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HomeMy WebLinkAbout0018 HOMEPORT DRIVE - Health 18 HOMEPORT DR., HYANNISPORT A=268.122 c Commonwealth of Massachusetts a&g.- r a-a- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 18 Homeport Drive ~i Property Address t,:'f Arthur Groberio-Birschner Owner Owner's Name information is H is ✓ MA 02601 02/04/2021 required fo ann y r every - page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms A. Inspector Information /,� 1{1(, filling out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Q Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector.in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 02/04 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive v� Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. CityrTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding a 10,x 29' x 2' leaching trench with 4 Infiltrators. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 l c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Home port Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owners Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d town water 9 ( Y 9 (gP ))� Detail In 2020-48,500 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I c Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No 1f yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 1 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 4411 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 -- page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 36"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: H-10 1500 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Home port Drive �� -- p Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 011 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4 Infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 f Commonwealth of Massachusetts jw Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): R t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 5' 0 . P I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts !n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 13 plus feet 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: I augered a hole at a lower elevation and shot it with a transit to show four plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I - c� Commonwealth of Massachusetts _ Title 5 Official Inspection Form 1' i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 18 Homeport Drive Property Address Arthur Groberio-Birschner Owner Owner's Name information is required for every Hyannis MA 02601 02/04/2021 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE 'C" SEWAGE„ —7 y 3 LOCATION o((o l VII,LAGE / �' S ASSESSOR'S MAP& INSTALLER'S NAME 8t PHONE NO. �� C°tfl Cd/1�r 77/ SEPTIC TANK CAPACITYU ° C � (size) LEACHING FACILITY: (tyPe) i`i'r- F BEDROOMS BUII,D OR OWNER TTDATE: /1/j 7!Q Sf COMPLIANCE DATE: Separation Distance Between the: 5 Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any"Wetlands exist Feet within 300 feet of leaching facility) l Furnished by LF b� 4� p q.h` TOWN OF BARNSTABLE E •CA/ LOCATION - SEWAGE 7 y 3 VILLAGE � �/9yliS�®/`T ASSESSOR'S MAP& INSTALLER'S NAME&PHONE NO. �r���f��✓`� 77/—�✓�� SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) 7--w .12� r5 (size) f0L21 VDROOMS 3 OR OWNER>ATE: 11h� T COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of.leaching facility) Feet Furnished b ��, i a� \ � �.... „r L3+ � � �' `''L �',, W • � � 1ls _� ,{ Fee THE COMMONWEALTH OF MASSACHUSETTS , Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi_4poOl *p5tem Con5truction Permit Application for a Permit to Construct( )Repair('�')Upgrade( )Abandon( Complete System ❑Individual Components Location Address or Lot No. Owner's Namg,Address and Tel.No. /f Assessor's Map/Parcel Installer's Name,Address,and Tel.No. /l Designer's Name,Addresd and Tel.No. Bar roG /7/ ��sr. Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(/LOW Other Type of Building 16 o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow JaJ® gallons. Plan Date S's 7l Number of sheets Revision Date Title Size of Septic Tank /,`^DD Type of S.A).S. L61 ZQ'X Z- Description of Soil Cyrr9h CQidQGJ7`�' Z� °�fy� 0�$ Nature of Repairs or Alterations(Answer when applicable) ble ) 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 thi B d Health. Signed J Date / Application Approved by Date / Application Disapproved for the following rea ons Permit No. Date Issued ----- -- ————————————— - 50 o , a+ _�'""� <- 6 �', .__.,,,,.�; Fee / THE COMMONWEALTH OF MASSACHUSETTS p* Enteredain computer:. 1// ( Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL-ES_MASSACHUS TTS 0[pprication for ]3i!5po!5ar �pgtem Construction Permit e fir; Application for a Permit to Construct( )Repair(�')Upgrade( )Abandon( ) U Complete System ElIndividual Components Iodation Address or Lot No. Owner's N Address and el.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Addres and Tel.No. ��� / Bof�DGD %G��sr. Ica A C4 1/ Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(� t Other Type of Building .51;zeelPICeNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 14 el gallons per day. Calculated daily flow J�J�a gallons. Plan Date Fig, Number of sheets l Revision Date Title Size of Septic Tank Type of S.A.S. 141 Z Q'X Z Description of Soil ���� ��i �/�/� 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 Certifi- cate of Compliance has been issued thi B d o0flealth. I Signed Date / l r Application Approved by F Date Application Disapproved for the following rea ons s Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY, that thf On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned )by ID! fD 4D fi`/ Gorr 5 at 1 h`Oe D/" �/'. /i1 Q�rl 5 O/T` ,� h s been constructed in accordance with the provisions of Ti e 5 and the for Disposal System Construction Permit No. �dated Installer Designer i The issuance of this permit shall of be construed as a guarantee that the system irll unctionas designed f Date Inspector _/ f't,fit _ 17 ��� 1 �' No. J (J '" / I� --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 7' Mioogar *pgtem on0truction Permit Permission is hereby granted to Construct C Repair( Upgrade( )Abandon( ) System located 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 it. Date: ��/ ��� Approved by I -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ®l w'� > a a EM -. � . , , �, JUNTOWN OHEA TITLE OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SL,13SUR.c.yCE SEW.yGE DISPOSAL SYSTEI'I FORNI PART A CERTIFICATION Property Address: N 0r. Owner's Name: Oivner's Address: Qo W a 3 Date of Inspection: :Name of Inspector: (please print) Compapv Name: 5_A4, Fn f, Mailing Address: D. a t an c c� 16Z3 Telephone"'\umber. (�$ �}p ? 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 rraining 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 CVIR 15.000). The system: Passes Conditionally Passes ?seeds Further,Evaluation by the Local Approving Authority ` ails Inspector's Signature: Date: (,, -7-0/ 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 ypd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments --This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t l itle Inspection Form 6i 15,'2000 page 1 U, OFFLCIAL" INSRE-GTION FORM-='NOT"FOR VOLUNTA:RYNSSESSMENTS SLBS'URF:�kCE}SEWAGE DISPOSAL SYSTEM-INSPECTIONFORIvI PART A- CERTIFICATION (continued) Property .address: N Home- r Owner: -- D-Ate of''Inspectitin: ---- Inspection Summary: Check A.B.C.D or E /ALWAYS complete all of Section D A. System Passes: 1 have noi mound anv information which indicates that anv of the failure criteria described in ',10 CMR !i.30= or in 3 i0 CMR 15.=0: exist. Any failure criteria not evaluated are Indicated below. Commgnts: c B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or ' . '. ..�, '�. re-,)aired. Tli'e s,%st'rr> upon!.'corripletion oft,.hY,e..r^f eIplace"tmerit or repair;,as approvi,:ed by the Board of Health will pass answer yes. !io br nordete !fined (Y,\ \1)) in the for the following statements. If"not determined" please explain. The septic [ank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound. exhibits substannal infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is :enlaced with a complying septic tank as approved by the Board of Health. `A metal septic can't; will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance utdicanng that the iank is less than 20 years old is available. XD explain: ` Obsen adorn 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 tu[even 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 t`. .i �D exniatn: "' --_ Thy sws[ermrequind-pump ino more-than-4-times•a-vear due-to broken or-obstructed pipe(s)--.The system-wi11--- pass Inspection r! t th approval of-the-Board of Health):--_._.—,._..__—.._.-._. broken pipe(s) are replaced obstruction is removed XD explain: f Paoe 3 of 1 1 OFFICLALINSPECTION FORM•,NOT•FOR,:VOLUNTARY ASS ESSMENTS ;:,f SLBSU-RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMS_? ; PART A CERTIFICATION (continued)- Property Address: HLYK enorf- ►r, Y�nn- : Owner: Date of Inspection: G-[0-O( 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, safery 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 _. Svsterh.NNill fail unless the.Board of.Health,(and Public Water Supplier, if anv).determines that the system' is functioning in a manner that protects the public health,safety and environment: _ The,system.has aseptic tank and soil absorprlo.n system(SAS) and,the.SAS is within,100 fee(of a surface eater supply or tributary to asurface water supply. Th;: s%,stem has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The sv stem has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Thy 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 thatfacility and the presence of a=orua 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: r v Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM aC'.ERTIFICATION (continued) Properry Address: �$ Ha�ne,oal`f fJ!'. ✓ f'f'kGln n�S Owner: Date of Inspection: - -05/ D. System Failure Criteria applicable to all systems: You must indicate "ves• or"no" to each of the following for all inspections: 1 es \o _ ✓ Bach-up of sewatze into facility system or r component due to overloaded or 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 '/, day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ AI-,, portion of the SAS. cesspool or privy is below high around water elevation. :/.M portion of cesspool.'or privy.is within 100 feet of a surface water supply or ributary to a surface water supply. fs • n An pornon of`a'ces'spool or`pnvy ts:,w.,ithina,Zone'°,]-;of a public well �A-P.v portion of a cesspool or privy is within 50 feet of a private water supply well. A_nV portion of a cesspool•or'.privy is Iess,+than:10,0.-feet but-Qreater,than 50 feet from a private water' y 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 t ri—y red. A copy of the analysis must be attached to this form. are t t e 1 be - P. (Yes,'No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 C1viR 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•'ves" or-no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) ves no the s.stem is,within-4)00 feet of a surface drfnl;dng 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 11 of a public water supply well It'you have answered "yes- to any question in Section E the system is considered a significant threat. or answered "ves" in Section D above the large system has failed. The owner or operator of any lame system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR :.304. The s.srem owmer should contact the appropriate regional office of the Department. 111- 4 i ::,inn 4 paiae of 1 L OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEIVI-INSPECTION FORM PART B CHECKLIST Propert-N' Address: I p ovi►-e /' 1 O . Owner: Date of Inspection D! Check if the folios,!n2 have been done. You must indicate .'yes" or"no" as to each of the following: 1 es o Pumou:g information was provided by the owner, occupant, or Board of Health ✓ `,ere any of the system components pumped out in the previous two weeks '? VX Has the system received normal flows in the previous two week period v Have !::rge volime's`of water been introduced-to the-system recently or as part of this.inspection ✓ Were as built Plans of the systt m dbtained.and,examined?.(.Ifthey;v✓ere;not available note as N/A.) +< Ras :h- facihr�Uor'dwellina inspected for stgns.of:se.wage back up ' �t as ;h° s!te nsot.:ted for.stgns of break out Were all system components, excluding the SAS, located on site '? v _ %ere tie septic tank manholes uncovered, opened. and the interior of the tank inspected for the condition of the baffles or te.s. inate nal of construction, dimensions, depth of liquid, depth of sludge and depth of scum %\%as th_ iaciiin,o%vner(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 Svstem (SAS) on the site has been determined based on: � ° /Exisnne information. For example, a plan at the Board of Health. ✓ Determined in the field (if any of[he failure critena related to Part C is at issue approximation of distance s unacceptabiel l `!U C\iR I .302(:)(b)] o Page 6 of 1 1 OFFICI:\.L INSPECTION FORM.— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM NRTC _. ,;S�YSTEIv1_.I,1V,F'O:RMA.TI.ON..`, . . �. .;�+".' .`_: >-• Property .address: csonr� { Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): -36 3 DESIGN flow based on 310 CMR 16.203.(for example: 110 gpd x ; of bedm roos): 3 Number of current residents: 3 Does residence have a Rarbace grinder(yes or no):zi� is laundry on a separate sewaae system (yes or no): :tVo[if yes separate inspection required] Laundry system inspected (,vsss or no):N Seasonal use: (yes or no);/Vo Water meter readings. if a% liable (last 2 years usage (gpd)): Sump pump (yes or no): I�O Last date of occupancy: COMMERCL4L/I\-*DUS'FRIAL Type of establishment: Design flow(based on 310 C\-iR 15 203): gpd Basis of design f]o\� (seats%persons/sgft,eic.): J - Grease trap present (.,yes or no): _ Industrial waste hoiding tank present•(ves or'no) 9r Non-sariitary'waste iii'charged to the Title 5 system (yes or nol'_ Water meter reacimLs. if available: Last date of occupancvvuse OTHER (describe): GENER-<'LL INFORMATION Pumping Records Source of nforn:atior,: O�J/i e� ✓t.(-- � Pei,,,,p S,n ce ,f�ecJ Was system pumped as par; of the in pection (yes or no): t/0 If yes, volume pumper.;: __gallons -- How was quantity pumped determined'' Reason for puripin_ _ . TY3 OF SYS"i E\I _ Septic tangy:. disc:tbution box. soil absorption system _ Single cesspool Overflow cesspool _ Privy Shared syste:r. )\.:s or no) (if yes. attach previous inspection records,.if any) _ Innovative!,%.lte native 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 •F: — Other(describe; Approximate 2Ljt components. date installed (if known) and source of inf6r nation: ' rs ' ere sewage odors cetected wren amving at the site (yes or no): �O r _ o .,,,., c �nnn 6 _ — r Page _ of 1 OFFICLAL INSPECTION FORM =.:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAG:E:D'ISPO:S:kE SYSTE_1VI'INSPECTION FORM PART C SYSTEM INFORMATION (cohiinued) Property Address: `6 Ho D r Owner: Date of Inspection: D BLUDING SEN ER (locate on site plan) Depth below '-ade ylatenais of construction: ast iron ✓40 PVC—other(explain): Distance from onvate water supply well or sucrion line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) Depth below ,-ade: Material of const:-ucnori: ,.oncrete_.,=metal_. _.fberglass.._._..polyethylene other(exoiaut) If tank is metai lts. age: _ Is age confirmed by a Certificate of Compliance (yes'or no):`— (atfach a'copy of c f cenificate) Dimensions: IC'(, X Sludge depth: �.. Distance from top of sludge to bottom of outlet tee or baffle: C:) Scum thickness: _ 1" Distance from top of scum to top of outlet tee or baffle: (b Distance from bonom of scum to borto of outlet tee or baffle: How were dimensions determined: c Pe Comments (on pumping recommendations, inlet and outlet tee or)baffle condition, structural integrity, liquid levels as r ated to outlet _n een. evidence of leakage, etc.): e on1 meAdlel GREASE TR:\P: _(locate on site plan) Depth below Material of coi:stn:cnort: _concrete _metal —fiberglass _polyethylene —other (explain): _ Dimensions:: g Scum thickness: .,_. Distance from too of SCUM to too of outlet tee or baffle: :'.. t .`(V "D' '- Distance front bottom of scum to bottom of outlet tee or baffle: Date of lass DLMDin2 Comments (Oa ourIptn_ recommendations, inlet and outlet tee or baffle condition, structural in[egnry, liquid levels as related to ot:tiet tnven. evidence of leaf age;,etc.)::;• Pate S of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYST EM INSPECTION FORM PART C' _ .. > SYSTEiV1'INFORMA11ON(continued)` Property address: N 40rke�0o•(-� �•SI A.►/1 iS Owner: Date of Inspection: (a-G-OI TIGHT or HOLDING (tank must be pumped at time of inspection)(iocate un site plan) Depth below grade: Material of construcrion: concrete metal _fiberglass _polyethylene other(explain): Dimensions: Capaciry: _ gallons Desien Flow: gallons/dav Alarm present (,,-es or no): Alarm level: alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBLtTtON`Ii0\.' f presentmust.lqe-opened)(Iocate on site plan) Depth ofai"qutc �e%e! above outlet invert: Comments (note_if_gox is level and distribution to outlets equal. any evidence of solids.carryover, any evidence of leakage into�or out of box, etc.): / nn-UoA tS eac GPI � c"i/Xy b PUNIP CH.ANIBER: (Iocate on site plan) Pumps in working order(yes or no): Alarms in wor:.:n2 order(yes or no): _ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Paee 9 of I '. OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY .ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (connnued) Propern, Address: Owner: Date of Inspection: &-(, o/ SOIL ABSORP"I"10N SYSTEN1 (SAS): z/ (locate on site plan, excavation not required) If SAS not located esPla!n whv: Type leaching Pits. num'ter: _ leachin , chambers. number: !eachine yai!enes. number: ,3 leachuig trenches:•numbei- length: leaching- ieic:s, number...dimensions: _ overflo%% cesspool. ❑umber: ianov atiy"aLernauve system Typeiname of technology: Comments (,nose cunduion of soil, signs df"'dia'ul e4aildre.'level of p'ondin2�,,damp,soil, condition of"vegetation. etc.): / 3 i� �t/�.�s^5 lo•1q l� /O' w (c(e . /Uo 51 f 4V5 d4', _ ,(�+cl-up CESSPOOLS: __ (cesspool must be pumped as pan of mspection)(locate on site plan) 'Number and c ,nf!,ura.mon: Depth- too o iiau:e to inlei !nven: Depth of solics Depth of scurf. Dimensions o : ssocoi Materials of runs:r.!ct:lo!.:—_ — Indication of eroL!!,J ater inflow(yes or no): Comments 1•n0,1e c(1nci:tion of sail, signs of hydraulic failure, level of pondina, condition of vegetation. etc.): PRIV-Y: locate on site plan, Materials of c.):�st:!c!1or.: _ Dimensions Depth of solics Continents(noit: t.nd!nc:.n of soil, signs of hydraulic failure, level of ponding, condition of vegetation. etc.): Page 10 of I ! OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SY.STEIVI•INFORM�ITION:(connriuedj Property address: /p Owner: _ Date of Inspection: - -OI 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 buiidina. a a� ---.. _ _ ti. b , i A-o- 31' (g p- ar OFFICLAL INSPECTION FORM — NOTs.FOR VOLUNTARY ASSESSNIENTS SUBSURFACE SEW.A:G.E D-IS'POSAl',SY-S'TEiV1'{INSPECTION FORM PART C SYSTEM INFOR.NIATION (continued) ProperiN :\ddress: -MP0-.-pr7L fir, l OMAiS O«ner: Date of Inspection: -O/ Slope Surface -rater �:... .. _ Check ce:lar Shallop+ ,. ei!� Esttrnaied deoth io eround water loft' feet Please indicate (checn) all methods used to determine the high ground water elevanon: ✓9bi-nned Tom system desiLn plans on record If checked, date of design plan reviewed: Obscn cd sit. (abutrtng pr(:Terty/obsenanon hole within 150 fee_t of SAS) ; Che::ked %%ith local Board-of Health-explain: ✓he ked local excavators nstallers (artach documentation) .-\ccessed U-SGS database-explain: ot! musi o"-s=b;-- how you established the high ground water elevation: �c ,h Des;yh ola� 51�aws Qerc o--� cL - 1-3 ,t 3 . riYANNISFORi. HA LOCHS R Not-SPORT 0 S C ONT U �� �. F O e LL - . EXISTING - - - - - - - 30 ►- �` _ m < + MINIMAL GRADING PROPOSED Ow mNN O WN(7 . O r PLAN REFERENCE M" PLAN BOOK 197 PAGE 123 ASSESSOR'S MAP: 268 N LOT: 122 D-BOX 28 LOCUS M A P .LL z 1500 GALLON w`0 SEPTIC TANK—' �\ NOT TO SCALE ' t r <N U 1'' 00 F JN, o z � _ \00• O \1 EC N Q = W w o EXISTING 0 o Z U J > CESSPOOL L < z Wow _IC7 w 0 28 O �E0 29 ft X 10 ft x 2 ft Q �< ,� CLEANOUT Q� cN \ LEACHING GALLERY TEST O 00 v �R` BORING 5 0 0 W LL 0 N N eo 3 Gi1.\' �N� t �% GAS >O� a� � � � LINE U z w 2 .L �J =o<n 1 \� OF c Q`O 1 -4 m o TEoG� � LOT 2� 0 AREA - 7500, sr �- N \ e 00 / 28 BENCH MARK Lr n' ADO Q \ PK NAIL IN DRIVE W1 V 0 ` ELEVATION - 2&30+- � ` AGP USGS DATUM ASSUMED W Z Y UTILITY 26 �O U. O POLE << °° PLAN O 0 W a p �m Z i SCALE: 1 i� = 20 fr SEWAGE DISPOSAL SYSTEM PLAN o � � 0 U o Its � N � • o a w -TO SERVE EXISTING DWELLING U,) V>1 BENNABY INC. N 18 HOMEPORT DRIVE HYANNISPORT, MA ECO-TECH ENVIRONMENTAL O N N o 43 TRIANGLE CIRCLE SANDWICH MA 0256 ETE-554 AUG 21, 1998 I/2 }. THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED IN SLUE AND STAMPED IN RED. SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: AUGUST 21. 1998 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. RS WITNESSED BY: JERRY DUNNING. HEALTH AGENT SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS NO GROUNDWATER ENCOUNTERED. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED). TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH DISTRIBUTION BOX: USE 3 OUTLET D-BOX ELEVATION - 28.6 •- PERC AT 78 in : 2 MIN/INCH IN C SOILS SOIL ABSORBTION SYSTEM: A 29 ft x 10 ft x 2 ft LEACHING GALLERY CAN LEACH Aboi - ( 29 x 10 ) - 290 sf DEPTH SOIL USDA SOIL SOL COLOR SOL OTHER A s d w. - ( 29 • 29 10 + 10 ) x 2 - 156 s f (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING A 1 o 1 - 446 s f Vt 0.74 x 446 - 330.04 GPD 0-3 A LOAMY SAND 10 YR 3/3 NONE FRIABLE USE GALLERY BELOW. V1 - 330.04 GPD > 330 GPD REQUIRED 3-20 B LOAMY SAND 10 YR 5/8 NONE FRIABLE 20-64 CI MEDIUM SAND 10 YR 6/4 NONE LOOSE 66-150 C2 MEDIUM SAND 25 Y 6/4 NOW LOOSE LEACHING GALLERY. CONSTRUCTION DETAIL CULTEC CHAMBER CULTEC RECHARGER 180 INTERLOCKING CHAMBER SYSTEM 14 in EFF. DEPTH 29 ft STONE N Q NOTES n `O ' N 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2.5 f 24 ft 1,25 {, 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 29 ft 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. ECO-TECH RECOMMENDS THAT GAS SUPPLY BE SHUT OFF AT GATE PRIOR TO ANY EXCAVATION, 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. OBSTACLES TO BE SEWAGE DISPOSAL SYSTEM PLAN PLACED TO PREVENT PARKING OR DRIVING OF VEHICLES OVER SEPTIC SYSTEM. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. -TO SERVE EXISTING DWELLING 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL BENNABY INC. STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 12) INVERT ELEVATION OF BUILDING SEWER WHERE IT EXITS THROUGH FOUNDATION 18 HOMEPORT DRIVE HYANNISPORT. MA WALL TO BE RAISED TO ELEVATION INDICATED ON FLOW PROFILE. ECO-TECH ENVIRONMENTAL 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-554 AUG 21. 1998 T 12/21 _ ,,.., .<..,...;::s,.... :s.<..,...z.-c- r,....v..,.:,..n -,.:x:-.ww-..-... ,....w.w,.arj �:"'1tzw.fr S-•�p!7^'a ..zw..:r+. ..._.,....,A.w......w.-;..v HYAIW9 GU. HA .. - CONTOURS. HompoRT EXISTING - - - - - - - 30 MINIMAL GRADING:PROPOSED a mn g wv,c`rf PLAN REFERENCE My t PLAN BOOK 197 PAGE 123 N ASSESSOR'S MAP: 268 28 , LOT: 122 D-BOX LOCUS MAP LL 1500 GALLON a NOT TO SCALE ON SEPTIC TAIL ; N 0 4 <� z Z 100- t O N = W w o EXISTING O o J� > CESSPOOL / O ' c _ LL < J Z W < _ w 26 0 61 29 ft X 10 ft x 2 ft Z t CLEANOUT s CZN LEACHING GALLERY 2 W x l?V p ;,-, Q -o - �G �� �L TEST \ p J Ox ORO �� a BORING cn o I` g,1��/ o�Gl O�({S ��% GAS f • LLI Li_ ' N N \ W V C o r l 1 L lNE ' 0 0 w oP 2a N U z w000, =o W .G < to v m oo < LOT 2 AREA - 7500 sf�- N 00 00 4A 28 BENCH MARK n' 1 Q \ PK NAL N DRIVE W ► �/ y O\ ELEVATION - 28.30*- AGP USGS DATUM ASSUMED �0 w � w N 0 z UTILITY 26 1!� ' I z -i < J POLE yam/ t_L_ J U. m J ~ , a J Z PLAN ryo, o Mi. . N o SCALE: i in = 20 ft SEWAGE DISPOSAL SYSTEM PLAN z 0 w -TO SERVE EXISTING DWELLING U)io _ `f' BENNABY INC. LL 00 N 18 HOMEPORT DRIVE HYANNISPORT. MA wri ECO-TECH ENVIRONMENTAL O o N 43 TRIANGLE CIRCLE SANDWICH MA 0256 ETE-554 I AUG 21. 1998 I/2 ITHIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT BEARS THE STAMP AND SIGNATURE OF TFE DESIGN ENGINE ORIGINAL PLANS NTENDED FOR SUBMTTAL TO THE BOARD OF HEALTH.WILL BE SIGNED N BLUE AND STAMPED N RED. I - F r SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: AUGUST 21. 1998 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. RS SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS WITNESSED BY: JERRY DUNNING. HEALTH AGENT INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED). NO GROUNDWATER TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH DISTRIBUTION BOX: USE 3 OUTLET D-BOX ELEVATION - 28,6 .- PERC AT 78 in : 2 MIN/INCH IN C SOILS SOIL ABSORBTION SYSTEM: A 29 fi x 10 fr x 2 fi LEACHING GALLERY CAN LEACH Aboi - ( 29 x 10 ) - 290 sf DEPTH SOIL USDA SOIL SOIL COLOR SOL OTHER A a d w - ( 29 + 29 10 + 10 ) x 2 - 156 s f UVCHES) HORIZON TEXTURE (MUNSELL) MOTTLING A 1 o 1 - 446 s f t Vf 0.74 x 446 - 330.04 GPD 0-3 A LOAMY SAND 10 YR 3/3 NONE FRIABLE USE GALLERY BELOW. V1 - 330.04 GPD > 330 GPD REQUIRED 3-20 B LOAMY SAND 10 YR 5/8 NME FRIABLE _ 20-64 CI MEDIUM SAND 10 YR 6/4 NONE LOOSE 66-156 C2 MEDIUM SAND 25 Y 6/4 NONE LOOSE LEACHING GALLERY CONSTRUCTION DETAIL CULTEC CHAMBER CULTEC RECHARGER 180 INTERLOCKING CHAMBER SYSTEM 14 in EFF. DEPTH 29 h STONE Q NOTES � - n O N Q 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2.5 ( 24 fr 1,2.5 fr 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT I/8 INCH PER FOOT MINIMUM. 29 ft 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) t 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. ECO-TECH RECOMMENDS THAT GAS SUPPLY BE SHUT OFF AT GATE PRIOR TO ANY EXCAVATION. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED ; 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. OBSTACLES TO BE SEWAGE DISPOSAL SYSTEM PLAN PLACED TO PREVENT PARKING OR DRIVING OF VEHICLES OVER SEPTIC SYSTEM. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. -TO SERVE EXISTING DWELLING 1 t) SSTABLE BASE THPTIC TANKS AT HAS' BEENLED ECHANICALLYD TRUE TO GRADE ON COMPACTED AND ON O WHICH BENNABY INC. SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 18 HOMEPORT DRIVE HYANNISPORT. MA 12) INVERT ELEVATION OF BUILDING SEWER WHERE IT EXITS THROUGH FOUNDATION WALL TOµBE�RAISED TO ELEVATION INDICATED ON FLOW PROFILE. ECO—TECH ENVIRONMENTAL 43 TRIANGLE CIRCLE SANDWICH MA 02563.. t _ ETE-554 AUG 21. 1998 2/2 Y. < �+ x�+.gazw+.v `_„a.F-u-' .m,.w�..�.srr..xs.ri+�� ...,a.»,.'F -....„n:�- .v.<..aw.","...++.:s'+rc�..,._.:.•.auea..m�...r,;4v+..-_-._-:-wr+,*+r.�=au=.-..•'es...>osw:km�ua»-'.ei..a».....a,.,,..,.�w.s.aars.�s _r.+:.cnn...,rsu - '._,.... r...-�:...,.,.. ,.....,...._ _ ._. �.,....7.. _.... .>. ,..._ v._.._ ..