HomeMy WebLinkAbout0220 FAWCETT LANE - Health mp-
220 FAWCETT LANE
HYANNIS
A = 270 133
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TOWN OF BARNSTA.BLE
;_C:,-ATION -P&Jail Ch SEWAGE # V 51 h
VILLAGE_ ASSESSOR'S MAP & LOT07 0-/3
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IILS NAME&PHONE NO. �v�- � f
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Q 0he►6m-N (size)
NO.OF BEDROOMS
BUILDER OR C rr6V)
PERMITDATE' CO fhl BATE:
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
TOWN OF BARNSTABLE
LOCATION 220 �,¢� �,�/� SEWAGE #
II.LAGE 11�,Q,U,G/f ASSESSOR'S MAP & LOT 1,33- 276
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 1006 (0L
LEACHING FACILITY:(type) �f-5.W0 � (size) B--PI4- !o SO,,
NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE
BiJILDER OR OWNER
DATE PERMIT ISSUED: ,?
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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t, Z
j,QT Town of Barnstable Barn
Regulatory Services Department aHlmt:ricaCdYv
• WMNSrABLE,
9 MASS. g
1639. Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7014 1200 0001 0358 3353
May 14,2015
David Holt
ToDay Real Estate
1533 Falmouth Road
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 220 Fawcett Lane, Hyannis, MA was last inspected on
4/23/2015,by Shawn Mcelroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Fails" under'the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
0 Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool.
You are ordered to do one of the following, within one (1) year from the date you receive
this notification:
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
s�McKe�anR.S
i
Agent of the Board of Health
I
Q:ISEPTIC\L.etters Septic Inspection Failures or Future Ev1\220 Fawcett Ln Hy May 2015.doc
{
Town of Barnstable
. HARN9T OM
p b A Regulatory Services Department
lfD MA'S
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/28/15
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000) .
An"x"marked in the ❑ is the failure criteria and-associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS'or cesspool
WE 1 YEAR DEADLINE CRITERIA
)(Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching pit or cesspool with high liquid level, <1.2" below pit(per Town Code
§360-9.1)
OTHER
❑ ,
Repair deadline:
Q-\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
it
page. C yR own 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.
A. General Information O
Cf
1. Inspector:
_ D
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
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:
❑ Passes ❑ Conditionally Passes Z Fails
❑ ,Needs Further Evaluation by the Local Approving Authority
4-23-15
l4p6tors Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future and r
the same or different conditions of use.
t5ins-3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System- •e 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form'
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) -
Owner Owner's Name
information is
required for every Hyannis MA 02601 4-23-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.) t
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:
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection, Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 'Y 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Hyannis MA 02601 4-23-15
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.) -
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.): r »
Observation of Sewage backti or break out or high static water level in the distribution❑ hbox due
9 P 9
-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 obstructedpipe(s). The
❑ Y q P P 9 Y
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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts -
W Title 5 Official Inspection 4 Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
G M SvO,� 220 Fawcett Ln
Property Address
Bank Owned (Contact David'Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
I
"* 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 fo'r all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
® El clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ Liquid depth in cesspool is less than 6° below invert or available volume is less
than 1/2 day flow
t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Hoff @ Today Real Estate 1-800-966-2448) ,
Owner Owner's Name
information is Hyannis MA 02601 4-23-15
required for every H y -
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.El., ® 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'pnvy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
r 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.
` Z. ; 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 If 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-3!13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts `
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Hyannis - MA 02601 4-23-15
required for every H y '
page. City[Town 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?
N �
ti ❑ t ® 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
® El
F available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® " °r ❑i 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.
E El 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)]
r
D. System Information
Residential Flow Conditions:
Number of bedrooms (design),: Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-3l13 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
�M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2014
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-3/13 „-, e 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
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. City/Town 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: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool T
❑ 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): r
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
I ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis _ MA 02601 4-23-15
page. Cdyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1990's
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 12"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.):
Good condition.
Septic Tank(locate on site plan):
Depth below grade: 6"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
Sludge depth:
12" �
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis , MA 02601 4-23-15
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
20" '
lotScum thickness - . , . . t
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
15"
How were dimensions determined? Tape
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 is in good condition with baffles installed and no sign of leakage.
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-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
b a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1=800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
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 HoldingTank tank must be pumped at time of inspection locate on site plan):
( P P ) ( p )
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-3113 Tale 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17
r
Commonwealth of Massachusetts . .
Title 5 Official ••Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is H annis MA 02601 4-23-15
required for every y
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.):
Good condition with water at working level and stain lines above inlet invert.
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
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 pond ing,.condition of vegetation,
etc.):
-
t n
I
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @-Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type
❑ leaching pits number:
® leaching chambers number: 2-500's
❑ 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.):
Leach chambers empty at inspection with stain lines above inlet invert.
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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Hyannis MA 02601
required for every y 4-23-15
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
l
La , r �
.EEZIJ
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
1 r
Commonwealth of Massachusetts -
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water:
12'+
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: 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:
Original design plans show groundwater at greater than 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 Fawcett Ln
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-23-15
page. Cityrrown 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•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
Town of Barnstable Po l jl 7ql
Departiment of Regulatory Services
t i Public Health Division '
>Hwaa S1011 p� L Date c2
200 Main Street,Hyannis MA 02601 f BOA "
Date Scheduled Time Fee Pd. �,j
. n.0 5���2✓ ��i
Soil Suitability Assessment.fo,r Sew ' e osal
Performed By: v0�
Witnessed f
LOCATION&GENERAL INFORMATION
Location Address ��Iq Owner's Name
i ! rn j 3 � Address ` A-(CA rs`�w �f V&
Assessor's Map/Parcel. �_ 12/ Bn in er's_�Ia-m 1 , r
NEW CONSTRUCTION REPAIR Telephone# L/g `�
Land Use- Slopes(9t,) 5 Surface Stones_ l�
Distances from: Open Water Body ft Possible Wet Area
ft Drinking Water Well . ft
Dralhage Way ft Property Llne ft Other
ft
SIKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 1n proximity to holes)
TL
i f
Parent material(geologic) TDopthlo Bedrock
Depth to Oroundwater.- Standing Water lr.Hole:
Weeping from Pli Face
Estimated Seasonal High Oroundwater
Method Used: DETERMINATION FOR SEASONAL•HIGH WATER TABLE
Depth Observed standing in obs.hole: In, Deptit to loll mottled:
Deilth to weeping from side of obs.hole: inII, Groundwater mottleAdjuA ..Index Well# Reading Dato: Index Well level __ p ,thetbr y
_ ...-. . . .. -.- � -_, Adj.ptxtuntiwtiterLevei,,,,_, i
PERCOLATION TEST
Observation
Hole# Time at 4"
D
epth '
Time at 6"
Time @ Time(9"-6") �
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observtition Hole Data To Be Completed on Back--
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Consefvation Division at least one(1) week prior to beginning.
Q:\SEPTIC\PBRCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Coylailtency,%'arayel)
A)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenov.
]DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling .(Structure,Stones,Boulders.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories;Boulders,
Consistancy.
i
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes .
Within 500 year boundary No- Yes
Within 100 year flood boundary No,,— Yea
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi u riai exist in all areas observed throughout the
area proposed for the soil absorption system? _-I�� 10
If not,what is the dep of h turally occurring pervious materlal`�
Certifiication
I certify that on �® C • (date)I have passed the soil evaluator examination approved by the
Department of Environ mental Protection and that the above analysis was performed by me consistent with .
the required training,a er' a:d perience described in 10 CNM 15,017.
Signature Date a
9
Q-.\SBPT 1C\PBRCPORM.DOC
TOWN OF BARNSTABLE
LOCATIONot,;Z O / �✓� ��''� ';SEWAGE#
VILLAGE ��'•�/'�/d'�� ASSESSOR'S MAP&PARCEL-)
INSTALLER'S NAME&PHONE NO.Q:7l `�® �/�
SEPTIC TANK CAPACITY �` !' " �4 e®
LEACHING FACILITY: (type) CI&4 erl � (size)�.�� ���
NO.OF BEDROOMS
OWNER
PERMIT DATE: /Q moo--/ COMPLIANCE DATE:
Separation Distance Between the:
Maxim"um Adjusted Groundwater Table to the Bottom of Leaching Facility 1� 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 B'Y
MN
� d
s
0 S
V
OQ �O
N
• T
r
Fee74a
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
�4pfirAtion for *pstem Construction Pffmit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) [:]Complete System Individual Components
Location Address or Lot No.,:;2,� o�i_Wed:& -' Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel — h/ v
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided gpd
Plan Date 9�'��'1 Number of sheets Revision Date
Title
Size of Septic Tank XJ✓kT�'� ��e'® Type of S.A.S.
Description of Soil cJ*4&".:�r' �ecat,,4— Z®
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 Certificate of
Compliance has been issued by this and of H
ign C- Date �d
Application Approved by Date /v
Application Disapproved Date
for the following reasons
Permit No. 7�i—? Date IssuecV0 Ze z
A
1
• No.`iN/ r9?-- Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH'DIVISION - TOWN OFF BARNSTABLE, MASSACHUSETTS -
'� . application for Disposal 6pstrm (Construction Vertuit
Application for a Permit to'Construct( ) Repair(�de( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.oZ o�jgWC4�� ,[ ow Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel //_ ;� Y �iF�� /'� -
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
.0 -dz'48O d`Cil"'w- �►� s' o P 07 4?�A vio •[� /ni4.lb,� GtJ� _167
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building OZ 4d"..P No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -T 3 Q gpd Design flow provided _ZeF gpd
Plan ' Date jq Number of sheets Revision Date
Title
Size of Septic Tank 67 �Q/G'-0 67'ype of S.A.S. _
Description of Soil
t
Nature of Repairs or Alterations(Answer when applicable) G'r� lid'-w
Date last inspected:
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 Certificate of
Compiia ice has been issued by this Board of He
A
Date 40 oZ 0
Application Approved by e. Date
Application Disapproved Date
for the following reasons
Permit No. a r Date Issued/ `-7,
-------------------------------------- =`
4
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliall re
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by Gr4kV0G-44o0,o-0- "EdQC'r"e ,f'yC.
at O- .-C If L!i has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N -? dated O
Installer ��l�J 1 Gr'L�l�ct"G/'r Designer !si /Q� ,✓ PP
#bedrooms 3 Approved design fl�. �fsi
gpd
The issuance of this permit shall not b c nstrued as a guarantee that the system will fu"ction
D t _74 f Inspector (�
�V- /V
F _
-------------------_-------------------------------- ----------------------------------------------------------.-.-__.__.__--._��_-_.___-
No.&Ar Z,— Fec
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS p
w Veposal 6pstrm Construction permit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
System located at O /X—i� Gr'Jf'�
3
i
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 b /
Town of Barnstable v
�I"E r ti Regulatory Services
o�
Richard V. Scall, Interim Director
• BARNSTABLE.
9� MAM. peg Public Health Division
CFO MA'S A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
���
Date: '1 �� Sewage Permit# Assessor's Map\Parcel l
Designer: �, Installer:
Address: ] /6"DMU 1 Address:
On �� �' I� ' was issued a permit to install a
(date)./ ((installer)
septic system at 9 r
ess) based on a design drawn by
(addr
rJ�.Cy� J 1AA� dated 0 7i zo��
(designer)
,% I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
V I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in co niiance with the terms
of the IAA approval letters (if applicable)
R of lhgsr, t
DAVID c� C
S MASON `�
'(Installer s Signature) 2 -�
GAS rE'�
S'1NITAWS 4
CD� "(Designers Signature) (Affix Desi hip Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
'
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS -F
E{;' a,' BAFIMSTABLE
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
7006 JAN 10 Pik 1: 42
io1M SVev
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 220 Fawcett Lane
Hyannis MA 02601
Owner's Name: Kevin&Melinda McCarron !�
Owner's Address: Same
Date of Inspection: November 29,2005 Job#05-360
Name of Inspector: PATRICK M. O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailing Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Number: 508-428-1779
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
_X_ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: �,_ �;.-� Date: 11/29/05
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: Leaching chambers Have 3"of standing water and have never had more than 6".
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
i
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin& Melinda McCarron
Date of Inspection: November 29,2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_XX_ 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:
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.
Answer yes,no or not determined(Y,N,ND) in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
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:
T410 Iq Inenan6n.I7nr All V,)nnn 2
f
' Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin&Melinda McCarron
Date of Inspection: November 29,2005
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
2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Titla C Tnenartinn Fnrm 4/1';i')nnn 3
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Page 4 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 220 Fawcett Lane, Hyannis
Owner: Kevin& Melinda McCarron
Date of Inspection: November 29,2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
—X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
—X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
—X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
—X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS, cesspool or privy is below high ground water elevation.
—X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_X_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
—X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
—X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this forma
_No_(Yes/No)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•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ 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.
Titles S incnartinn Fnrm 4/1 VlAi)() 4
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin& Melinda McCarron
Date of Inspection: November 29,2005
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_X_ Pumping information was provided by the owner,occupant,or Board of Health
_X_ Were any of the system components pumped out in the previous two weeks'?
_X_ _ Has the system received normal flows in the previous two week period ?
_X_ Have large volumes of water been introduced to the system recently or as part of this inspection?
_X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_X_ _ Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out?
_X_ _ Were all system components,excluding the SAS, located on site?
_X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of
scum?
_X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
_X_ _ Existing information. For example,a plan at the Board of Health.
_X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)[310 CMR 15.302(3)(b)]
Titles'; Tnenortinn Fnrm All V'Mn 5
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 220 Fawcett Lane, Hyannis
Owner: Kevin & Melinda McCarron
Date of Inspection: November 29,2005
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents: 5
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Two years total: 162,000 gal.=221 gpd.
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system (yes or no):_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records: None
Source of information: Owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
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:
Compliance date: 4/25/01
Were sewage odors detected when arriving at the site(yes or no): No
T41a C Tnon fin.Rnrm 411 siInnn 6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin& Melinda McCarron
Date of Inspection: November 29,2005
BUILDING SEWER: XX (locate on site plan)
Depth below grade: 1'
Materials of construction:_X_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 6"
Material of construction:_X_concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of
certificate)
Dimensions: 8.5' long x 5.2' wide—1000 gal.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 27"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: STICK WITH HINGE FLAP.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Tees intact and clear,liquid level at bottom of outlet invert
GREASE TRAP: No (locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Titla G lnenartinn Rnrm A1J,;JJnnn 7
• Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 Fawcett Lane, Hyannis
Owner: Kevin& Melinda McCarron
Date of Inspection: November 29,2005
TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: XX (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.):
No solids or high stains present.
PUMP CHAMBER: No (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Titles S incnartinn 17nrm AlI VIM)n 8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin&Melinda McCarron
Date of Inspection: November 29,2005
SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
_X_leaching chambers,number: Two 500 gal drywells
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.): Chambers have 3"standinss water and have never had more than 6"
CESSPOOLS: No (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: No (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
Titla C Tnenartinn nrm All Vinnn 9
• Page 10 of I l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 Fawcett Lane,Hyannis
Owner: Kevin&Melinda McCarron
Date of Inspection: November 29,2005
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.
Fawcett Lane
Water service Driveway
15
29 26
37 34
Titles C Incnartinn Rnrm All s/')nnn 10
• Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 Fawcett Lane, Hyannis
Owner: Kevin & Melinda McCarron
Date of Inspection: November 29,2005
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water: More than 20 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked, date of design plan reviewed:
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)
_X_Accessed USGS database-explain: USGS topo map and town GIS
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water below el.25 and topo map shows property at el. 50.
Titla G Inenartinn Fnrm ail�i�nnn 11
FROM :down cape engineering inc FAX NO. :15083629880 Aug. 25 2005 09:34AM P3
• Towvn. of Barnstable
Regulatory Services
Thomas F. Geiler,Director
8''"?AAS& � ' Public Health Division
019
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 503-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
\Parcel'
l4 e Permit# ZG 9--5—3J�Assessors Ma
Date.. Z� � Sewag .�. P
k
Designer: D0 V1 w t. Installer: aV_l y
Address: Address: (l • D
Y -
On �`M CIOW`S�was issued a permit'o install a
(date) (installer)
i / � ,
septic system at a J 3 �An,J _ Q�^M based on a design drawn by
(address)
dated
(dt perj
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (Le.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State.& Local Regulations. Plan revision or
certified as-built by designer to follow.
���ZFi Of MgSs9C
ARNF. H �ln
UJ-7 ALA
(Installer's Signature) civic
No. 30792
90'-�.��I8TF.p`�G\C�4
SS/()N L Ea
(Desi er's S igna ) (Aif x De s Stamp Mere)
PLEASE E RETURN TO BARN TABL P LIC HEALTH DI ION. CER11FICATE Of
COMPLIANCE WILL NOT BE issUFD UNTIL B TH TH-S FORM 6,tM AS-BUILT CARD A tE
RECEIVED BY THE BAR STABLE PUBLIC HEALTH DIVISION. SANK YOU.
Q:Health/SepticMesigner Certification Form 3-26-04.doc
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1. n0,LOCATI j=�4w� rl:. it).. SEWAGE it 11./�J ` r2 Lb ASSESSOR'S MAP &LOTZ? i3.3
VII.LAGE_ CJL)i i _ o
I. INSTALLER'S NAME&PHONE NO. i
SEPTIC TANK CAPACITY A0 C6 �'!1 IUC
LEACHING FACILITY: (type) C/ m a "�`��'� (size)
NO.OF BEDROOMS
p ... ......_ - rliaJlLllER.OR.UWNhtC. � �..
PERMITDATE:
/l COMPLIANCE DATE: L- —a 1
� �l � , S
Separation Distance Between the: 1 f
i 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) y Feet
Edge of Wetland and Leaching Facility. (If any wetlands exist
r
within 300 feet of leaching facility) -�
Feet'
Furnished by 1�'Ii�4mn % i i j�c
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LOCA'I'IOtd W �r;L m SEWAGE`# _
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ASSESSOR` ` riAP_c°t 'OT
INSTALLER'§�dAi�E&,g�iotdE PICA
sEa nC ZANK CAFAC x
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NO :OFZMRt7C)M 3
PE £DA3E.- COMFI�fAAICE gA
separac�nn Ihstance Between C
Max im�un Ad-i*W- G-ountiwaier T91 to the Bottom of Le thing Facility Feed
t Wate Watt r Supply Well Batt I. chng F calat3t ( at►►y gieI9s exist
on site ur:;wxetun?A�t fit-oTieing fad
Edge of Wetland and Leaching€" c tY(If any wstlands exist c
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TOWN OF BARNSTABLE Z
.UCATION 0 154 wC 6 T- 1-iL)• SEWAGE #
LAGEi a X)►I=%f<- - / � t5 ASSESSOR'S MAP &�LOTZ
INSTALLER'S NAME&PHONE NO. 9 YI Ate.- �'�� F` 10`1)-5
SEPTIC TANK CAPACITY Y-e
LEACHING FACILITY: (type) - �� (size)f,?K Q J
NO.OF BEDROOMS,
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE: u Z �OI
Separation Distance Between the: f
Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility Z Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) AI A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by k",�esiar�
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No w' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes /
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migoga[ bpotem Construction i3ermit
Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System 144 `vidual Components
Location Address or Lot No. 17 w 66,T-T 4,K), Ow,nper'ss Name,Aed`dress and Tel.N^o.
644-A
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures {�
Design Flow ® gallons per day. Calculated daily flow °l JD_Z gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 11V7 0 J22j::j. ��Cs T fer✓G Type of S.A.S.,3ZDC-44-1/,�C9 mZEZ5
Description of Soil 0-- 37z? P AkyQ -Yv kT le z w/ 3 2� /o s C4�U I 3,g,,
Nature of Repairs or Alterations(Answer when applicable)7 1A4CfE F541 Gj
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 y this Board of Health.
Signed tea- n,. Date c' /� e
Application Approved by ��Iy �l� P�D �p Date d
Application Disapproved for the following reasons
Permit No. Date Issued
No. -- 7- _ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for ;0i5pool �bpgtem Construction Permit
Application for a Permit to Construct( )Repair(l/ pgrade( )Abandon( ) ❑Complete System alydtvidual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel O T
y 7 h
Lc� hl�fLcJG�%
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
y/3-c f0f 6,4
Type of Building: 7
Dwelling No.of Bedrooms J Lot Size sq:-ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow O gallons per day. Calculated daily flow `% - gallons.
Plan Date Number of sheets f' t Revision Date
Title
Size of Septic Tank /rT1 lQ f�. /=Yl 77zK/6- Type of S.A.S.
Description of Soil 7;?:) P d4mt ,Q 7,,i-T /o / C-l 4- 571 / 3e7l J
f7/�,04,A 7/neL LL= /iF 0e, G I7 y ivi cf'1A—i I i ,4 CA::!Y= A—' �7.c
Nature of Repairs or Alterations(Answer when applicable) t2114 f-,—f i—74 Z :.,,,4 C /'/ �, I
/a.i ,7 �_ S7T '� 4 C f-/ / L,4 !.» �'? 4 S. !�l"L i :/1 U r/
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<tle Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date
g - -
Application Approved by— /. ,c � Date U 7
Application Disapproved for the following reasons
Permit No. a0n�33 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance /
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X)Upgraded( )
Abandoned( )by IV� ��' I�M � �C/n
at �l�)� A� has been constructed in accordance ;
with the provisions of Title 5 and the for Disposal System Construction Permit No. �2lY")I dated
Installer Designer
The issuance of this permit sh 1 not be construed as a guarantee that the system 11 fu cfign as/desig:ne ,ten
Date Y/Z S 0 l Inspector 0
———————————.— ———————— ———————————
No.rJt��1 �t .� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
igoof 6potent on!6truction hermit
Permission is hereby granted to Construct( )Repair(/N Upgrade( )Abandon( )
System located at
3h
AT-
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 permit. /
Date: y/ I7 I0 I Approved by
r -
1/6/99
NOTICE: This Form Is;To Be'Used For the Repair Of Failed
.Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I,CJ1A1 O/E S M�Oiet aQw` , hereby certify that the application for disposal works
t
construction permit-signed by me dated J-[?2A l d,1cz 1 , concerning the
property located'at'-T10 - EA-w z. L%;i I-ApiE meets all of the
following criteria:
This failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
✓� There are no wetlands within 160 feet of the proposed septic system -
/
v • There are no private wells within 150 feet of the proposed septic system
There is no increase in flow and/or change in use proposed
• There are no variances requested or needed. '
f/ • The bottom of the proposed leaching facility will not be located less than five feet above the maximum
adjusted groundwater table elevation. [Adjust the groundwater table using the_Frimptor method when
/. applicable]
v If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following: -
1%
A) Top of Ground Surface Elevation(using GIS information)
B) G.W.Elevation �d +the MAX.High G.W`Adjustment.
i
DIFFERENCE BETWEEN A and B / d
SIGNED : +!. - - DATE: ® f
k t r[Please Sketch proposed plan of system on back].
NOTICE --
Based upon the above information,a repair permit will be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
i
q:health folder:cert
7,4
q®` o
0
ASSESSORS MAP : •
Avo -- _ __ TEST HOLE LOGS
-� PARCEL : '
�.��- .-l____. _.-- ------- —.----._ ;' C 1) The tns(a(laliuit Shall co>»hhy +vitli 'I�itle V and �fuwn ol�Uq�}��'lu��rd o>_
FLOOD ZONE: MI SOIL EVALUATOR: �V� Ilealth Regulations.
,0 RF
_- - ------------ - WITNESS : t W 10 ID 2) The installer shall verily the location of utilities, sewer inverts and septic
REFERENCE:
components prior to installation and setting base elevations.
I- DATE: � ,V,�` t� t l 6
�, TE; 7 M, ( 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per loot. •I he first
Z two feet out of the d-box to the ieaching shall be level.
PERCOLATION RA
4) This plan is not to be utilized for property line determination nor any other
TH- 1 TH-2 purpose other than the proposed system installation.
�A A,, n tQ`t7 5) All septic components must meet•Title V specifications.
l� GIr 6) Parking shall not be constructed over I110 septic components.
17 L
� t� U"� �/ 7) The property is bounded by property corners and property lines.
\� l0 ��� �` i J�Q�✓ 8) The property owner sl►all review design considerations to approve of total
LOCATION MAP A design flow and number of bedrooms to be considered for design. Receipt
of payment for the plan and installation based oil the plan shall be deemed
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within (lie proposed SAS shall
lJ2� ? be removed along with contaminated soil and replaced with clean sand per
--- I Title V Specs.
qwv. � - ` yy0-- 10)System components to be 10 feet from water line. Sewer !fines crossing the
m water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if
applicable. 'I'lie proposed SAS is being installed below the water service
lice. 'The lice is to be sleeved as aforementioned and maintained in place.
SEPTIC SYSTEM D E S I Gil 11) If a garbage grinder exists it is to be removed and is the responsibility of the
l0 2
�It1, 0 � owner to erasure such.
12)The installer is to take caution in excavation around the gas line if such
FLOW ESTIMATE
l- 1W � /J exists.
I r -' � ll.'� "t2 l3 'bite installer shall verif the location quantity and elevation w
BEDROOMS AT ID GAL/DAY/BEDROOM - GAL/DAY ) Y , q y t of the sewer
lines exiting the dwelling"rior to the installation.
i — 1 14) I'his plan is representative only that a system can n fit o a property meeting
�
_ -11 SEPTIC TAIJK Title V requirements.
GAL/DAY x 2 DAYS - GAL
—__ USE 10M GALLON SEPT 1 C TANK 6Qt`I 1V
SO FL ARSORPTION-SYSTEM
OK9u5 W .
-Y"=- S 1 DE AREA: i YC 7sx tit I !I I� oDAVI i
_ \ SON
4 BOTTOM AREA: . 2 ' V- N1AorJ y
SEPTIC SYSTEM SECTION
Yd
t�or riouW 0vt
to I U
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goc
c, IA /2 '� o y .._ D—fit) . N �
/CJ ,00 -- ��.. GAL 3g1 5 , � - L 6
SEPTIC TA K
Hm
t\)j Le
SITE AND SEWAGE PLAN
JRU
DODO ,qu_,p I LOCATION : -Aao K 1
PREPARED FOR : Zi Hof
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~ �
M.
P
� f�S ( SCALECK
o
DAV I D� B . MASON R5 DATE: 2. Zo
Z DBC ENVIRONMENTAL DESIGNS
V -
a EAST SANDWICH . MA
DATE HEALTH AGENT ( 508 ) 833- 2177
ASSESSORS MAP :
TEST HOLE LOGS
PARCEL:
_ �, .- ---__._._.._.- _ _.___----._-___-- ___-- I) fhe urs(allaliott shall comIA tvitlt 'I,itle V all.] 'I�cmvu of )urud of
FLOOD ZONE: 3 Il ��I SOIL EVALUATOR,: I�VI >� Ilealth Regulations.
_ _ _�k ���l�-- - __ _________-._-_.____._ __
REFERENCE: WITNESS : t "V lo ID 2) I'heinstaller shall verily the location ol'ulililies, sewer inverts and septic
��- C _.--__._ - _.. _Z I Jb . ._ -- DATE: CO components prior to installation and selling base elevations.
PERCOLAT I ON RATE: M10. 11 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per floot. 1 he first
two feet out of the d-box to the ieaching shall be level.
�I iY• ?i�' y' _ Z, � 4) 'I'his plan is not to be utilized for property line determination nor ally oilier
TH- 1 11-1-2 purpose other than the proposed system installation.
,A 1pLov)\Aor 5) All septic components must meet'fitle V specilications.
L \ G) Parking shall not be constructed over I l 10 septic components.
/� to tie t2 ��� ,/ 7) 'I'lie property is bounded by property corners and property lines.
8) 'lie property owner shall review design considerations to approve of total
LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt
of paytnettt for the plan and installation based on the plan shall be deenied
1��0 -✓ IJ approval of the design flow by the owner.
/ 9) 'I'lte existing leaching or cesspools shall be pumped and tilled with material
per'1'itle Vabandotuneut procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
------ 1 title V specs.
00 C)C— 10)System components to be 10 feet from water line. Sewer !fines crossing the
go water line shall be sleeved with 4 inch SCI 1110 PVC with ends grouted if
applicable. 'Ilie proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
2 SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
--T FLOW ESTIMATE 12)'Che installer is to take caution in excavation around the gas line ifsuclr
4,7 exists.
BEDROOMS AT I� GAL/DAY/BEDROOM - ' GAL/DAY I3) I ue installer shall verify the location, quantity and elevation of the sewer
— -� lines exiting the dwelling p
-111 SEPTIC TANK rior to the installation.
14)This plan is representalive only that a system can fit on a p m
roperty eeting
' -
'T Title V requirements.
O ( GAL/DAY x 2 DAYS GAL
o _ USE I GALLON SEPTIC TANK EY 1�
N - SO> L AEtSORPTI�N-SYSTEM
—rc �,_ _ (v l I
= ` UkI Roo n Q-7 ��
----- _- ---------- SIDE AREA: t YC 7��C t� - I I f f a UAVID r
_ O
BOTTOM AREA:. 2, ' 9 ,,�7 N sor '
&►u/+.toes,
qFP
Jf J�
SE T I C SYSTEM SECT I ON
�,�� I- ` � l�of►�w►�►4
I Iwo �Ilrlr\
1 to tub
ly
AZ
b
J in ,oo _ -
•_ / -.�- _------ lnnb GAL 38i 5 1►�.�1 �� . �,�,. � � f�1� �•-
- -- O SEPTIC TA K t M
LfJ�j 11 kJ
-- - SITE AND SEWAGE PLAN
VDDO 4t� - l.. ' I�—==� —�' LOCAT 1014 : Z2�
PREPARED FOR : Z)
e
0
yqltQ IZE M4F, DeP914 W '17f,
SCALE:
W
Z
DAV I D- B . MASON I& DATE: 2 Zo
S� �rz DBC ENV I RONMEN AL DESIGNS
EAST SANDWICH . MA
Z
D TE HEALTH AGENT ( 508 ) 8337 177