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HomeMy WebLinkAbout0103 FAWCETT LANE - Health 103 Fawcett Lane Hyannis . P A = 269 078 r ti I i k { P c I o �{ a TOWN OF BA RNSTABLE LOCATION SEWAGE # :;Z�'D VILLAGE ASSESSOR'S MAP& LOT �IINSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 108© . P LEACHING FACILITY: (type) GG.ew�(size) 3'I® Q-2 1 fzv-NO.OF BEDROOMS 5 BUILDER OR OWNER -�w�`.L�\G-. �� 2 > PERMITDATE: S f (Ql r' 'a 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 g :t - �r. .r ,�.,.� e_ G 40 y TOWI��11OFj'BARNSTABLE LOCATION lo h SEWAGE # VILLAGE ASS.E�S,S�ORR'S MAP & LOT 2640c)-171 INSTALLER'S NAME& PHONE NO. 71M VOWe 1��j— SEPTIC TANK CAPACITY l000 LEACHING FACILITY: (type)�Z 5xg�2 4 � size) O n NO. OF BEDROOMS . BUILDER OR OWNER //.��/��✓' PERMITDATE: % �9" 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 leactung,faic�tL'ty,)_ r' ,� Feet Furnished by �/Ij �jQe�lJf 3 y , �v 7 , t Commonwealth of Massachusetts . Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 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 forms A. General Information �UUptI�Illtl/��� on,the computer,. \ VjN OF M9S�'i,�i use only the tab I .�`� �. •.. S, key to move your 1. Inspector: 9 cursor-do not James JAMES G James D. Sears '•u' use the return key. Name of Inspe or' so: EARS ca Capewide Enterprises,LLC *„'• n/�i„h 11 Company Name 153 Commeercial Street Company Address unt Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed(based on my training.and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000T The-system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i d� 3-26-13 ector'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 jb#WDER. The original should be sent to the system owner and copies sent to the buyer, If pa pticabie ai� =tfie approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspeggo%does not addresshow the system will perform in the future under the same or different conditions of us. dil�il t5ins•11/10 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Fawcett Ln. Property Address .Monica-DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described -in 310 CMR 15.303 or-in 310 CMR 1-5.304 exist. Any failure criteria-not evaluated-are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. 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): t5ins-1 Ill 0 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 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityrrown 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 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): i M -❑ 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: ❑ 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 t5ins•11/10 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 wM 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. City/Town 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 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 99 P ® 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 s less than 6" below invert or available volume is less than day-flow FC/Iiti6: t5ins 7 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 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. El ® 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—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. t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is Hyannis MA 02601 3-26-13 required y d for every page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal tank D Box and two 500 Gal Chambers Number of current residents: 4 Does residence have a garbage grinder? Yes No 9 9 9 ❑ Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2011-5,835 Gals 2012-116,703Ga1 s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present 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: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: galions 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 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: 2002 Permit# 2002 -421 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"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.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal Precast Sludge depth: 6" t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityrrown 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 24" Scum thickness 4" 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 14" How were dimensions determined? Asbuilt Tape-plan Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank and cover's at 1' below grade. inlet old type baffle, oulet tee, tank at working level. Tank to be pumped after inspection. 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-11110 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 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. City/Town 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M y 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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 is 16"x16"-18 below grade w/cover at 2"two line's out. Box issolidw/no sign of over loading. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal dry well chambers w/4'stone. 13'x24'x2'chambers are 2' below grade w/one cover at 1' 6 "water. No sign of over loading or solid carry over, wall clean like new. 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•11/10 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 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityrrown 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•11/10 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 w 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityfrown 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 13s,13- l 9 3 - ❑3 i t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells pd 10, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8-21-02 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on design plan 8-21-02 No G.W. at 10'. Bottom of leaching at 4'-6'. Bottom of leaching at 5'-6" above T.H. depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 Fawcett Ln. Property Address Monica DaSilva Owner Owner's Name information is required for every Hyannis MA 02601 3-26-13 _ page. City/Town 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•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form .1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /-% m Pro arty Address �} v ;5 ay-6 no Owner Owne's Name C� LC— information is required for every page. City/TovAi State Zip Code Date of Inspection ' 1 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 ��Jr�'�' cursor-do not Na a of Inspector use the return key. y-V\s ompany flame Company Adkress rm�fsu�.s ry)- s Kk City/Tow State Zip Code �50�6� 7 O5 !�-x 'A 9 Telephone Number License Number B. Certification I certify,-that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience'in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: a' Passes ❑ Conditionally Passes ❑ Fails -M �t ❑ Needs Further Evaluation by the Local Approving Authority > ns or's Signa lure Date The system inspector shall submit a copy of this inspection report to the Appr _ing 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Ti Sewage tle 5Official Inspection Form Susurface Disposal System Form - Not for Voluntary Assessments I Z Prop rty Address Y Owner 1 Owner's Name information is i t M ®2��� 3 (� required for i e`��As j o every page. CityfFo n State Zip Code Date of In pection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: %V- Tg�l CIA,.., A� �IJ-1Z is <e-A 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ? i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address Owner Y V C Owner's Name information is �i „ required for every page. City/TofV11 State Zip Code Date of In pection 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 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address i l�C— Owner Owner's Name information is i\�`+��, � ��� -3� I �d required for 1-1 �� every page. Cityrr6wn 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 aseptic 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ r__i Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Q Discharge or ponding of effluent to the surface of the ground or surface waters f ❑ "'� due to an overloaded or clogged SAS or cesspool ElStatic liquid level in the distribution box above outlet invert due to an overloaded VA or clogged SAS or cesspool El � Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h 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 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments PrgRerty Address Owner O ner's Name information is n /� required for y�"��1�� / '� OT2 (A �1-0 117 every page. City/T wn 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.) ❑ Aor 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,— 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. t5i6s•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Fry Property Address Owner Owners Name r I information is required for "V 041%r+� every page. City/To 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 El � Pumping information was provided by the owner, occupant, or Board of Health ❑ 9(\ 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? (�i( ElWere as built plans of the system obtained and examined? (If they were not 1� available note as N/A) ( , ❑ Was the facility or dwelling inspected for signs of sewage back up? 1119` ❑ 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. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): . t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form -I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i Pr terty Address Owner Owners Name q information is ��` "f— required for rh,1���, 5 �p�Y � 3�oq every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 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? ❑ Yest< No Seasonal use? ❑ YesIX No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date N 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form f l Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Pr erty Addresg Owner Owner's Name information is r` .r+ a p„o� required for Yl�C �NS �"11'� every page. City/T wn 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: XSeptic 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Pr erty Address Lt) M nn�nn m8A7nn ne U 'r Owner Owner's Rame information is L, required for nil 5 every page. City/TAn State Zip Code Date of Inspection D. System Information (cont.) Approxi ate ag of all components, date installed (if known) and source of information: 971 Q'-z Were sewage odors detected when arriving at the site? ❑ Ye�< No Building Sewer(locate on site plan): 2J & Depth below grade: feet Material of construction: ❑ cast iron PVC ❑ other(explain): If Distance from private water supply well or suction line: I� feet Comments(on condition of joints, venting, evidence of leakage, etc.): \ Septic Tank (locate on site plan): ('- i Depth below grade: 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 ai j W Dimensions: ` Sludge depth: l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments DO 5 f e,wC-P �t Pro,Rerty Address H . CnrWoiLn b4nanp ) Se-r�j U-C— Owner Owner's Name information is required for V\y C�hh\s .41 fi �-�` - o 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 i1 Scum thickness Distance from top of scum to top of outlet tee or baffle 1� Distance from bottom of scum to bottom of outlet tee or baffle 1 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.): - r\ ,p Sweyc, .�.� e� 2- y,r5 , 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 I Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Pr ert Address Wri H04-MC Owner Ow er'�ls Name �. information is required for C�1r�1r�'r5 � G every page. City/Tow1h 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments PrPr erty Address n32rvICL i Owner Owner's Name information is required for every page. City/Towil Slate Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on sit 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.): R 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 Commonwealth of Massachusetts V Title 5 Official Inspection Form 1I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 103 9 p Y Y Pr ert Addregs Owner Owner's Name information is IJ ��Q"VNVNNS MA required for �V every page. CityrTownl State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chamberknm �`�, ro.- &�ber: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): eS 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 :- Commonwealth of Massachusetts r ,a Title 5 Official Inspection Form �-II Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Pro erty Address - f I �� PLC Owner Owner s Name information is �i required for riV every page. City/Town Slate 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.): 1 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 I Title 5 Official Inspection Form IIM Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Prop rty Address 1 Owner ' Name T1l ^ L� Owner / information is 0- ` required for /41 07 0A 7© 0 every page. CitylTown State Zip Code Dat4 of Inspection D. System Information (cont.) Site Exam: [Check Slope C) j a Surface water Check cellar Shallow wells I ��i Estimated depth to high ground water: feet 1 Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) XAccessed USGS database-explain: You must describe how you established the high ground water elevation: 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 i Commonwealth of Massachusetts � c Title 5 Official Inspection Fora I Subsurface Sewage Disposal System Form Not for Voluntary Assessments Lo Pro rt Address, Owner Owner's Name information is \� r�\S K ®�( ��� �L 0 D required for �i �' every page. City/Town 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 At _ ZS-%" AZ A3 M ZZ� - Q z - 131 - i11 3z - z�' --14 S a3 - z 6 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 15 of 17 f <` Commonwealth of Massachusetts Title 5 Official Inspection Form /,I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Prop ty Address , Owner Owner's Name )n —3ex� C LLC information is i\ ^S �1� �Z6C�� 7`�Q a� required for AN n� every page. City/Town 1 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 f� Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS _ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SJ•�� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A €� CERTIFICATION -�P L Property Address: 103 Fawcett Lane -h' p ` - Hyannis Owner's Name: Derrick Feliz Owner's Address: s Q Date of Inspection: 3/23/2005 Name of Inspector: (please print) Patrick T. Sullivan __ Company Name: Ready Rooter LP Mailing Address: P.O. Box 371 C:) -� Sandwich,MA 02563 cn Telephone Number: (508)888-6055 ^? 5 CERTIFICATION STATEMENT rn I certify that I have personally inspected the sewage disposal system at this address and that the informatiok reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: ..Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: � Q 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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: ave not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional ss"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as pproved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND) in the for the'following statements. If"not determined"please explain. ` i d' 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 oftank 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 struct'orally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled/or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced f ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by t Board of Health in order to determine if the system is failing to protect public health,safety or the environmen . 1. System will pass unless Board of Health det mines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner whi will protect public health,safety and the environment: _Cesspool or privy is within 50 feet o a surface water Cesspool or privy is within 50 fee 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 a environment: _The system has a septic tank and soil absorption system(SAS)end the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. r>` The system has a septic tank and SAS and the SAS is witPm 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. f _The system has a septic tank and SAS and the SA 's less than 100 feet but 50 feet or more from a private water supply well". Method used to determi a distance r ! "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates t at 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 analyp's must be attached to this form. r f /r f l� f F f 3. Other: 1 r r r F Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION(continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 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 _,Z 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _,Z Any portion of a cesspool or privy is within a Zone 1 of a public well. _,LZ Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above 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 h a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the followinP� (The following criteria apply to large systems in addition t�e criteria above) i yes no ! the system is within 400 feet of a surface dr ing water supply the system is within 200 feet of a tributary/to a surface drinking water supply _the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply,Well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large stem 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 shoulfd/contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? _ Were all system components,excluding the SAS, located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3,10 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):__�_ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): �33<:) Number of current residents:_z Does residence have a garbage grinder(yes or no):_LQ;n Is laundry on a separate sewage system(yes or no):as[if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use: (yes or no): "`r «�3= '{8't Cam. •c�. �''�' uw.�,�.� Oc�.�S Water meter readings, if available(last 2 years usage(gpd))'" q : It�;?Q G �1.0. Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL , Type of establishment: Design flow(based on 310 CMR 15.203):j' gpd Basis of design flow(seats/persons/sgft,e .): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to th itle 5 system(yes or no):_ Water meter readings, if available? Last date of occupancy/use: i OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:o. Was system pumped as part of the inspection(yes or no): If yes,volume pumped: ,o allons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM t%e/'.'-eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: n 13 . epG - ,ems o iA N Were sewage odors detected when arriving at the site(yes or no): � Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron_40 PVC_Z- other(explain): ©r Distance from private water supply well or suction line: ,AD(A_ Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade:�'� Material of construction:�oncrete_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: 7 v- 5' k t/, ,- Sludge depth: (1- 1% Distance from the top of sludge to bottom of outlet tee or baffle: Scum thickness: k J'� A-7 '%.,ems;% 17" .k - Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: 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 leaka e,etc.): l� �� - �'.✓� �— , o�,t�� ��.�. iw Q`,.r,c.-2 (n•�c:. ur� (�a1C.` '.�-C— � •,�-...�J.Y� �..+�.��.G_ ��V�,���6,Q GREASE TRAP:_(locate on site plan) 1 Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): i 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,&c.): J. i l i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 TIGHT or HOLDING TANK: (tank must be pum/pet time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal_7erglass polyethylene_other(explain): Dimensions: ' Capacity: gallons f Design Flow: gallons/day, Alarm present(yes or no): Alarm level: Alarm in working,.order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:—Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): G,ex(( s `Cc-X_ �JG,\`Q Y Jlnc'�•. + \!�.G.. L`�JG Clb '@'\G�-t.JJ J��`Q h ®T Co Imo' �,jc,�`u�., C.RY�L `J\•A i V�.�yL� PUMP CHAMBER: (locate on site.,pfan) V Pumps in working order(yes or no): Alarms in working order(yes or no):,- Comments(note condition of pun jjy chamber,condition of pumps and appurtenances,etc.): f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 SOIL ABSORPTION SYSTEM(SAS):_,Z(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: to t o STc7w� . leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): 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/or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) r, Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): � , II I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. A i 3 y • 3 LA Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 103 Fawcett Lane Hyannis Owner: Demick Feliz Date of Inspection: 3/23/2005 SITE EXAM Slope _ Surface water Check cellar Shallow wells Estimated depth to ground waterer feet Please indicate(check)all methods used to determine the high ground water elevation: _ZObtained from system design plans on record—If checked,date of design plan reviewed: ':? a ( O Q Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the 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: qA c c s o r Message Page 1 of 1 Stanton, David From: Stanton, David Sent: Friday, January 30, 2004 12:02 PM To: McKean, Thomas Cc: Mattos, David; Schlegel, Frank; Klimm,John; Geiler,Tom Subject: RE: 113 Fawcett lane Tom, I went to both locations today. No one answered the door at either location. One violation I noticed is the incorrect house number posted on # 113 Fawcett Lane, Hyannis, Map 269-079. According to the town, this house should be# 113, but it is clearly posted on the house and on the mailbox as "#50." For this violation, I have copied Frank Schlegel. I had to drive by this location multiple times trying to find out what house should be posted with # 113. 1 have confirmed with the Town Assessors Aerial map that I stopped by the correct location, and that it was in fact an incorrect posting of a house number. The only other violation observed is that house # 113 has a large (10+) bags of yard waste, which is a violation of Board of Health Regulation Nuisance Control Reg. #1. As for house# 103, no violations were observed. There were no signs of excess people living at the house observed on the outside, in fact the property appears to be well maintained. I went into# 103 in September of 2002 during the septic inspection with septic installer Jim Leboeuf and observed three bedrooms, which is o.k. with the Health Division. On file is a letter from David Mason, Health Director, Town of Sandwich, stating that the house consists of three legal bedrooms. David Mattos has been in the house most recently and also concluded that the house is three bedrooms. It appears at this time, the only action the Health Division needs to make is to issue a warning to Robert Bryan to clean up his large accumulation of yard waste. A warning notice will be mailed today, to have this cleaned up within 7 days. -----Original Message----- From: McKean, Thomas Sent: Friday, January 30, 2004 8:30 AM To: Stanton, David Cc: Mattos, David Subject: FW: 113 Fawcett lane suggested The address might be 103 Fawcett Lane according to Dave Mattos. Tom G Geiler gg ested both locations should be checked. -----Original Message----- From: Geiler, Tom I Sent: Thursday, January 29, 2004 9:27 AM To: McKean, Thomas; Perry,Tom Subject: FW: 113 Fawcett lane Please have staff look at this and forward a brief report to me. Thanks -----Original Message----- From: Klimm, John Sent: Tuesday, January 27, 2004 12:34 PM To: Geiler,Tom; 'bass@cape.com' Subject: Hi Tom- Have received a complaint about 113 Fawcett Lane, Hyannis regarding too many people living in the dwelling. Could you have Health, Building, etc. check it out. Thanks, John 2/3/2004 Zoo2.�f� � .. -,. �• Fee vv / No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for ]Bigoml *patent Construction Permit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.IG 3 / ��"�Jj� �r`', �l� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7J9'0 70, f�'y 'c�`T�'Li�R' e%�/i��"L`ot'ij✓ ��Sd='•Pam.✓% 't� -,Or - Type of Building: po^1 oA `J Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ; ' Jl No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3,� 3 qo gallons per day. Calculated daily flow 330 gallons. Plan Date a 1"1-4 Number of sheets Revision Date Title Size of Septic Tank cS o P x<I Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 this Board of Health. Signed Date 9`��"�"'Z Application Approved by lit, Date 23_,6� Application Disapproved for the llowing reasons Permit No. ��2 _`�� Date Issued THE COMMONWEALTH O, MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for 10igpozar bpgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No./03 !�i'wGEJy .�/". /y!}, Owner's Name,Address and Tel.No. \ y Assessor's Map/Parcel U ��/��~�� ✓ 9. ti Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. _ .3��,3�•LZ . Type of Building: - � (aoM! 0/t r Dwelling No.of Bedrooms Lot Size / sq.ft. Garbage Grinder(, ) Other Type of Building No.of Persons Showers( )Cafeena( ) Other Fixtures Design Flow r�r' gallons per day. Calculated daily flow 1"c gallons. Plan Date ja—.r/-VZ Number of sheets, > Revision Date Title Size of�Septic Tank 9A 1 Type of S.A.S. 4r-IX l-CA." Description of Soil Nature of Repair§or Alterations(Answer when applicable r Date last inspected:'"__ nspected:"__ Agreement: The undersigned agrees to ensure the construction and maintenanceiof'the afore d6cnb4d'on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code a d.not to place the system in operation until a Certifi- cate;of Compliance has been issueddbb this Boaiazd of Health. q";9 Signed C �-- _ 1 ., . ,.: r -;, Date,, .. F. - 8. Application Approved by 7 Date- Application Disapproved for the following reasons Permit No. 'LLY3Z- `(2 Date Issued'��." THE COMMONWEALTH OF MASSACHUPETTS •' a d►�r11 �ed p BARNSTABLE, MASSACHUSETTS o� Certificate of Compliant" Y THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded ) < `*'1 Abandoned( )by at, /0 3 Fi«cF7J` �i4i. �ly��a/r' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 20�Z"y� dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function designed. Date �()Z Inspector "'t QC �� _ ---------------------------------- r No. 1.00 2 —`4 2/ , Fee 5� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 1=izpogar pgterrt Congtructiott Permit Permission is hereby granted to Construct( )Repair( )Upgrade&Abandon( ) System located at /O 3 /�AGfiQ'F'.�` .G'i✓ �aly.1•'•r/.P 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 completed within three years of the date of this pe Date: Approved by / TOWN OF BARNSTABLE LOCATION ICA Y!Owwl tA046 SEWAGE # Q VILLAGE / .��h/�J ✓ ASSESSOR'SMAP & LOT �. 6 1� INSTALLER'S NAME&PHONE NO. --nm �{,�t-/we -CY SEPTIC TANK CAPACITY . 000 LEACHING FACILITY: (type)�Z SxgXZ , b. size)/ O NO. OF BEDROOMS A �S'Y4`1wrel-;,ber°J BUILDER OR OWNER PERMITDATE: /� '�9" COMPLIANCE DATE: 93— 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 le�aacchin facili �. Feet Furnished by 3t• 1 �� � F �i olWa-f� �e— I " I r� . a t V�07' � ;S CA LC David B. Mason, RS September 23, 2002 Barnstable Health Department Barnstable, MA Re: Installation review at Lot 49, 103 Fawcett Lane, Hyannis, MA This office conducted an inspection of the referenced property to verify the installation relative to the Title V design criteria. This inspection was at the request of Jim LeBoeuf Septic Services. Due to a concern of the design for the number of bedrooms that exist in the house a walk thru was conducted and there appears to be legally 3 bedrooms and the Town of Barnstable Assessors Records supports that determination_ I;;was"informed that an illegal apartment.is in the process of being removed per the order of the Board of Health. The system as installed meets the criteria of the plan prepared by Sweetser Engineering dated August 21, 2002 with a revision date of September 20, 2002. The only variation is that a removal of material for 5'around the SAS was not done due to the nature of the soil. A removal was not necessary since'the soil was representative of the C Horizon referenced on the aforementioned plan and thus the system had been installed in that material. Overall all components were in place with the risers on the components to the applicable hieght and the system should meet the inspection criteria of the Town Health Field Inspector. ~ Sincerely, AB „ David B. Mason, RS 4 Glacier Path, East Sandwich, MA 02537 508-833-2177 Tdwn of Barnstable Assessors Division Page 1 of 3 a. �'0 bf�,� r., :. �a`' AiM� �VW ..i✓'Sa" fi"z,. . Your Location : Home : Town Departments : Administrative Services : Assessors Division : Property Results <<Back -Forward>> Friday, September 20, 2002 Assessors Division- Property Results Data is based on Fiscal Year 2002 Assessor's Fiscal Year 2002 Assessed Values database and is provided for information Tax Information purposes only. Sales History Land and Building Description <<Search Again Construction Details Out Buildings & Extra Features Building Sketch 3 FAWCETT T LANE Map/Parcel/Parcel Extension: Mailing Address: 269/078/ MIRANDA, RUI A Owner of Record: MIRANDA, RUI A 103 FAWCETT LN Property Location: HYANNIS, MA 02601 103 FAWCETT LANE Parcel ID:269078 Map:: Fiscal Year 2002 Assessed Values ^Top Appraised Value Assessed Value Building Value: $ 92,100 $ 92,100 Extra Features: $ 5,900 $ 5,900 Outbuildings: $400 $400 Land Value: $29,000 $29,000 Totals: $ 127,400 $ 127,400 Tax Information ^Top Town Tax $ 1,179.72 Tax Rates (per$1,000 of valuation) HYANNIS FD TAX $ 323.60 Town 9.26 Fire District Rates Land Bank Tax $ 35.39 Barnstable 2.61 C.O.M.M 1.38 Cotuit 1.69 Total: $ 1,538.71 Hyannis 2.54 W. Barn. 1.54 Total does not include special assessments— Other Rates http://www.town.barnstable.ma.us/comeonin/Departments/administrative_services/Finance:... 9/20/2002 Tbwn of Barnstable Assessors Division Page 2 of 3 fLand Bank 3%of Town Tax Due to rounding differences these values are approximate. Sales History ^Top Owner: Sale Date: Book/Page: Sale Price: MIRANDA, RUI A 12/31/1996 C143173 $ 92,500 GOSSELIN, LINDA M 10/15/1990 C121786 $ 1 CATALANO, FRANCINE 10/15/1984 C98524 $69,400 WALKER, FRANK P C68133 $ 0 Land and Building Description ^Top Land Building Lot Size(Acres): 0.23 Year Built: 1966 Appraised Value:$ 29,000 Living Area: 1387 Assessed Value: $29,000 Replacement Cost: $ 110,999 Depreciation: 17 Building Value: $ 92,100 Construction Details ^Top Style: Cape Cod Interior Walls: Drywall Model: Residential Interior Floors: HardwoodCarpet Grade: Average Grade Heat Fuel: Gas Stories: 1 1/2 Stories Heat Type: Hot Air Exterior Walls Wood Shingle AC Type: None Roof Structure: Gable/Hip Bedrooms: 3 Bedrooms Roof Cover: Asph/F GIs/Cmp Bathrooms: 3 Bathrooms Total Rooms: 6 Rooms Outbuildings & Extra Features ^Top Code Description Units/SQ FT Appraised Value Assessed Value BRR Bsmt Rec Room 816 $ 3,400 $ 3,400 FPL2 Fireplace 1 $2,500 $2,500 SHED Shed 64 $400 $400 Building Sketch ^Top http://www.town.barnstable.ma.us/comeonin/Departments/administrative_services/Finance:... 9/20/2002 Town of Barnstable Assessors Division Page 3 of 3 . t �aa Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story (Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Uni FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unf FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story (Finished) •�'— Back -Forward o Home Departments I Town Information I Contact Town Hall I Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Many Files Require Adobe Acrobat Reader P L Click Here to download free Copyright 2001©Town of Barnstable. All Rights Reserved. http://www.town.barnstable.ma.us/comeonin/Departments/administrative_services/Finance:... 9/20/2002 4i1q No...........T_7 ��� Fxs..... ..... "'�' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....... -=...O F.......... ....... �! = I-----..-...------------------------------ Appliration for Dispos�al Works Cfoustrurtio nmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......_..._ - a................................. Q.�13�... 1!a-��i ---------------------------------•-------------•----------------...........------------. Lcc ion-A d ss or Lot No. ..............................................- Owner - Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ........... No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------•------ ...................... d --------------------------•--------------------------------------------------..._......------------ W Design Flow............................................gallons per person per day. Total daily flow....................................... WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........---.--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date-----.................................. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------..-,--. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----.................... Q+' ------•-----•••----------------------•---------••---•----------......-•-----•---•---•-------•--•---.......................................................... ODescription of Soil......................................................................................................................................................................... W U •-•-----------------------•-------------------------.---.-.----•-------------------.----..------------------------------•---...-----------------•-----------------------•------•-----------•--------- W ----•- . -------------------------------------------------------------------------------------------- ° Syr ... ---------: _-•� ' V Nature of Repairs or Alterations—Answer when applicable..... '� av CY_-_....�_ry O_--••-••j f� .. •--• •-- .... ----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'L Uj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b and of health. Signed.0r y.............................. *L'y ....................................... -7. /-.---`_�_.'7 f to Application Approved By-------- ti ...�/� �!/1 .. '�''�_._._...... tl- 77 Date Application Disapproved for the following reasons:................................................................................................................ ..-•------------------------•------•-----...----•-.....------------------------....-----•--•---.....-------•........•--------•--•--•----•-•-•-•-------•-------•-•----•----••----------•-----•--.......-- Date Permit No......................................................... Issued-- -......f-- _ _.... Date No.........:j^ZZ Fizz...............:a:r.a.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ......OF......... .. i ................................................... Appliratiou for Dispm al Works Tongtrurtuott Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -11 LC, J�(t (t/(- -0 ) / / U........-- �'��rs ............. --..........--•••--•-•--•-•••-•-•-- -----•-•-•--.....•••-•----•••-••-••-•----•••••....----•--•----•--•-•-••........................... Lo 1p ion- dress or Lot No. 1- .( 1. Y .. ......--.....----------------------•----...................._..... Owned --► Address... ....--------•-•••...__... - - • ------- ............................ Installer V Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers A YP g P ( ) — Cafeteria ( ) Q' Other fixtures .................................. w Design Flow............................................gallons per person per day. Total daily flow...........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.......--------. Diameter.............--. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter----..--............ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•--•••---•-••••-•-••••••---•-••--•••--•----•-•---•--••---••-••-•-----•...................................................................................... 0 Description of Soil........................................................................................................................................................................ x U ..............................••••-•••-•-•---••--•.................................•---•-•-------•••-••---•----•-••-•-••-•-•---••-•-•-----•-••-----•-•--•--•------•--......---•--•-----................ W -••••-••••-•--------------------••••...•-•••-••----••--•-••----------------•------•-----•-••-----•••---------- UNature of Repairs or Alterations—Answer when applicable..----j�.:°.11_tl..i._r__......_. __�4.0_��.._._.�..�--..1.......•....•..... •-- ° `aJ......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITTIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. i f/ / X rLC f ft rx vlrv_ ' Signed b, 7 ) / _. ...--•-•-------•............................................••----•----•-----•---• .......................... °~ Date Application Approved BY -•-•- 77 c =, •----- Date..............•- Application Disapproved,for the following reasons_................................___________________ ........--•--------------•--•--------------•-----------------•---•-----•----------------.....----------•---••-•-•--••-•--•-•-•--•-------•--••------•--••---•----•-•----•-•----••••••-•-•--•••-•••--•---- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEALTH V 6'�. ..........................................OF.......... .....° I ...... ..................................... (Irrtifiratr of TautpliFaurr THIS S TORTIF ,That the Individual Sewage Disposal System constructed ( ) or Repaired .r ,� .................. ......•...•.•....:....................................................-'--•---------------------`=--1"---..•.l......._.............________.... } Installer at........ .... ................. ...6................................... �"�r ' ; `� �................................................ has been installed in accordance with the provi ons of DIT15 5 of The State Sanitary Code asciescribed in the application for Disposal Works Construction Permit No(� ------7 :� ......... da.ted................................../ "' �THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........7�---�•��----�--�-••-•-------------------••---. Inspector.---.........---- -----......•.....-•-------•--.........---•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD O"EALTH ,,, w 0......................... FEE........................ i al aal, arrk Tanstrur#aan rrmit 9' Permission is hereby granted"" � •--------------------- � :.. to ConsstMruc.,,C ) or R pair ( n Individual Sewage DisposalrSystezn� j � at No.. - -arc. .� `° ! .................... PF Street -y as shown on the application for Disposal Works Construction Permit No._- __/-Dated..-.. "./!�-'_.7 --•••-•--•...--- 7 Board of Health 7 --• - - DATE-------•--- ---•---w•---------•- .......................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _)r__.-..`-:.v'--' .[ -^ :1'P"'^. -t x/c:j-*'�`.Y+�'+sr`R-,,...'r. w,M4�!V .7.—"".k '�"+F'var5}F.Ti'* .. TYs'.."�+'9�"..'�1.r✓ ..syr':�r'a.-xc—.--=..-"+s*.:r^..,_ TOWN OF BARNSTABLE' BAR-w M12 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager r 1PV Address of Offender MV/MB Village/State/Zip „ 'A"A'4t /'0 Business Name a amfim ,on / 2oo6 Business Address < Signature of Enforcing Officer Village/State/Zip Location of Offense I, f �„c '.,s,. r� 0c,11�4rr. ' Enfoarcing/'Dept//Division Offense �,,� l'at�^f�S �'' (OG' e �{�t*C 4,')o r f t;7 r Facts 3 }nnr,b, / b v q T f bi-cf.D / 60An r✓ { l 0r can✓ ..,> �1 �+ aP � �f�l() 1��� -�7 e �P�l #�f-J� S �t� r,r t`y f'afwr t��r�aw• rr� r��/�e 'r" This will s§.rve only as a warnin a At t� y g his time no legal action has been taken. It is the (goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE OFFENDER CANARY-ORD./REG.-PROG. PINK ENFORCING OFFICER GOLD-ENFORCING DEPT. .;; -i�:.- ---,-.__;,,� ..T_.::.,....r ,� -.Y.::-�. ._.ter...-�.....,._..��c: .-.,T*.----'�, s+r— n`;e^-r —'�tv-'eK.•_"^ ;, +,.�.-wy�:.� .i.�—w-.r• .-. _ ._.- TOWN OF BARNSTABLE BAR-W ?M 3457 Ordinance or Regulation f WARNING NOTICE Name of `Off ender/Manager ro fi• ; 3 r r ti Address of Offender 5 r.: _! �'- ?, MV/MB Reg.# Village/State/Zip ( ,b -r•i Business Name d t � am/pm;~ on /20 Business Address t '11V `" ii _ Signature of Enforcing Officer Village/State/Zip Location .of Offense ,°�� .(r Enforcing�Dept/Division f Offense r ,. ,.� ,�f�, . +�t -�rCa'P"` ��r/r A� P Facts )(" n,�. i �t• � � r e <, z #:��C�t+ 1n r. �^ i� i• ��y£� r h -'r..�" 1 t r 1 f •" r �t„r '�+'`J 6 Thisjwill serve only as a warning: At this time^no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances,Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �'•' -�.J: :It.:l JC s-r�i�T„Z �Gt7.v: ''�vk..� ..+ rr. . . •.:'=.-rP .,X:..;x:,i+'�:-_4y"9'1:+' .s. i u.,_ :`-:.x. '..- . n. TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date �'/ 73 -7 n Owner -Pat" /� rev (� Tenant Address )b �G wCx t"/ L���P. t7/. i.�,�!_I Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents ' r� 3J p 1.�- �,; � J(✓'c win/_ 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal -' 17. Temporary Housing PART II 1 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition nu cord �i j Person(s) Interviewed Ins p�-or JJ�, If ublic Building such as Store or Hotel/Motel specify here YU 1A du+-t .5 5 hi, Cvrmc� VID 11 &A 1 , Certified Mail#7002 1000 0004 6683 1518 Town of Barnstable Regulatory Services UARNSURM Y Thomas F. Geiler,Director 1.3 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 r Office: 508-862-4644 Fax: 508-790-6304 February 4, 2004 Edilson Deoliveira 19 Circuit Road West Yarmouth, MA 02673 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE 11 - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 103 Fawcett Lane, Hyannis, was inspected on February 02, 2004 by Thomas McKean, RS, Health Director for the Town of Barnstable, because of a complaint. The following violation of the Town Rental Ordinance was observed: Section 4-4: Owner's name, address and telephone number not posted. Section 4-4 of the Town Rental Ordinance specifically reads as follows: An owner of a dwelling which is rented for residential use, who does not reside therein and who does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained on the exterior of such dwelling within five (5) feet of the main entrance or within five (5) feet of the mailbox(es), at least four(4) feet and not greater than six (6) feet above ground level, a notice constructed of durable material, not less than twenty square inches in size, bearing his/her correct name, address and telephone number. If the owner is a realty trust or partnership, the name, address, and telephone number of the managing trustee or partner shall be posted. If the owner is a corporation, the name, address, and telephone number of the president of the corporation shall be posted. Where the owner employs a manager or agent who does not reside in such dwelling, such manager or agent's name, address, and telephone number shall also be included in the notice. 310 CMR 15.00: Too many bedrooms at the property. Only three bedrooms allowed. Health Director Thomas McKean, RS investigated a complaint of overcrowding on February 2, 2004. Q:Health/Order letters/Housing violations/103 Fawcett In.doc I Mr. McKean spoke with tenant Alex Rodrigues who stated that there are four bedrooms in this dwelling; two are on the second floor, one is on the first floor, and one is in the basement (without a proper egress window according to Dave Mattos). The basement bedroom was constructed without first obtaining a building permit. Per 310 CMR 15.000, Title V and the Town Wastewater Discharge Ordinance, you are allowed no more than three bedrooms at this property. You are directed to correct the violation of Section 4-4 listed above within Seven ( ) Days of your receipt of this notice, by posting the property correctly. You are also directed to remove the basement bedroom within thirty (30) Days of your receipt of this notice so that there are only three (3) bedrooms present at this property. You may request a hearing before the Board of Health"if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Q:Health/Order letters/Housing violations/103 Fawcett ln.doc r Health Complaints 04-Feb-04 Time: 8:30:00 AM Date: 1/30/2004 Complaint Number: 17244 Referred To: DAVID STANTON Taken By: JOHN KLIMM Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 103 Street: FAWCETT LANE Village: HYANNIS Assessors Map_Parcel: Complaint Description: TOO MANY PEOPLE LIVING IN THIS HOUSE. Actions Taken/Results: NO ONE HOME. OBSERVED NO VIOLATIONS. DS HAS BEEN IN THE PROPERTY IN THE PAST, IT IS A 3 BEDROOM HOME. NO ACTIONS MAY BE TAKEN AT THIS TIME BY BOARD OF HEALTH, EXCEPT TO POST AN OWNERS NAME PER TM. UPDATE, TM WENT TO SAID LOCATION ON 2/2/04 @ 9:30 PM. TM DID NOT WITNESS 4 BEDROOMS, BUT WAS TOLD BY A TENANT THAT THERE ARE 4 BEDROOMS IN THE HOUSE. TM HAS ADDED HIS INFO TO THE RESIDENTIAL FILE. DS TYPED UP AN ORDER LETTER WITH THE INFORMATION. Investigation Date: 1/30/2004 Investigation Time: 11:00:00 AM 1 a6?- o7 LOCATION SEWAGE PERMIT NO-� u1C'-e0� � a.�r 77 -- 3 ?3 VILLAGE I N S T A LLER'S NAME. & ADDRESS 7-7, -� 13 � � BUILDER OR WNER DATE PERMIT ISSUED ZZ DATE COMPLIANCE ISSUED 7-/ P"A? , !.� � , W a� 1�_ �� `N q ti � 2 � a � � '� �., _ `� /� �,- glm� SOIL TEST i 20 FT. MiNIN1UM-FROM CELLAR DATE OF SOIL TEST AUGUST�t1�Q�2__ TOP OF FOUNDATION 10 FT. MINIMUM FROM SCAB OR CRAWL SPACE SOIL TEST DONE BY $�jM_ENGWEERING ELEV '�•00_ 10 FT. MINIMUM -i I ,— CLEAN SAND (ASSUMED) ! WITNESSED BY _____________�___ COVERSTE (-LOAM AND SEED 08MVAlION HOU 1 ELEV.=_ 93.40 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE __K_ __ MIN./INCH AT __79_ INCHES MIN. PITCH 1 /8" PER FT. 1 "LAYER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER /$ TO 1/2" LEGEND: 7.70 -- WASHED STONE 4" CAST IRON PIPE "15 MAX. 4i1.G0 INN. OTTREQUIRED EXISTING SPOT ELEVATION 00 G 0-8 A LOAMY SAND 10YR6/1 NO ROOTS SLAB ELEV. _ 9?•50 (OR EQUAL) MINIMUM EXISTING CONTOUR - --00---- PITCH 1 4" PER F,. ----� FINAL SPOT ELEVATION _ 8-36 I B LOAMY SAND 10YR5/8 ROOTS & / T 1 CU i I . FT. OF CONCRETE FINIL TEST AL CONTOUR 207 COBBLES FLOW LINE I 1.1 m ANCHOR SOTILiTY POLE LOCATION -c � 36-120 C MEDARSE/SAND t0YR7/6 20% COBBLES CO 10" ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ TOWN WATER �W /..----w --- `-ELEV. _ VIM- -- MIN. , 2 0 0 0 CATCH BASIN ELEV. = _�1 � _ LEVEL 0 ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 °) GAS LINE JI GqS 6" SUMP = 1. o o �° I CLEAN OUT - - ELEV = __>���_ AD� FFLE ELEV. _ _ 91.70_ ELEti �_ ' __ 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑.❑ ❑ o Z 0 A o CESSPOOL C P i / L_ DIS1RIBUTION ELEV 0 000 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° LIQUID OUTLE BOX -�0- 0 0 ° ELEV. DEPTH TEE (EXISTING) 2 500 GALLON GALLEYS WITH r 4 FEET 14 INCHES j TO BE VvATER TESTED STONE IN AN 5 FEET 19 INCHES I lI= MORE THAN ONE OUTLET 6 FEET 24 INCHES I 1000 GALLON JO BE PLACED ON FIRM BASE) 13' X 24' X 2' TRENCH FORMATION z_ WELL—_t�LLS_ NO WATER ENCOUNTERED AT 12fL_ ELEV. _ __a3.4a 7 FEET 29 INCHES I 1 X ZONE 18 FEET 34 INCHES ! SEPTIC TANK 3/4" TO 1 1/2' CLEAN SOIL ABSORPTION INDEX DOUBLE WASHED STONE ADJUST FREE OF FINES & SILT _ SYSTEM_ SAS DESIGN CALCULATIONS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED UWATER SGS RTABLEE( WATER TABLE ELEV. _ ------ GARBAGEUMBER ODISPOS BEDROOMS NOT TO SCALE BOTTOM OF TEST -TOLE ELEV. TOTAL ESTIMATED FLOW ( 110 GAL/ k/DAY X _3 OR.) —,MQ— GAL./DAY REQUIRE4 ACTUAL D IZEPOF SEPTIC TANK TANKTIC ITY _ GAL. (DUSTING) SOIL CLASSIFICATION DESIGN PERCOLATION RATE MIN./IN. EFFLUENT LOADING RATE O.Z4_ GAL./DAY/S.F. LEACHING AREA SO. FT. (13X24)+(37XZX2) LEACHING CAPACITY (AREA X RATE) I" GAL./DAY 460.00 X 0.74 RESERVE LEACHING CAPACITY _AQW_ GAL./DAY ; NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P TITLE 5 AND THE TOWN OF _. ___ RULES AND I REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO j 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 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS. 4 ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DETERMiNATiON HAS BEEN M^0E AS 10 COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY, 00.00' 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 .AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 7. CONTRACTOR IS TO 'VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE ANY VARIATION 900XI 1 IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. 8. PARCEL IS IN FLOOD ZONE ____C__- 9. LOT IS SHOWN ON ASSESSORS MAP _ � _ AS PARCEL __78� lety71 10. EXISTING CESSPOOLS ARE TO BE PUMPED AND REMOVED. 7S �ws:3-- — - 11. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND FOR A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255:(3). 44 LIMIT OF ORtVE `N OF � /5' O VERDIG J ' ,1� , UUMAS(� $ ALL u V` "° 619 BOARD OF HEALTH w � 4, � �,, APPROVED: q i\ D.O 0 GALLON BOI T DIi£CLING _ DATE AGENT PROPOSED SEPTIC DESIGN IJ.00 ( _ \ - _ _ - � _ - y FOR _ 6 DECKCH w ' RUI �[IRANDA AREA � � I z �--- - -- I Q 10 OD p S. I j PROJECT LOCATION .22 ACRESt '�, ■ 98.2 w HECKERBER Y RD LOT 49 i �- I I 103 FAWCETT LN, HY� t �Yoaov 8 98 3 LOCUS Q c�) m swimu� i 97.4 �I\� PR LACES PINE R 235 GREAT WESTERN70AD 508- P. C BOX 713 7�' v 1398-3922 SOUTH DENNIS, MASS. 02660 FERNDALE RD f DATE r} SCALE AUG. 21 , �002 1 11 = 20 I I I --� REV.SEPT. 20, 2002 JaB No. 5503_00 REVISED LOCATION MAP SHEET 1 1� ` i _ L --- C: S58'1PR0✓ 550,3-00 dw 5503-00.0WC 02002 SWEETSER ENGINEERING