Tank /or0
Description of Soil y 77 y f a r
r
Nature of Repairs or Alterations(Answer when applicable) ✓ (6 f, &C p_e (,k i - 4-r.Y-ti 2 4•K
Date last inspected:
Agreement:
The undersigned agrees to ensure tL
intenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 o e and not to place the system in operation until a Certificate of
Compliance has been issued by this Bo of (' ie &0!� �A,4F Date
Application Approved by Date y
Application Disapproved by
Date
PP PP
for the following reasons
Permit No. Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
o Certificate of Compliance
THIS I :TQIIRTIFY,that thrOn-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( ) i
Abandoned
at dr-Z Fa4,,Ce_W L a+ 9,M AAv has been constructed in accordance y
with the provisions of Title 5 gd the for Disposal,System Construction Permit No� r Z� 0' dated
Installer CC_ .P Designer
#bedrooms Approved design flo! gpd '
The issuance of tthi peerrinit shall not be construed as a guarantee that the system wi fun ron as de igned. e
Date { 7'�t�- Inspector /
---------------------------------------------------------------------------------------------------------------------------------------
No. fir' Z 7 Fee
--THE-COMMONWEALTH.OF MASSACHUSETTS , .
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction JPrm[t
Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( )
System located at (/-C—f �Gu✓ �1 444 A•wJ
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
ti
Title 5 and the following local provisions or special conditions.
i
Provided:Construction must beltompleted within three years of the date of this ermit.
i
Date Approved by
l
of Barnstable
Regul .,yry Services
Richard V.St jnterint Director
Public Health Division
Thomas McKean,Director
200 Male Sheet,Ryaanls,MA 02601
Office: 509-862-4644 Fax: 50&790-6344
Property Address: l La w e., 1'fy •a i, ,�
Assessor's Mapwarcd:
Property Owners Name: T o► C v f�+vr al r; ut ��
In accordance with Massachusetts DEP alternative sstm approval letters, the lbllowing certi0cation
information is required by the Owner of record. Thu Owner of record met place an `V in the
applicable box next to each line certifying the information.
YesMA
1V ❑ I have been provided a copy of the Title 5 IlA technology Approval letters.
(15 page Standard Conditions letter and the specific technology letter)
EK ❑ I have been provided with the Owner's Manual
❑ 211 have been provided with the Ope Won a A Maintenance Manual
❑ For Systems installed under a Remedial Use Approval,I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(l 0)
and the Approval
For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to
provide written notification of the Approval to any new Owner,a3 required by
310 CMR 15.287(5)
If the design does not provide for the use of prbage grinders,the restriction is understood
and accepted
w n Whether or not covered by a waminty,I understand the requirement to repair.replace,modify
or take airy other action as requirod by the Departtm t or the LAA,if the Department or the
LAA determines the System to be failing to protect public health and safety and the
environment,as defined in 310 CMR 15.303
40 — -a( vG to fly with an tenu and conditions above.
Property Owners printed fime,7
Propthy Owners 54VOMe Deg
Note. This 1brm must be sI&Mtted along lath the Se Worb
Q:►sw�hormeamw QWt1A0afiWL4 sc
gown of Barnstable
,*utatory Services
low
St. Thomas F Geiler,Director
ELAWMAMM = Public I MAM alth Division
.`� Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: Sewage Permit#;O/f- Z?$ Assessor's Map/Parcel `� ® /®
Installer&Designer Certification Form
Designer: �- > P� Y�f. Installer:
Address: �4,5&_ M.4. Address: 3z- Xivtke
On was issued a permit to install a
(date) (installer)
septic system at r�vCe H �►;f based on a design drawn by
(address)
la� ✓i t j �v,.,� �Z. dated 7/ l�
(designer)
certify.that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory. e--� A J' ;�-410%. 4- lOv°0 kw f 114 ,
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State&.Local Re ulations. Plan revision or
certjfied as-built by designer to follow. Stripout(if regj ected and the soils
we found satisfactory. "4 OFM4
1C
XAM
1
stal er' gnature) '�' F
io.1070
rt `
(Design s ign ture) (Affix De p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH-THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice formAdesignercer ificaton form.doc
�,►tE t�
Town of Barnstable P# 14
.
y` Department of Regulatory Services
: .A,,'� Public Health Division Date 121 /15MASSL
�a
039.
39. 200 Main Street,Hyannis MA 02601 "`'/► " "
raM
��.7"9
Date Scheduled d '2 Time ( Fee Pd. 1,3
qi, �
Soil Suitability Assessment for Sewgge Disposa
Performed By: &"`^� Witnessed By: w d d� I
vtIFO LOb TO .
Location Address Owner's Name Od 1-1 vi✓C y'
_
}�yQ11 Address&o .qN�/
Assessor's Map/Parcel:/ �w -� d�d Engineer's Name ld l�� r�� j ,9 119.
NEW CONSTRUCTION REPAIR Telephone# �� O? q(o%
Land Use 104, ll�a. / Slopes(%) V/ Surface Stones- ti°
Distances from: Open Water Body �U� ft Possible Wet Area e//� ft Drinking Water Well -/-ft
Drainage Way ft Property Line Za ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole. Weeping from Pit Face
Estimated Seasonal High Groundwater 14
MUM . ATION "( Yt EAS.O JAT : Ili WATER TA
Method Used ��/tG(r�• ���d''
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: _ in. Groundwater Adjustment ft•
Index Well# Reading Date: Index Well level . _ Adj.factor_-__--_._ Adj.Groundwater Level
rEOOLAT
ION TEST 1Dute 'lima
.� .
Observation
Hole# / Time at 9"
Depth of Perc Z-ID d Time at 6"
Start Pre-soak Time @ (0^,U 0 Time(9"-6")
End Pre-soak Q
f` Rate Min./Inch. L Z
Site Suitability Assessment: Site Passed �- Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back--------
***If percolation percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning. Q �S
Q:\SEPTIC\PERCFORM.DOC � v
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
z
3 -Z
�1 lf4 yo
10G-/Z6 C Z &J15 €s
410
DEEP OBSERVATION HOLE LOG Hole# y
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
`o),f� l�
ZtsA
l o IW C ?,� aa;lf� � Zr 7 Rio
OEEP OBSERVATION HOVE L;OG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
DEEP OBSERVATION HOLE LOG )Tole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) (Mottling (Structure,Stones,Hou.lders.
Consistency, Gravel)
P
Flood Insurance Rate Mau:
Above 500 year flood boundary No_ Yes._
Within 500 year boundary No_ Yes
Within 100 year flood boundary No— 'Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? _ _W4
If not,what is the depth of naturally occurring pervious material?
Certification /
I certify that on Mil,J (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required tr n ,experti d experience described in 310 CMR 15.017.
Signatur - Date
_7ZWO
Q:\SEPTIC\PERCFORM.DOC 1
I
� 0
DATE 7/12/06 .
PROPERTY ADDRESS 62 Fawcett Lane
Hyannis
MA 02601
On the above date, the septic system at the address above was
Inspected.
This system consists of the following:
1 1-1000 gaQ2on set.ic tank.,
2.1 1-6 'x10' 9.Qock ce,3.3pooe.,
Based on inspection, I certify the following conditions:
3.1 7h.Ls .is a 7.i.Ue Five. Se/?tic .system (Wode)
4.1 SeRz-ic system .is .in /2/z0/2ea wozk.ing oadea at the
/22esent rime.,
SIGNATUR '
Name: Robert A. Paolini
Company: Joseph P. Macomber & Son P. Macomber & Son Inc
Address: P. O. Box 66
Centerville, Mass 02632 M" _
Phone: 508-775-33.38 or 508-775-6412
JOSEPH P. .MACOMBER & SON, INC.
Tan ks-Cesspools-iLeachfields
Pumped &.Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 026.32-0066
775-3338 775.6412
•
•\ COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
;DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—.NOT.FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART-A
CERTIFICATION -
Property Address: ., 62 Fawcett Lane
Hyannis MA 02601
Owner's Name: Ermo Rodriquez
Owner's Address: Same
Date of Inspection: 7/1 2/0 6
Name of Inspector: (please print) Rob rt A F o.l''a
Company Name:-.g. %.Aa.cogge/i S:o.n Lne.
Mailing Address:
en Tesv,.c e, rl a6.9..026 32
Telephone Number: 5 0 8-7 7 5 3 3 3 8
CERTIFICATION STATEMENT .
I certify that I have personally inspected the.sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in.the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section.15340 of Title 5(310 CMR M000). The system:
XXXPasses
°Conditionally Passes
Deeds Further valuation by the Local Approving Authority
F it
Inspector's Signature: Date:
6
The system inspector shall submit a copy of this inspection report to the.Approving Authority(Board of Health or
DEP)within 30'days of completing this inspection.If the system,is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the
DEP.The original should be sent to-the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
""This report only describes conditions at the time of inspection and under the conditions of use at that
�. time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION:.FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 62 Fawcett Lane ,
Hyannis MA 02601
Owner: Ermo Rodriguez
Date of Inspection: 7/1 2/0 6
Inspection Summary: Check A,B,C,D or]E✓A4WAYS=eomp1ete all of Section:D
A. System Passes:
NO I have not found any information which indieates'that-any of the failure criteria described"in 310 CNM
15303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
Set is .system �� in 122o12ea woick�rtq o2de2 at the �2ezent
t tine
B. System Conditionally Passes:
NO One or more system components as described in the"Conditional'Pass":section need to be.replaced.or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not.determined(Y,N,ND)in the for the following statemen
explain. ts.If"not determined"please
No The septic tank is metal and.aver 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 tanks approved by.the.Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
NO.
Observation of sewage backup'or breakout or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection-if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distriOution box.is leveled'or replaced
ND explain:
NO The system requited 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) �P
are laced
obstruction is removed
ND explain:
2
f
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 62 Fawcett Lane
Hyannis MA 02601
Owner:. Ermo Rodriguez
Date of Inspection: 7/1 2/0 6
C. Further Evaluation is Required by the Board of Health:
No 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:
No �'Y
or cesspool privy is within 50 feet of a surface water
P P
No Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
No 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.
No The system has a septic tank and SAS and the SAS is'within a Zone 1 of a public water supply.
No The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well.
No 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 visual z.._.
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page.4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A .
CERTIFICATION(continued)
Property Address: 62 Fawcett Lane
Hyannis .MA 02601
Owner: Ermo Rodriguez
Date of Inspection: 71121 0 6
D. System Failure Criteria applicable to all systems:
You must indicate"yes".or"no"to each of the following:for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded.or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ound or surface waters due to— — gr an overloaded or
clogged SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than..6"below invert or available,volume is less than May flow
X Required pumping more than 4 times in the last year.NOT due to clogged or obstructed i e s .Number
— � PP ( )
of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X .Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply:
X Any portion.of a cesspool or privy is within a Zone I of a public well..
_.X_ Any portion of a cesspool or privy is within.50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.[This system:passes if the well water-analysis,
performed at a DEP certified laboratory,for coliform bacteria.and volatile organic compounds
indicates.that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered:A copy of the analysis must be attached to this forms,]
No (yes/No)The system fails.I have determined that one or.more`f the above failure.Sriteria 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 101000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to.each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 62 Fawcett Lane
Hyannis MA 02601
Owner: Ermo Rodriguez
Date of Inspection: 7/1 2/0 6
Check if the following have been done.You must.indicate"yes"or"no"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks ?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this.inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out
X _ Were all system components,excluding the SAS,located on site?
X _ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?' _
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
y Existing information.For example,a plan at the Board of.Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSA)i_,:SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 62 Fawcett Lane
Hyannis
Owner: Ermo Ro a7riguez.
Date of Inspection: 7 1 2 0 6
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example:,110 gpd x#of bedrooms):
Number of current residents: unknown
Does residence have a garbage grinder(yes or no):n o
Is laundry on a separate sewage.system_(yes or.no):n o [if yes separate inspection required]
Laundry system inspected(yes or no):n o
Seasonal use:(yes or no):&Q 2 0 0 5_712 5.10.0 ga e i o n s g D=19.i 5 2
Water meter readings,if available(last 2 years usage(gpd)):2 0 0 4=712 5 o 0 0 ga.e.e o n s G%D_-19.' 5 2
Sump pump(yes or no):n o
Last date of occupancy: /2 e h e n t
COMMERCIAL/INbUSTRIAL.
Type of estabWlut ent: NIA
Design flow(based on 3l0 CMR 15.203): gvd
Basis of design',flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records N��!
Source of information:
Was system pumped as part of the inspection(yes or no):_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
ob_tained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Appro ate age of all components,date installed(if known)and source of information:
�t yea/tz
Were sewage odors detected when arriving at,the site(yes or no):n 0
6
Page 7 of l 1
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION'(continued)
Property Address: 62 Fawcett Lane
Hyannis MA 02601
Owner: Ermo Rodriguez
Date of Inspection: 7/12 0 6
BUILDING SEWER(locate on site plan)
Depth below grade: 1811
Materials of construction:_cast iron X 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
loin; z aR pea2 .t.igh.t.4o eeakaae.i Vented th2ough houae vent.,
SEPTIC TANK:y_"(locate on site.plan) 7000 ga i e o n.3
Depth below grade: 12"
Material of construction:X_concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 8' 6"X5' 8'X4' 10
Sludge depth:_ taace
Distance from top of sludge to bottom of outlet tee or baffle: tea ce
Scum thickness: t a a c e
Distance from top of scum to top of outlet tee or baffle: tea ce
Distance from bottom of scum to bottom of outlet tee or baffle: t as ce
How were dimensions determined: m e a z u 2 e d
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
21imn fnnk o>>o 1 2 uonn.t_ TnCgt P,' 01119,2t ia,26 aaa in :—� C66S4i
Tank .iz .6tauctu2aRy sound.,
GREASE TRAP,: N0(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom_ of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Gaeaze taap .ie not ?2ezeat
7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address: 62 Fawcett Lane
Hyannis MA 02601
Owner: P.rmn Rnriri g»P7
Date of Inspection: 7/1 7 /n 6
TIGHT or HOLDING TANK:NO (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explaui):.
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes.or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
7igh.t oa hoid-incg tanks ate not /sae-6eni
DISTRIBUTION BOX: NU (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.
Diztaigu ton lox .iZ not /12eZent.,
PUMP CHAMBER: NO (locate on site plan) �.._.
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
P umN ehamge z .ins not /2aezeat
8
Page 9 of I I
OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 62 Fawcett Lane
Hyannis MA- 02601
Owner: Ermo Rodri uez
Date of Inspection: 7 12 0 6
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS?of loc fed explain why:
oca ed zee/zagL 10.,
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
_ overflow cesspool,number: I_
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.):
Loamy .to medium .sand., No z i .
ayo Vegetatzon iz no zmaio
CESSPOOLS: y e'-3(cesspool must be pumped as part of inspection)(locate on site.plan)
Number and configuration;
Depth—top of liquidto inlet invert:
Depth of solids layer: 0 =
Depth of scum layer: 0
Dimensions of cesspool: Q 10
Materials of construction: P i')Q k A
Indication of groundwater inflow(yes`or no): no
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: No (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.):
P,TiVy 1,3 not PTeben.t —
9
r
Page 10 of 11 J
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE;DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address: 62 Fawcett Lane
yannis,..MA OM1
Owner: Ermo Rodriguez
Date of Inspection: 7/1 2/n F
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent refertff&e landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
LJ a M d r
k
/ O o A
I a
31
j
Q
C . ,00
10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 62 Fawcett Lane
Hyannis MA' 02601
Owner: Ermo Rodriguez
Date of Inspection: 7/1 2/0 6
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater O feet
Please indicate(check)all methods used to determine the high ground water elevation:
-NO Obtained from system design plans oh record-If checked,date of design plan reviewed:
u e z Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain: A 0.a p f c a 2 d
no . Checked with local excavators,installers-(attach documentation)
®ccessed USGS database-explainAtt/2 r t o wn.19aanzt a 2a.,ma.,uz
%— You must describe how you established the high ground water elevation:
11,3ed • Cape Cod Comm.iz.ion ldate2 7agie Cohtou4z And %ugiie Ugte2 Suppiy
Oeii head 121toteet.ion aaeaz mal2 , Sel2t 7995
ldatea aesouacez o-Lice cage cod eomm.c,3.ton --
-ftp of Ground
Leaching
Pit feet
Groundwater eet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore,the vertical separation distance between the bottom
Of the leaching pit and the adjusted groundwater table is
feet. .Z
11
• �i
'I'UWN OP BARNSB•LE. BOARD QF 11$A1LT11
��TA_ �_.._.r
190SURFACR MAUS DISPOSA4 SYM,14 INSPECTION FORM - PART D CERTIFICATION
«. .r•tMtrt�tnt'ts�r+R+nw•wn�r40 —40 tonIn.
��t•« '
-TYPE on PRINT 0113410-
PRO.PERT y Msprl OT.&D
STREET ADDRESS "62 Tawceett Lane Hyannis 02601 �
ASSESSORS MAP, BLWK AND 'PARCE'L
OWNStrs NAM
E Ermo=Rodri uez
.,
PART'.' D 08RTIFI0ATX0N
NAME *OF INSPECTOR
Robert A':Paoli.r
COMPANY NAME
COMPANY ADDRESS f'..DO lox .66' zxt vil3.e MAr32-0066
str• y Town-or City. StaLR• L1P
COMPANY TELEPHONE 508. Q7.5 3338 FAX 508-.1790 f578 .
CERTITICATION. STATEMENT
I certify that I ha •vo personal-I' 1,ns-pected .•the aewage 'digpoea`i. system at
this address and that-lbe information reported .is true,. aoofta•te•, and
omplete as of the time .cRf�inspeetion.t• The in$peotiorn was per-formed and any
recommendations regarding upgrade., .ma•intenance,' abd repair .afie• eongis'tent
with my trainip,g and eXV. rience in the proper futrc.ti.•on' and maintenance of on-
site sewage disposal systems t
Check one:
A47stPASSID
eid ,
The inspection whic.M J. have -conducted has .,n.ct •found any information .
which indicates that. the system' fails to * aded�tately. protest .public
health or the envi.ropment as defined in .310 CMR. 15':30.3.r -Any failure
criteria trot evaluated* are as stated in the FAI'LURV CHI-TWA :s�eatJa�n of
this, form.
System FAILED*
The inspection which I have ootid ted -has found that the system fails to
protect the public health and the enV4roninen•t ' in accordance with Title
61 310 CMR 15 t 303, and as - specifically noted 'on -PAT-0 -. FAILURE
CRITERIA of this inspectti9n .• rmt
Inspector signature' Date D
ne copy of this certi,f i�.c�tt•i�ah Mu P Must •be rovided 'to the •QWN R, the BUYER
where appli.aable) and th0 I gARD OV HEALTH ..
* If the inspection FAIL•Eb,, 'thb .owno$'.9r"'gperator whiLl3R the eyetem•
within ene year of the da't•e of the inepeation, unless. allowed Qr- reg4,red -
n t.hArw{se. as Provided in ;110 CMR 15 ,306 .
SITE PLAN CROSS-SECTION Al N
�y
SCALE: 1 "=20' Standard ChamNot tobS rail Bed Detail
BENCH MARK ON CORNER OF GARAGE O he
ASPHALT APRON ELEV.=50.00' (ASSUMED) �0 P 53.15' Mound for Proper Drainage Establish Vegetative Cover eery
d e t eat , I
e a aVelY1. ' ' . ` _�,'', I �. ,;r�� �,Topsolr �ctii_ .,,•��,'" ��' .i- 1; I
12' Min. 36' Maximum a, D•
'•fJntive Hnckflll or,?'
DAI E
0
N
�y:, ',rr,:• �.+!;"' ••Select Flll (Title ••5•; '•+, ff
3
3'
0•
�r
•M,+s
N
SITE
O O
;: WEST
.�� T 12' MAIN SIRE
ET
6.5
OT 103 _
A.=2 ,344 sq.ft. f 34• -�
11-4' LOCUS
OO -EUSE 4 ROWS OF 4 STANDARD CHAMBERS
�� �. GENERAL NOTES NO SCALE
115
�� 51.30'
1. ADDRESS: #62 FAWCM LANE, HYANNIS, BARNSTABLE, MA
Q ::::::: F a0 2. ASSESSORS NUMBER: MAP 290 PARCEL 010
.:... °� O �� 3. DEVELOPER'S LOT: LOT 103
4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN
c 51 O ON THE GROUND INSTRUMENT SURVEY.
52.00 C) c� 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES.
!� 6. REFERENCE PLAN: L.C. PLAN 22825-P (SHEET 2)
O� 7. NO WETLANDS ARE LOCATED WITHIN 150 FEET OF THE PROPERTY.
o OFX�Sr/ /,. 00 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS.
9. UTILITIES WERE LOCATED BY DIGSAFE #20152914699.
/w / F�� AN'G/ Existing CH PIT 10. THIS DESIGN PLAN SHALL BE USED FOR SEPTIC INSTALLATION PURPOSES ONLY.
Gi
Design Calculations
55.54' ;....w. x 50 Number of Bedrooms: 3 EXISTING
°o Garbage Grinder: NO, GRIgDER NOT ALLOWED WITH THIS DESIGN
V. GO
A " PROPOSED SAS Septic Tank Capacity Recuired: 330 gpd X 200% = 660 gpd.
2 10�0 24'-01 X 11'-4"W X 6.5"D leaching Septic Tank Provided: USE EXISTING 1,000-GAL SEPTIC TANK
9B_g a field using 24 STANDARD Infiltrator Chamber Leaching Capacity Required: 330 Gal./Day
53.89' slob of^k D-H° o ' with no stone. Observation ports Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. (Class I Soil, LTAR=0.74 gpd/sq. ft.)
or n� to be provided, as shown. Leaching Area Provided: 4 Rows of 4 STAND',R!) Infiltrator Chambers in 24'L x 11-3"W x 6.5"D SAS
Leaching Area Provided: 24 lin. ft x 4 ROWS =96 lin. ft. x 4.73 sq.ft./lin ft=454 sq. ft.
55 54.81'' Bran tp� 5N Total Leaching Capacity Provided: 454 SQ.FT. X 0.74 GPD/SQ. FT.= 335 gpd > 330 gpd. req'd.
M. TH #1 DESIGN NOTE: IF THE STANDARD INFILTRATOR CHAMBERS ARE NOT
50.72 AVAILABLE, QUICK4 PLUS STANDARD (5.3" INVERT) CHAMBERS MAY BE
`
❑. r USED BY PROVIDING 4 ROWS OF 6 CHAMBERS (SAME EFFECTIVE LEACH AREA).
,o
a :.
CONSTRUCTION NOTES
TH #1 1. Contractor is responsible for Digsafe lotification
and protection of all underground v (ties and pipes.
50.82' P 9 P P
+ 2. The septic tank annj distribution br' shall be set
;;•;'w;:;: ��} + u level on 6" of 3/4 -11/2 stone.
.. o .. 3. Backfill should be clean sand or gravel with no
+ + RFA r
(� stones over 3" in size.
+ + SERA , - SF 4. This system is subject to inspection during installation
+ ?� +7 A•A + �� by Glen E. Harrington, R.S.
+ 5F +�� L� T C CT Q, C (1 I I �\'A I I A T I 0 ! 5. The contractor shall instr" tf!ie ;,Ystem in accordance
�fk +wFjO -- _�I I L�� I �51 L i i- t-rvL�.JYr I I V with iltle v of the Massu�,iusetcs Environmental Code
�_w and the Regulations of the 'town of BARNSTABLE.
53.92' + Date of Perc. Test & Soil Evol.:July 22, 2015
Test Performed By. Glen E. Harringtom, R.S. 6. Provide a Wiggin Precast H-20 •`4-5 D-Box and
WITNESSED BY: David Stanton, R.S. Agent 24 STANDAR, Infiltrator chambers •.h TWO end sections per row.
-�J P "ONVENTION, RL--ERVE S S CAN BE 53.34' EXCAVATOR: Scott Campbell, Cardinal Construction 7. No vehicle r heavy machinery shau drive over the
CC �STRUCTED ON THE PROPERTY PERK RATE: LESS THAN 2 MPI in C1 a"er 24 gals applied. septic system unless noted as H-20 septic components:
G 8. Install gas baffle or equal on seF : tank outlet tee end.
•�j 9. All existing L erts and site conditions shall be verified by contractor.
Test Hole Test Hole 10. The Infitr,r..ol chambers shall be installed according to the manufacturers installation requirements.
NO. No. 2 11. Install 4" diameter PVC pipe as observation port within 3" of grade, as shown.
12. If, during installation the contro'-'or encounters any soil conditions or site conditions that are different
53.89' DEPTH SOILS ELEV. DEPTH SOILS ELEV. from those shown on the soil I-g or in our designthe installer shall halt installation and immediately
notify Glen E. Harrington, R.S.
53.38' x A A 13. Designer not responsible for undocumented septic components.
/ Foamyy.and loamyy.and 14. The existing LEACH PIT sh6 be pumped and abandoned.
10YR5/2 10%/2
3" 50.47 4" 50.49
!/ H
Bw Bw ALL 0 i�"i" F,PE FROM I'HE
loamy wad loamy wad �3STi�'.3i)Tit3f� ':,�K 43.9R1.€. 131: __.
10YR5/6 10YR5/e SET LEVEL FCR AT LEAST 2 FT� r.xi..... 16•'
47.22 24" 8.72' 22" 1 147.99'
V mod wad mod
wad I :y.y1......
off, ` s fl'tli1,ET
25Y5/4 25M/4 6. `� `, KNOCKOUTS ��'`.•.� ` V �i E�
106" 41.89' 104" 42.15' r iNL T
C2 c2
45.7^
aoarw wad coarw wad / a ^'-....... •.... p
25Y7/4
4�,• 1 0• » 40.22 40.82 P�. rty Y'...•3' § .7 :�_ ".............. ...
»
NO GROUNDWATER ENCOUNTERED ..._.
PERK TEST P14774
_ .... ._, ll...,.., . < < s'..:� a :...:...• Ic�r.
2 �+dLef DEPTH: 42-60" LE DI`�TRI��...ITIOf'�•� BOX
t°W`� BEGIN SOAK: 00: 00
NOT TO SCALE
54.07' END SOAK: 06: 30
ABLE
UISE <2 MPI FOR CLASSUN O SOIL, LTAR=0.74 gpd/sf PROPOSED SEPTIC SYSTEM REPAIR
PREPARED FOR
Existing House CARDINAL CONSTRUCTION
LEGEND AT
house to se
y 10' min.septic tank from *NOTE: ALL PIPES ARE TO BE 4" D6,4. SCHEDULE 40 P.V.C. O EXISTING LEACH PIT #6 2 FAW C ETT LANE
.•
USE WIGGIN Provide 4" SCH 40 PVC TO BE PUMPED AND ABANDONED
5 HOLE H-20 observation port 3" below grade a ° (HYANNIS) BARNSTABLE, MA
GARAGE DIST. BOX Sv`15 EXISTING 1,000-GAL
SLAB EXISTING GRADE ELEV.=50.7 t OR EQUAL Finished grade over system=2% slope away Existing Grade Elev.- 't H-10 SEPTIC TANK
BSMT FL. ELEV.=50.0'f . Tank covers shall be D-Box cover shall be 2- min. DENOTES EXISTING CURRENT OWNER: E R M O R O D R I G U E Z ET U X
S = within 6" of finished grade within 6" f finished grade 6" max. X 104.46 SPOT GRADE
APPROX. Inv. elev. 0.02' ft. _ Elev.=47.9±
Level fcr 2' g=0.01'8' EXISTING - /ft.
1,000 GAL. 9' 95 EXISTING CONTOUR �pl��Mgs PREPARED BY:
Inv. eev= _ 10' Invert Elev.-47.43' S,q
SEPTIC TANK v lev.=47.79' DEEP TEST -OLE C� Glen E. Harrington, R.S.
Inv. eler.= 47.70' 6 5" ��GAS BAFFLE � �:nv. elev.=47.53' of Leach .'1, 9 Leda R o =- Lane
I 24'_ Facility Elev.=46.89' ApprOX, IOCatIOn
6" OF 3/4"-11/2" STONE existing water line � � Marstons Mills, MA 02648
6" OF 3/4"-11/2" STONE 6.T PROVIDED (5' RECI' '�ED) O Tel: 774-238-1813
_ Approx. location 9� 4�
m Test Hole #1 EI.=40.22' existing as service S',q 016-T , I�a,/ EMAIL: GHARR88®HOTMAIL.COM
SYSTEM PROFILE g g MrrAR
Not to Scale LEACHING FIELD Observation Port
o 1"=20' DRAWS BY: GEH DATE: 27 JUL 2015
0c.o. Clean Out DATUM: ASSUMED FILE: CampbellFawcett SHEET 1 OF 1