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Home My WebLink About0071 HOMEPORT DRIVE - Health 71 Homeport Dr 268-138 Hyannis i I i I / TOWN O;FIBARNSTABLE LOCATION 7/ /7c�► ;?d lL T Y'2 1 uf SEWAGE# ® 1 — 7' z/ VILLAGE 3 ASSESSOR'S MAP&PARCEL 'O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY E X 4s To�t LEACHING FACILITY:(type f2) 5'�o C�.o.y,le etJ (size) A-0 X (6 ,S ,Y D_ NO.OF BEDROOMS n OWNER 0 w WA /_,q PERMIT DATE: ' Z "/ COMPLIANCE DATE: �/�b� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY o � , • x • e N ((�� C � C-7Z)j No �- 14 Fee THE COMMONWEALTH OF MASSACHUSETTS Enteredinc mputer: PUBLIC HEALTH DIVISION -TOWI l-OF PARNSTABLE, MASSACHUSETTS Yes 01pprication for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair WVipgra�E--( ) Abandon( ) ❑Complete System ❑Individual Components Location�jddress or t No. YF1�/iY S' Owner's Name,Address,an el.No. 21 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L �v2 uA 5`D Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require ) (' gpd Design flow provided 3 gpd Plan Date 2 00 Number of sheets Revision Date Title r Size of Septic Tank 6' X, s T / GOD Type of S.A.S. L2 s OO Description of Soil 41 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 no lace the em in operation until a Certificate of Compliance has been issued by this Boar Date 6 YY Application Approved b &A Date Application Disapproved by Date for the following reasons Permit No. Date Issu11 .-- :'v'^o4..K...+-,.rwv..n—r^'�,��'-i�^nl`7 Fl,,,'7,�t 1,�-•a'"Z'a,*r.... ti. � .. s..-w,.r.._ . - ... Fee v No t THE COMMONWEALTH OF MASSACHUSETTS Enteredinc mputer: Yes PUBLIC HEALTH DIVISION -TOWIOF BRNSTABLE, MASSACHUSETTS :L ,, 0[pplitation for Vsposal 16pstem Construction permit Application for a Permit to Construct( ) Repair opgr-ade�°) Abandon( ) ❑Complete System ❑Individual Components Location ddress or�t No. Owner's Name,Address,and Tel No. Assessor's Map/Parcel 6 /_3 d 5 t} ✓� �= Installer's Name,Address,and Tel.No. Designer's'Name,Address,and Tel.No. fV Q Sd r 775- i3 �-� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y gpd Design flow prow ided 3 5�� gpd Plan Date 6/ Z / 0 O Number of sheets } 1 Revision Date Title r t Size of Septic Tank f= �' s r (�o D Type of S.A.S. 2 s-OU Description of Soil 1 f Nature of Repairs or Alterations(Answer when applicable) may` Date last inspected: a ' Agreement: _ - Theundersigned 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 e Date 6�O// ( o Application Approved by,,, Date- " Application Disapproved by Date for the following reasons Permit No. Date IssulK THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS f' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 2 e' at ;2 / /t t f PO 12 T J y s has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N -e/fdated Installer A dZ- Designer 1--,q< /t� Sli 2 41 1 y #bedrooms Approved design flow gpd The issuance of this perms sh. 1 not b co striiedaas a guarantee that the system wil function Ig ed'. Date �/' .Q�-�/ `1,°' / Inspector G No. .--- - Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS NspoSal *pstrm Construction �Prmit Permission is hereby granted to Construct( ) Repair(/� Upgrade( ) Abandon( ) System located at I'le r"" 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:Construc_tio . ust b co � pl to within three years of the date of this ermit. - Date � � Approved by f ! 'down ,of Barnstable RegWatory Services Thomas F. Geiler,Director Public Health Division f4�p t Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office. 508-862-4644 1:ax: 508-790-6304 \ Installer& Designer Certification Form Dote: Sewage Permit# Assessor's MaP\Parcel Z" 13S Deisigner: S_7 la�+t� t*, 'S, r� Installer: E44 L Sc S eJA—✓.*AX, MAT a Address: 2Z-&__Xo.,iz- e.A Address: �/f+�.".tors77,r7etiT HA oze.on 7�' (date) (installer) was issued a permit.to install a septic system at '71 k O"C- Poor M a uc. based on a design drawn by ' (address). —'PC dated ep h t 20 r P-4-01 S 4;-b e (J ��1 Z° ►1 (designer) V 1 certify that the septic system referenced above was installed substantially a=rding 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 certified as-built by designer to follow. ... (inst er s Signature) v1 NQ, IL All 1 (Designer's Signature) (Affix D igner s Stamp Here) PLEASE RETURN TO NARNSTABLE PUBLIC HEALTH D)NISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH.THIS FORK! AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEAL' I DIVISION\. TUNK YOU. QAS*tic\Designer Certification For,Reviscd.doc i TOW)a 0 Barnstable P# %3Z Department of Health,Safety,and Environmental Services Public Health Division i Date -•� 367 Main Street,Hyannis MA 02601 y MASS. a D Z«x�• ate.Scheduled_ .� �/ car/ Time 111-' Fe e Pd . Soil Suitability Assessment fog Sewage Disposal Performed By: .51&V/ y, Witnessed By: 4CTIQI�& GTP ,<IIY�Q Location Address R1Y14TIQ1�T ' -71 H n), e L -6 � Owner's Name �oAi;-.)A -/�ibN` Address Assessor's Iviap/Parcel: Engineer's Name 5725)-01 NEW CONSTRUCTION REPAIR e— ,� I g Telephone# Land Use , Slopes(%) -e—2_ Surface Stones A.)0. Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way 13-G ft Property Line. Other ft. SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) VJ Parent material(geologic -/—,kj-1"7S i`l Depth to Bedrock z ' t Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face-- A Lstimateu Seasonat High Groundwater —A-)Jf} DETERi1HNATT�N FJREASONA .HIGH'F �'ER TABU Method Used. .��C... ' Depth Observed standing in obs.hole: in; Depth to soil mottles: in. Depth to weeping from side of obs.hole in. Groundwater Adjustment ft, Index Well# RradingDate: Index.Well level � Adj.factor_ Adj.Groundwater Level ;.:: WF -. PAR C1D ;AT7N Ti ST nac� r r, � / Observation / Hole# / Time at Z �r. • Depth of Perc Time at 6" • Start Pre-soak Time cr Time(9"-6") End Pre-soak- Rate Min./Inch GZ Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Bacic j Copy: Applicant SEEP 0.13 E RVA XQ EE Hole:# Depth from Soil Horizon . Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ' nc ° el AL s 26 LS 1v 3 Zea 6 ,� DEEP OI HC)LE Z,QG IFiae # 2 : . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) I (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Cr I 10 L 5 l a;'�/s ]SEE Q SERYA ONY OLE LOB HQIe# Depth from Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Co isi to c %Gravel) 7lEEF;bBSERVA 10NHALE LQ;G foie Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes: ons' e c %Gra e I Flood Insurance Rate Mao 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? YCS If not,what is the depth of naturally occurring pervious material? Certif ccation I certify that on (date)I have passed the soil evaluator examinatiron approved by the Department of Enviro tal Protection and that the above analysis was performed by me consistent with the required trai ' p lise and experience described in 310 CMR 15.017. Signature Date /�5�� Certified mail: 7008 3230 0002 5178 0073 Town of Barnstable Regulatory Services anRtvsrnst.E. rAA-Qa Thomas F. Geiler, Director ' 039. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Donna L. Lauder March 28, 2011 71 Homeport Drive Hyannis, MA 02601 NOTICE OF VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND ,TOWN OF BARNSTABLE CODE & 353-9-DISCHARGE ONTO GROUND PROHIBITED. On March 10, 2011, Health Inspector David W. Stanton, R.S. investigated a complaint regarding sewage in the driveway of the property owned by you located at 71 Homeport Drive, Hyannis. The following violations of 310 CMR 15:000, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and the Town of Barnstable Code were observed: 310 CMR 15.303(1)(a): Septic system is in hydraulic failure. A sewage puddle was observed in the driveway. Town of Barnstable Code 4 353-9: Discharge of sewage onto the ground. (1) You are directed to keep the on-site sewage disposal system pumped as many times as necessary to prevent it from overflowing onto the ground until the septic system is repaired. (2) You are ordered to hire a licensed septic system installer who will obtain a septic system permit with the Health Division and have the septic system installed in strict accordance with the approved engineered plans within sixty (60) days of your receipt of this letter. r You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance'will result in the issuance of a non-criminal ticket citation of $100. Each day's failure to comply with an order shall constitute a separate,violation. &PERER OF HE BOARD OF HEALTH McKean, CHO, RS Director of Public Health Q:\Order letters\Septic\71 Homeport Drive.doc TOWN OF BARNSTABLE 4 LOi.ATION `irk C SEWAGE # / Z VILL,IGE ASSESSOR'S MAP& LOT < �' INSTALLER'S NAME&PHONE NO.Tn — � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNERp- PERMITDATE: _COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _Lq- 4 No. / " a/ •`FeeVY:7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Migoml 6potem Con.5truttion i3ertnit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 "^F U��J`ei Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. to%6-CAPsSEPNtcr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow— gallons per day. Calculated daily flow 3� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 4 OtAj Type of S.A.S. �tG►y C W-kw1 l Xh, LTVti,ol2 Description of Soil r Nature of Repairs or Alterations(Answer when applicable) _T STfal I VDU Sr-PT I t— -F4, -)V— r "r AJ� 'C'tur�L°<YhTili�l S �✓ N i sru,v� a� .s r,�r-��-� � �ii Date last inspected: Agreement: The undersigned agrees to ensure the construction and,maintenance of the afore described on-site sewage disposal system j in accordance with the provisions of Title 5 of the Environmental Code a not to place the system in operation until a Certifi- cate of Compliance has be Signed Date ' Application Approved b Dates Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC"HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication,for Dizponl *p! tem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.-� ' j� - �r,J Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. nnnn Designer's Name,Address and Tel.No. �-G a F t2 rut �0_� tq n� Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow a;D�0 gallons per day. Calculated daily flow 33 D gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. %AiG►a- 06CC,T� .T4 �LTyci�o� Description of Soil AA Nature of Repairs or Alterations(Answer when applicable) DU ,L a-IK— 0- 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 Cod/an not to place the system in operation until a Certifi- cate of Compliance has been �d�y� is Bo Haal . Signed i '�. Date Application Approved by 0 Date ..� � Application Disapproved for the fol owing reasons t S, Permit No. ' � . / Date Issued `""i THE COMMONWEALTH OF MASSACHUSETTS } . BARNSTABLE, MASSACHUSETTS ip Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ) Upgraded Abandoned( )by M't 6 G A() Q 0101r1_T;;11�� at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction ermit No. dated ,mot. Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date P 7 Inspector ---------------------------------------- No. +.ter. Fee ^✓ i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Im wfi6pont 6pztem Construction Permit Permission is hereby granted to Construct( )Repair grade( )Abandon( ) System located at "�1 j)�AA-& OL)= Dy, ILrP T" 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 oft it. Date: �" Approved by'I f NOTICE: This Form is to be used for the Repair of Tailed Septic Systems Only CER7 IFICA TION OF SKETCH AND APPLICATION FOR A DISPO_SA_L WORKS CON TRUCTION 1'I;jtMj,j' twITIIOU T DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 8�,�_� concerning the property located at `7 1 1-40•nO P64 Or"—e— `"l�tt4—z— 'meets all of the P Y � following criteria: J• There are no wetlands within 300 feet of the proposed septic system "• There are no private wells within 150 feet of the proposed septic system v• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility J• There is no increase in flow and/or change in use proposed �1 • There are no variancesrequested or needed. SIGNED : DATE: 17 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. jxcrt 0 z Q � e 0 . � r - - - - TOWN OF BpRNSTABLE ,r SEWAGE# 9 LOCATION ASSESSOR'S MAP &LOT VITLAGE n i — INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY , LEACHING FACILITY: (type) --�—� (size) -NO.OF BEDROOMS - BUILDER OR OWNER PERMITDATE: ' "g7 COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and 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) Furnished by Z77Z- : o 4 � COMMONWEALTH OF MASSACHUSETTS 0000,1 ! , EXECUTIVE OFFICE OF ENVIRONMENT AIRS DEPARTMENT OF ENVIRONMENTAL TIONL ib ONE WINTER STREET, BOSTON MA 02108 (617) - 0 MAY 9 1997 29 WILLIAM F.WELD TOWN OF 80-4 TRUDY COXE Governor HEALTH oFP Secretary ARGEO PAUL CELLUCCI B. STRUHS Lt. Governors�� Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: .;;r f O `04L&L Address of Owner: e ct- Date of Inspection: yip ! (If different) Name of Inspector: M. x 7z, ,\ Company Name, Address and Telephone Number: Piv A- c_ Ew�v�ac»-�.v.��r.�,�t•c��cz a-��yI Knm4,�`-t P1w. oZ�.-�°t CSot4 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ey 'Passes �' �a�� S 6 w Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority r./Fails Inspector's Signatur : Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 i�Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM j PART A CERTIFICATION (continued) Property Address: Owner: �eu /� J`""V. Date of Inspection: 4 B] SYSTEM CONDITIONALLY PASSES (continued) f Sewage backup or breakout or high static water level observed in the distributio box is due to broken or obstructed Tpipe(s)i-5-r due to a broken, settled or uneven distribution box. The system will ass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to br en 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 Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board o Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETER/INES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water privy Cesspool or ri is within 50 feet of a bord ring vegetated wetland or a salt marsh. _ P 2) SYSTEM WILL FAIL UNLESS THE BOARD OF H LTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and so' absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system'has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank a soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank a d soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well w ter analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from t t facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER i' (revised 11/03/95) 2 f f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: 7-1 f��-2� Date of Ins"p Act.-� D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system,is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7/we,�� w Owner: 4', & -k Date of Inspection:Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. l None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. WAs built plans have been obtained and examined. Note if they are not available with N/A. IThe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. I The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided.with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �— Owner: e, Date of Inspection: / Old 3vl y.� FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms: Number of current residents:b3 Garbage grinder(yes or no):NO Laundry connected to system (yes or no):kAC!�, Seasonal use (yes or no):_±��O Water meter readings, if available: f�f� Last date of occupancy: COMMERCIAUI NDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING R�CORDS and source of information: �"ii.Y►-y �S QUVYI(�1,nx_., �� Qs,0�c�4!_�...�4�n.t System pumped as part of inspection: (yes oV no)_ If yes, volume pumped: gallons Reason for pumping: ) TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)1 (revised 11/03/95) 5 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ;;r/ ems Owner: A �> Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal FRP —other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,/epthof level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _oth.r(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 to or baffle: Comments: (recommendation for pumping, condition of inle and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) i (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ( Owner: /'e'-, A , Ct 4pq- o Date of Inspection: c'�4l�015 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: .(condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids cayryover, evidence of leakage into or out of box, etc.) 1 PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: -;Z/ Owner: K /Sc" 7 Date of Inspn: 3zn SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits,.number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: `) Depth-top of liquid to inlet invert: �`[xs�1L. �+•�1�2.i Depth of solids layer: Depth of scum layer: Dimensions of cesspool: /&k, Materials of construction: Indication of groundwater: r-J1(11 inflow (cesspool must be pumped as part of inspection) NO Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level or ponding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _7-/alb Owner: �,� Date of Inspection: `t'�a " SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' XZI a� DEPTH TO GROUNDWATER Depth to groundwater: .Zc7 feet (1 method of determination or approximation: S, t�� 1'4a3%,Z-)\ T (revised 11/03/95) 9 - o V� rowvoF COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS �+ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Address of Owner: 71 HOMEPORT DR.HYANNIS,MA 02601 Date of Inspection: 611/00 Name of Inspector: JOHN GRACI /am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-6644813 FAX 608-564-7270 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further E71, n By the Local Approving Authority Fails Inspector's Signature: Date:611/00 The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 5/1/00 INSPECTION SUMMARY: Check A, B, C, Of D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,.structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced Wa The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 6/1/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance n1a(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 6/1/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an 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 1/2 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 f!. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECKLIST Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner: HOWES Date of Inspection: 611100 Check if the following have been done:You must indicate either"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 - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X - As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X - Existing information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X - The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 5/1/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:4 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM M ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: NEW SYSTEM IN 1997 PERMIT 97-221 S@w@g@ odors d&ded when arriving at the sil@°(y@s of no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 5/1/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 9" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 1". Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 150OG L 10'6"H 5'6"W 5'8"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a 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 Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 6/1100 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal Fiberglass _Polyethylene _other Explain: n/a Dimensions: nla Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 911/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,If possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (4)INFULTRATORS leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS APPEARS TO BE FUNCTIONING PROPERLY.THE SOIL PROBED DRY IN LEACH AREA,SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to Inlet Invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: nla Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 k , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 6/1/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) r IA �g ❑C AA)jq A6 3a q Ac 3 QA i �B a� 600 revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 HOMEPORT DR. HYANNIS, MA 02601 M268 P138 L18 Name of Owner HOWES Date of Inspection: 6/1/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow— Moderate— Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET ti i revised 9/2/98 Page 11 of 11 ACCE55 COVERS MUST BE WITHIN 9 - MINIMUM. 4- VENT OR 6' OF FINISH GRADE 3 ' MAXIMUM COVER CHARCOAL INVERT ELEVATIONS : DESIGN CR I TER I A GENERAL NOTES / F 1 L TER INVERT OUT SEPTIC TANK 99,5 DESIGN FLOW: 102. 12 FIRST 2 TO MIN 2' OF PEAS TONE BE LEVEL ,/ /-OR FILTER FABRIC INVERT IN DIST. BOX. 96, 77 3 BEDROOMS MIN AT 1 /0 G. P.D. PER 1 . THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION ` IB'M/N INVERT OUT DIST. BOX: 96. 6 BEDROOM FOUALS 330 G. P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4' DIAM PTp- / INVERT IN LEACH CHAMBER: 98. 5 99. 0 0 - NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS 9.5 9 � 2 H_P0 �' BOTTOM OF LEACH CHAMBER. 96. 5 Gas J 98. 77 9 . 5 b 96~5�3/4' - 1 1/2' D%A. SET. SEE SITE PLAN. BAFFLE ;7 ADJUSTED GROUND WATER N/A DOUBLE WASHED STONE - SEPTIC TANK REQUIRED: 3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A EXISTING 330 G. P.D X 200x - 660 GAL . 3. ALL CONSTRUCTION METHODS AND MATERIALS AND D-BOX W/4' STONE AROUND. 16. 5 1 x 20 'r x 2 'd BO T TOM OF TEST HOLE f I 91 !94. 5 1500 GAL SEPTIC TANK PROVIDED: 1500 GAL . EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL � 94. 5 SEPTIC TANK 6" CRUSHED STONE OR CONFORM TO MASS. D. E. P. TITLE 5 AND LOCAL COMPACTED BASE SOIL ABSORPTION SYSTEM REOUIRED. BOARD OF HEALTH REGULATIONS. 40 M L L POLY DESIGN PERC RATE ( 5 M/N/I NCH V4POR BARBlER PROF I LE 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: 2-500 GAL LEACHING CHAMBERS W/4 ' STONE AROUND. 2 ' BETWEEN. A-476 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 476 S F. x 0. 74 - 352 G. P.D. APPROVED EQUAL. 7 SO I ! TEST P I I DA TA 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED 1 RECAST CONCRETE OR APPROVED POLYETHYLENE, INDICATES Q- INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER PERCOLATION = OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TEST GROUNDWATER OUTLET. TP a/ P*13296 TP f2 7. BEFORE CONSTRUCTION CALL -DIG-SAFE". � HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR LOAMY 10 YR 1-888-DIG-SAFE AND THE LOCAL WATER DEPT, A LOAMY I OYR r /0/. l 0' 101. ! FOR LOCATION OF UNDERGROUND UTILITIES. f A I �i1 SAND 3/3 SAND 3/3 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE B ' 100. 4 /0' 100' 3 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION LOAMY IOYR D LOAMY !OYR L7 D OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE S 85°26 40-E � SAND 3/6 SAND 3/6 100. 00 '- STOCKADE 26-- ... . ...... . . .. ....... . . 98.9 24' - ...... /99. I CONSTRUCTION INSPECTIONS. ---� TP'I �Trr2 I �i C I MEDIUM /OYR c MEDIUM /OYR E SAND 6/6 SAND 616 9. EXISTING LEACHING TO BE PUMPED DRY AND ABANDONED. for CAA �o ! 10. WHERE THE SEWER L !NE CROSSES THE WATER L 1NE. EXISTING 48' THE SEWER L /NE 1 S TO BE SL EE vED W r TH A LARGER NGROUND POOL EXf STING'SAS DIAMETER PlPF LOT 18 SEPTIC,TANK 7. 500+ S . F. E105T,NG DWELL ING �•x", G 12Q_i NO WATER I I NO WATER In. 9 120" 91. 1 TOF-102. 12 j 5LE£OF a - ' PIPE t) DATE: MAY 26. 20! I 2 r D-Box' O TEST BY: STEPHEN 1444S 1 o' Q, WITNESSED BY: DONALD DESMARAIS PORCH W I `� PERC RA TE l 2 M/N/I NCH ti o h 101, OF 2Q', __-- -�-}� =--- 26 ---® VA R / A NCE S REQUIRED : "�-- 40 HILL POLY ! 1 -`�1'S Bid. CATCH BA I N v 8s°26 VAPOR BARRIER Ems` � ST.flOF^ RIM-99.47 T I TLE 5. MAXIMUM FEAS/BLS COAIPL /ANCE 40-W CIVIL y loo. 00 . E j VENT SECTION 15, 211 - tI) MINIMUM SETBACK DISTANCES No.35461¢ HYDRANT (/�9121e 20 IS REQUIRED BETWEEN THE SAS AND THE FOUNDATION WALL . /0 /S PROVIDED. A IC ' VARIANCE IS REQUESTED. At E 2-500 GALLON LEACHING CHAMBERS 1 /0 ' IS REQUIRED BETWEEN THE SAS AND THE PROPERTY LINE. W14' STONE AROUND 7' 6 5 ARE PROVIDED. 3' 6 5 ' VARIANCES ARE REQUESTED. 2' BETWEEN i t3 1( I SEAT / C SYSTEM DES / GN i 7 / f--HOME-POR T 0R / VE . ",4 RCEL / 38 RA ( /! Y-1 /V/V / S MA / rw�N i EE PREPARED FOR >� L EGEND I ■ CB CONCRETE BOUND D O /�//\/,q L � U D E P -W- WATER L /NE j � SCALE / - 20 .JU/VE r4�_L ocuS / i o fIYDRAN; -G CAS L l NE EAGLE S OHW_ OVER HEAD WIRES U V Y I N G 1 I �J I C LIGHT POST _ 923 Rou t e 6A Syr T --E- UNDERGROUND ELECTRIC LINE \� Y a r rno u t h p o r t NA A 02675 -T- UNDERGROUND TELEPHONE LINE 5 O 8 3 6 2-8 1 3 2 -CTV- bNDERGROUND CABLEV/SION LINE 1�11\ C 508 432-5333 > + 40 4 SPOT ELEVATION / 1 \ � � \ _ _40-- _ EX/S T/NG CONTOUR OEM" PROPOSED CONTOUR REVISED: AUGUST 25. 2011 O CV S MAP u 10 20 40 JOB NO: 1 I -049 FIELD: CANAL CAL C: SAH/CFW CHECK: CFW DRN SAH