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Home My WebLink About0263 FAWCETT LANE - Health 263' Fawcett Lane Hyannis r A= 270 — 113 ° o � ° 0 O o 0 e Ili TOWN OF BARNSTABLE LOCATION (®S 1�kW CAA SEWAGE# g010 VILLAGE • .,�.ASSESSOR'S MAP&PARCEL �a►7c� 0\ INSTALLER'S NAME&PHONE NO. .�rk�4 C)0C9`l SEPTIC TANK CAPACITY LEACHING FACILITY.(type) \C' �t-` MM rbrS (size) NO.OF BEDROOMS �� a X I� Oe•P OWNER PERMIT DATE: 'JQ (o i k Q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility tj Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) IQ A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) WA , Feet FURNISHED BY q_C NOICAA cl C W .1 b l � . i No. gdIo '-0/0 ` � Fee AU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftPYicatiou for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System dividual Components Location Address or Lot No. a C, G w Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 01 Insta ler's Name ddress,and Tel.N Designer's Name,Address,and Tel.No. ,c-C ,A i 3 Type of Building: ^� Dwelling No.of Bedrooms _ ) Lot Size sq.ft. Garbage Grinder Pq Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ?3(� gpd Design flow provided a � gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Q.) 1 S A I b O D Type of S.A.S. /_4 1�p Description of Soil „� '�r`(A r_�5 �t V L ( I L X %*?11 6 �-P Nature of Repairs or Alterations(Answer when applicable) �(� 2L a(\, c c a _ C—`1�- 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 Board of Health. Sign Date, /at, /`b Application Approved by , Date Z4o Application Disapproved by Date for the following reasons Permit No. G �/ Date Issued � .-,,, ��...w.v,.-.,.r.,...�,w,-`v+..-.;...._ .r1 __-.v:..v+.s^+Hr"*•_5�.,,r;..aw-"Nti„}+.a- +uK-.n-'•^ _� ......P-....r _ _ .. ... Y .., _ -....,.. ,. �., No. �1,� 't Fee o U � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes i ftpYication for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System ndividual Components Location Address or Lot No. (o G w i.R 'XA t G—J,, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel '7 d t 3 C- N6 Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.No. S(vH �rCr�� Spy ac, 00 loci 1 117 Type of Building: 1 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(UP Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Tr gpd Plan Date Number of sheets Revision Date Title t, Size of Septic Tank Q)C 1 s A � b 0 b Type of S.A.S. /-(a p T"C, }U r Description of Soil Q "FI`f�.[tn5 ��+�- (e.� L F X %')y ,$F �-P Nature of Repairs or Alterations(Answer when applicable) AJ(I Q r�k ,s,n C s {� 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 the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / Signed Date Application Approved by S, Date -A Plication Disapproved by Date for the following reasons Permit No. f ) 1161 Date Issued /�� 6 Z46 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by S cp Y� 7.-,UC at `J( 2 'V-(,),.L.�A Lc r-Q 9 V(" k has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit No. / -/� dated 11.26 /o Installer !r Designers -G,(� #bedrooms Approved design-flow ? gpd The issuance of this permit shall not be construed as a guarantee that the system will function designed. Date` 6 Inspector � No. 20 I a - %)lC► Fee 60 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal bpstem onstruction i3Prmit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �l�� w C.c SA, LC, -�c �f�/P\)\,N. 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 permit. ' Date ► 7 ( /n Approved by cr i Town of Barnstable OF THE T Regulatory Services t - Thomas F. Geiler, Director • sA"srnat.E, 9 MASS. Public Health Division i639• �� Tliomas McKean, Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# 10 j Assessor's Map\Parcel C�— Designer: _S Eip RC—,o,,3 �. 1-A4A!�O,PE Installer: "5csg1 T- q. f=�j:_ EACi-4E Scan�r' `aG lam. Address: �v�3 P-e;- ,;Z eeA Address: i I C t_b '?A-2._-t6— P4 A. V On \ ��p _ oaf-(- �,(, �� was issued a permit to install a (date) (installer) kA septic system at �, c-e� 1 �, )A based on a design drawn by (address) SW P Hf:, 5 A. 14 A,A�, P4 dated k I IQ \%0 (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. 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 �d certified as-built by designer to follow. lyyn.�V aA (Installer's nature) rx (Designer's Signature) (Affix Designer's Stamp 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. QASeptic\Designer Certification Form Revised.doc Town of Barnstable P# Departiment of Regulatory Services s W2N6r 8L% : Public Health Division Date0—//Y//11) MASS 039. �e� 200 Main Street,Hyannis MA 02601 ' Date Scheduled ho Time (Q AM r Fee Pd. //a� Soil Suitability Assessment for Sewage isposal - Performed B ��1 ��►—� )-�Ya-, � r y A E Witnessed By: W. > c ' LOCATION & GENERAL INFORMAT ON s Location Address oI 1'Gu J _ j� `•a Owner's Name �`• u . Address (� a b aL 'Assessor's M;ap1Parce1: 2�0 + f Engineer's Name CJ t s NEW CONSTRUCTION REPAIR _ Telephone# cT,ind Use s� ��R—L Slopes(%) G'Z Surface Stones �y Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line I 4- ft Other — ft 1 SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) At 1. Y t/ ti l s Parent material(geologic) d y r 4-)n s H Depth to Bedrock 4- Depth to Groundwater. Standing Water in Hole: st' Weeping ftom Pit Face Estimated Seasonal High Groundwater I-�, DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: A-X) N Depth Observed standing in obs.hole: In. Depth to Boll mottles; in. Depth to weeping from side of obs.hole: in, Groundwater.Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST We- Thne Observation I ( ' Hole# Time at 9" Depth of Perc ,D Tlme of 6" Stan Pre-soak Time @ Time(9,.(") End Pre-soak Rate Min.11nch �Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\.SEPTICtPERCFORM.DOC i DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soll Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% v 1 /b'r lt- V3 Z10'' L S DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) ,4 Ile DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsi to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consist n Flood Insurance Rate May: Above 500 year flood boundary No`_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No, ✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material's ..� Certification I certify that on t ' (date)I have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis was performed by me consistent with . the required tr ' ' xpertise and experience described in 310 CMR 15.017. ,t, �. Signature Date r } Q:\SElyriCTERCFORM.DOC Town of Barnstable Barnstable 'SHE Tp� ,., v ti Regulatory Services Department AD-WRiCa Uty BARN$TABLE. p K"i6g .9 Public Health Division op tip+ 200 Main Street, Hyannis MA 02601 2007 0 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 12/7/09 �(�O 6 Patricia Northup � j r � � 263 Fawcett Lane ! 1 Hyannis, MA 02601 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at,�O Fawcett Lane, Hyannis, MA-was last inspected on 09/13/2007, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. ,The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "," - 10 D "System is in Hydraulic Failure-Backup of sewage into facility or system component due to an overloaded or clogged SAS." co The deadline for repair has passed. We, The Department of the Board of Health, have,) not been informed That you have tame i any Steps to bri g ;-o::r failed ,y-s in 0 compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven(7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. 50;ac F THE BOARD OF HEALTH ean R.S. CHO Agent of the Board of Health Town of Barnstable Barnstable ~ ' Regulatory Services Department All-MedEe Cftv snxrtaTASIMA � Public Health DivisionASS FD MA'S a1� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 07/27/09 Patricia Nort p p 248 Ca . N-6 West Y th, MA 02673 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 263 Fawcett Lane, Hyannis, MA was last inspected on 9/13/2007,by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "System is in Hydraulic Failure-Backup of sewage into facility or system component due to overloaded or clogged SAS" The deadline for repair has pa , We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven(7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. i PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health f Town of Barnstable Barnstable �P�ppTME Tp�Q Regulatory Services Department e'cac fty I�> DARNS't'ABLE, A. ON Public Health Division y a6gq. ,gym m �ATFD MAt a' 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 2 2008 Patricia Northup 248 Camp Street N6 2 West Yarmouth, MA 02673 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 263 Fawcett Lane,Hyannis MA was inspected on September 13, 2007 by Patrick O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within Sixty (60) days 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 T E BOARD OF HEALTH 7007 0710 0005 5820 7571 omas McKean,R.S., CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures\263 Fawcett Lane.doc 7007 0710 0005 5820 7571 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF (ENVIRONMENTAL PROTECTION M t TITLE 5 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: :263 Fawcett lane Hyannis MA 02601 Owner's Name: Patricia Northup Owner's Address: 248 Camp Street N- West Yarmouth MA 02673 tv Date of Inspection: September 13,2007 Job#07-216 � - _ Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD w -,m MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 E - CERTIFICATION STATEMENT i 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 aml 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 Approving Authority _)C_ ails Inspector's Signature: Date: 9/13/07 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: Tank and pit were previously full to top,system is in hydraulic failure. ****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 I 1 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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. 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 cvill 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 clue 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: Page 3 of 11 OFFICIAI.INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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:;upply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I 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 ofammonia 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: Wage 4 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: :i63 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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_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 I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, Performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes (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 lairge 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. { Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: '263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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:0 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:36,000 gal.=49 gpd. Sump pump(yes or no): No Last date of occupancy: November 2006 COMMERCIALAN DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped one year ago. 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 al I components,date installed(if known)and source of information: 30+years. Were sewage odors detected when arriving at the site(yes or no): 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: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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 liner Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 2' 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: 2" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a 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.): Outlet bafftie is missine,must be replaced with a PVC tee at time of repair.Liquid level was found at bottom of outlet invert.tank shows no evidence of leaks.Tank has solids on top of outlet pipe indicatine hydraulic failure. 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.): t • Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 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: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 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.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers,number: _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.): High stains indicate pit has been full to tom pit is in hydraulic failure. 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.): • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection: September 13,2007 SKETCH OF SENVAGE 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 38 16 12 48 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 263 Fawcett Lane,Hyannis Owner: Patricia Northup Date of Inspection;: September 13,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells Noise Estimated depth to ground water: n/a 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 i abutting property/observation hole within 150 feet of SAS) Checked with ocal 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: :. ., f'fP.�# ._.. - ... ..! , .. ...� R'21.... ... ,#,T_ ,..cFM'"��`5•'.:-::: ,-. .A/y.. .a-...S ., :W..m,,. .:.. e.x.. -M :.. -,. ... .a.„ , "I: :.Fe'. Rb�i` '9�f ,r v. -+%++«.,. ..ww :z.. ,•. ;.: ,. ... ,.. _ _:_,2... .. � s,, ::. .,Y ..._.. .•Is" ,. "�, a: T.. :. , � d^.:'v .. w ,m^k .,...r,..'a..^T^w;'-,.,T..,.,..µ ;:na....,...:a,» n~r+.:.,.: ACCESS COVERS MUST BE WITHIN INSPECTION 9_7.MINIMUM. IN R 4 6. OF FINISH GRAD V� T EL E A T 1 ONS DES L GN CR I TER l A GENERA L NOTES . PORT 3 MAXIMUM COVER FIRST 2 TO ' INVERT OUT SEPTIC TANK: 97.85 DESIGN FLOW: - - INVERT f N DI ST. . BOX: 97.47 3 BEDROOMS AT l IO G.P.D. PER 1. THIS ,PLAN.I S FdR THE DESIGN AND"CONSTRUCTION BE LEVEL OF INVERT OUT D(ST X, 97.3 BEDROOM EQUALS 330;G.P.D. THE SEWAGE DISPOSAL SYSTEM ONLY.. DtAM p I CLEAN SAND BACKFILL INVERT IN LEACH CHAMBER: 97,-17 , , 96.25 NO GARBAGE GR INDER ' 2. VERTICAL DATUM l S'ASSUMED. FOR BENCH MARKS • 97.85 97.3 AROUND AND.2 BOTTOM OVER CHAMBERS 0 0 OF LEACH CHAMBER GAS 0 96 RS N/A SET, SEE SITE PLAN. , 97.47, r � ADJUSTED GROUND WATER:..., BAFFLE 97. 17 • SEPTIC TANK REDUIREDr - - •<_`. _ IO HIGH CAPACITY INFILTRATOR '= OBSERVED GROUND "WATER. N/A 3 OUTLET 330--G.P.D. X-200V - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND * EXISTING _ CHAMBERS IN TRENCH FORMATION. 2 x 5 BOTTOM OF TEST HOLE *1: 91.2 D-BOX SEPTIC TANK PROVIDED:= 1000 GAL EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL - ,;;, 1000 GAL CONFORM TO MASS. D.E.P.' TITLE,5AND LOCAL , • SEP TIC TAN K 6 CRUSHEDSTONE. OR .� SOIL ABSORPTION SYSTEM REOUI BOARD OF HEALTH REGULATIONS.RED COMPACTED BASE DESIGN PERC,RA TE ( 5 MIN/I NCH PROFILE : NOT TO SCALE ¢ ` SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER - 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3 IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. PROVIDED:. l0 HIGH'CAPACITY; INFILTRATOR CHAMBERS IN TRENCH. 62 LF x 7.79 SF/LF 5. ALL SEWER PIPE SHALL-BE SCHEDULE 40 OR - 463 SF x .74 GPD/SF - 357 GPD APPROVED EQUAL. 6. SEPTIC TANK AND D-SOX SHALL BE REINFORCED - SO I L TCc S T PIT DATA DATA& PRECAST CONCRETE AND WATERTIGHT. D-BOX'SHALL 1 ND I CA TES C7 I ND I CA TES BE WATER TESTED TO CHECK FOR LEVEL'WHEN THERE PERCOLATION -- OBSERVED IS MORE THAN ONE OUTLET. TEST GROUNDWA TER 7. BEFORE CONSTRUCTION CALL "DIG-SAFE'. TP #! P*I2809 TP2 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR FOR LOCATION OF UNDERGROUND UTILITIES. \ 0 101.2 0 101.5 LOAMY IOYR LOAMY IOYR 8. EXISTING LEACH PIT TO BE PUMPED DRY AND ror.A tl �` `� A SAND 3/3 A SAND 3/3 BACKFlLLED." 56 cr LOT 65 t N B .......................................... 100.5 6• 10/.0 r�8 o LOAMY IOYR LOAMY IOYR14. 888+ S.F. DB EXISTING SAND 5/8 SAND 5/8 PIT t P8• .. 98.9 26' ......... .... ........ 99.3 of FED �,-' MED-COARSE IOYR MED-COARSE 70YR sloryA lol,r ti¢ `?� C SAND WI TH 6/8 C SAND WI TH 6/8 TWIN 8' PiNc'S EXISTING � `'` GRAVEL GRAVEL Y 101.5 SEPTIC TANK -- OHW t UP 47/36 CB/D I SK Tom' C 1 50, �] 16' OAK / 10 HIGH CAPACITY TPs2 -- Z_ INFILTRATOR CHAMBERS !0' 00?c.o BY, CORNER PH \l "? I EL-J 02.0 •CS\�00 6" OAK _ 8. OAx NO WA TER NO WA TER 120' 91.2 120" 91.5 7 DATE: JANUARY 6. 2010 t i TEST BY: STEPHEN HAAS ` D-Box WITNESSED BY: DAV I D STANTON tis. o \ I 11 PERC RATE: ( 2 MIN/INCH r t ' Qz sq �• pa }R IOl.7 , a pp $srt 1f. h , s A 32 38`3p•W i 6a° - S E P T / C S Y S T EM O E_ S- ,; G/V I I 9 TEL PED�i o O 2 6 3 I=,4 WOE-,T T =L A NE . "AP 2 70 PAR CEL 113, 0. t �1 E / CATCH BASIN LA 29A R / V •,5 TA SL Em C' HYANN S J A I RoUT9?8 PRERARE•O F;OR A F ` LEGEND P A T R / C % A /V O R .7-H R UP ■ CB , CONCRETE BOUND .. _4 SCAL E- . / 2 0 ._JAIVUAR Y 22 . 2 0 0/ a 1 a• . -•W '; WATER LINE • l L OCUS, 0 HYDRANT , -_ GAS LINE Ql � + / � I OHW- OVER HEAD WIRES A G L� U �/ ++I i V G I NC �f •# LIGHT POST < 923 Route 6A a �F -E r UNDERGROUND ELECTRIC LINE Q _ 'ti �--� Ya'rmo u t h p_o r t ; . - MA I. 02675 , °: .. q�y, �, T UNDERGROUND TELEPHONE"t l NE �/j %7• r i '`�� 5 0 8 362---8132 s ` i CTV- UNDERGROUND CABLEV I S l ON LINE 5 0 8 4 3 2-5 3 3 3 +40.4 SPOT ELEVATION 40 EXISTING CONTOUR _�4Q] PROPOSED CONTOUR LOCUS : MAP 0 l0 20 40 JOB,NO: 09- 125 FIELD: TAW/RBW; CALC: SAH/CFW CHECK: CFW DRN: SAH fa , er _ ±h • , t t x , ' i , r... t.. - , n