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HomeMy WebLinkAbout0073 ISALENE STREET - Health 73 Isalene Street Hyannis Port A =267 040 �1 1I I i Commonwealth of Massachusetts m . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments / r� l °w 73 Isalene Street Property Address ~" Mario Parella, South Weymouth, MA 02190 Owner Owner's Name .«5 information is x. required for every Hyannis MA 02601 9/8/2017 -. page. City/Town State Zip Code Date of Inspection s.M t.d"I �i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist_at the end of the form. Important:When filling out forms A. General Information 5/4 / a 54g on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return ey. Name of Inspector k(►��IC=V Company Name 4 Glacier Path Company Address .East Sandwich MA 02537 City/Town State Zip Code 508-833-2177 S 1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/11/2017 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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The system passes based on the information observed and documented in this report on the day of the inspection but it does not indicate the future operation of the system from the date of inspection forward. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):, ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):, ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment, ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or El clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E Larg e Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to.each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ . Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: 2016; 21,750 gallons 2015; 21,750 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: BOH Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow-cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Isalene Street M Property Address Mario Parella, South Weymouth, MA 02190 Owner Owners Name information is required for every Hyannis MA 02601 9/8/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information(cont.) Approximate age of all components, date installed (if known) and source of information: Compliance issued 3/17/2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: ee Comments (on condition of joints, venting, evidence of leakage, etc.): No observable issues Septic Tank(locate on site plan): 17" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Typical 1000 gallon tank Sludge depth: 2" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2" 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 12" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street M Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.).- Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): .Depth of liquid level above outlet invert Level with 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.): H2O dbox that is 38" below grade. No evidence of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500's with stone. chambers are 40" below grade. 7"of effluent standing in the leach chambers. No indication of staining observed. No excessive vegetation growth. 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 I Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): J t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System form -Not for Voluntary Assessments 73 Isalene Street M Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater contour map ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Records on file with BOH and groundwater contour map M Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 73 Isalene Street Property Address Mario Parella, South Weymouth, MA 02190 Owner Owner's Name information is required for every Hyannis MA 02601 9/8/2017 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 9/6/2017 Assessing As-Built Cards TOWN-OF BARNSTABLE LOCATION 3 SEWAGE# VILLAGE .0e4 ASSESSOR'S MAP&LOT ? dye Q NAME&PHONE NO. SEPTIC TANK CAPACITY UACHING FACILITY:(type) (size) NO.OF BEDROOMS w. R OWNER �7 O�o PERMITDATE: 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 j on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist I within 300 feet of leaching facility) Feet Furnished by pLlnnaaGNbtiWo l0066 We¢.hrtP��uVNY�ne emeuq . � O 7,wr -M' I Fca*e g,ad 6 yam. o 0 STD j ZTA L"f sf http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=267040&seq=1 1/2 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION J TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION A Property Address: 73' Is-i&1eii6 Street . Hyannispor '�� Owner's Name: Paul Finlay Owner's Address: 3'� nre 44es SIyd. �s /y JIL - / V ca Date of Inspection: 3 1 7/aco(o Name of Inspector:(please print) William _ • Robinson Sr. fir' =, Company Name: William E. Robinson Septic Service a Mailing Address: P O Box 1089 =T; Centerville, MA rv ' Telephone Number:(5 0 81 7 7 5-8 7 7 6 c 0 r- . rat CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported . below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: /Passes Conditionally Passes Needs Further Evalua ' by the Local Approving Authority Fails Inspector's Signature: { Date: 1 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatih or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies'sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 73 Isolene Street Hyannisport Owner. Paul Finlay Date of Inspection; 3,i7�r3co6 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: , / r �/ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: , B. System Conditionally Passes: IVIA One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent_System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or obstructed pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstnacted pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 'Fage 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address• 73 Isolene Street yannispor Owner: Paul Finlay Date of Inspection:. 31 17 )aro b C. Further Evaluation is Required by the Board of Health: ^f/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety,and the environment: _ Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well- Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 or 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 73 Isolene Street Hyannisport Owner: Paul Finlay_ Date of Inspection: /7 .W6 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ali 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 jclogged 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 _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates(hat the well is free.from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more ofthe above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large sy lcm the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has faiikd.The owner or operator of airy large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 73 Isolene Street Hyannispor Owner: Paul Finla Date of Inspection: I o Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health /Were any of the system components pumped out in the previous two weeks 7 —ZHas 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 7 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 baf/fles 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: Yes/ no Existing information.For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 73 Isolene Street Hyannisport Owner: Paul Finlay Date of Inspection:_=3117 /,2oo(6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x ii of bedrooms): 330 6Pa Number of current residents: O Does residence have a garbage grinder(yes or no):Na Is laundry on a separate sewage system(yes or no).No [if yes separate inspection required] Laundry system inspected(yes or no):�A Seasonal use:(yes or no): s Water meter readings,if available(last 2 years usage(gpd)): 9/0 3—9/0 4 — 8 4 , 7 5 0 Sump pump(yes or no):. AD — 5 — 80, 250 Last date of occupancy: ; L ;�zo". COMMERCIAL/INDUSTRIAL IV/A Type of establishment: Design flow(based on 310 CUR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: V lq K.j ov+N Was system pumped as part of the inspection(yes or no): avo If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TY OF SYSTEM — OF tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Ap roximate age of all components,date installed(if known)and source of information: �-Ro7t o,,t brrw-416 i,_ re- w+_jk d 1 ,j avow Were sewage odors detected when arriving at the site(yes or no): ✓JO 6 I� ]'age 7 of I I OFFICIAL INSPECTION FORM—NOT FOK VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PA1tT C SYSTEM INFORA'1ATION{continued) Property Address: 73 Isolene Street Hyannispor Owner: Paul Finlay Date of Inspection: 3 '7 vob BUILDING SEWER(locate on site plan) Depdi below grade: >d " Materials of construction:_cast iron ✓40 PVC_other(explain): Distance from private water supply well or suction foie: Comments(on condition of juutts,venting,cvidcncc of leakage,etc.): Jdaj-s Wife W GGYX� ('cnc�)ftar! ,yo ,e /la 9E SEPTIC TANK: ✓ (locatc on sitc'plan) Depth below grade: )6" Material of construction:_✓concrete metal fiberglass�,olyctliylene _odrer(explain) — — If tank is metal list age:— Is age confinned•by a Certificate of Compliance(yes or nu):—(attach a copy of certificate) Dimensions: /00o GAl/oAs Sludge depth: &>I' Distance from top of sludge to bunont of outlet Ice or baffle: 3 Scum thickness: U" Distance from top of scum to top of outlet ice or baffle: (o" Distance from bottom of scum to bottom of outlet ice or baffle: /y" 1 lore were dimensions determined: DPeAed &)vets e.,1 a J\�ho­ ,Pasumv.rd h . Comments(on pumping recommendations,inlet and outict ice or baffle condition,structwal integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): IG'\k-- a/o es 40-1- ✓teaJ la L-e- c ee4ed et �A. 'i-J✓nv ';Ca 'i'4,d ,/2/,eh i�ls c.cre /✓��4 _ti2� Le4G� (N �Ovel COncJ��r�.v Ie v— L- &s 5-r✓evralf 4G t. �t GREASE TRAI':�(locatc on site plan) Depth below grade:_ 1vlaterial of construction:—concrete—metal fiberglass polyeth}-Iene__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 ice or baffle: Dale of last pumping: Conunents(on pumping rcconuncndations, WCI and outlet Ice or bank condition, structural integrity,liquid levels as related to owlet invert,cvidcncc of Icakagc,etc.): 7 'age 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOIL VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 1NFORA'IATION(continued) Property Address: 73 Isolene Street Hyannispor Owner: Paul Finla Date or Inspection: v7 0eC,6 TIGHT or IIOLDING TANK."JA(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:—concrete_tnetal_fiberglass rolyethylene other(explain): Dimensions: Capacity: gallons Design Flow. gallons/day Alarm present(yes or no): Alarm level: Alarm in working ordcr(ycs or no): Date of last pumping: Conunents(condition of alann and float switches,etc.): DISTIUBUTION DOa:v(if present must be opcncd)(locate on site plan) Depth of liquid level above outlet invert: 0A Conunents(note if box is level and distribution to outlets equal,an)•evidence of solids carryover, any evidence of leakage�linto or out of box,ctc.): y' &-A wGs I-Nd a.ad �N CCbcQ 1V1d,-44N nra evidence de 60So%J lG1/y/O�CT �o� PUMP CHAMBER: N A(locate on site plan) Pumps in working ordcr(ycs or no): Alarms in working ordcr(ycs or no): — Conunents(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Isolene Street Hyannisport Owner: Paul Finla Date of Inspection: 3 ,7/,a0 6 SOIL ABSORPTION SYSTEM(SAS ):) ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type , leaching pits,number:_ leaching chambers,number: o? leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): W45 f)N ND Slip-• VA Ilad nra waf,r -D1cY.na Oil eF )nsGy<fri Cuss 313" a^,4s CESSPOOLS: N A(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:� . (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Isolene Street Hyannisport Owner• Paul Finl Date of Inspection: i o0(0 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. ?AN tc .A-1 A/' 3-1- 37 N 2or-'T 0 P House D-(Sox .STEP 3 �3•a = ao' C-a SAS 13-3: d7' f�JrwA`( O ------------- 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 73 Isolene Street Hvannisport Owner. Paul Finla�� Date.of Inspection:__ ///2 jPfe SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If checked,date of design plan reviewed: cP00d Observed site(abutting property/observation hole within ISO 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: i4ti /fchhfwc�r L 4f �s4-&b rd by arCClSSIne bni.* , tole on Ole 4fi Tor, . r n � t�.F l�.rnc�cb[l 3ocn-.P of Na.11t,. 11 f TOWN'OF BARNSTABLE SEWAGE # Vf.LLAGE 41-4 2E ASSESSOR!�S_MAP & LOT 7 Ea;&TA�66ER'8 NAME&PHONE NO. SEPTIC TANK CAPAC= LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 1 . OR OWNER RAJ PERMITDATE: COMPLIANCE. DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 enchinarks.Locale all wells within 100(at-Lacatewerepublic water supply en's uic num.g. �l • TAHr �•a ti>. x_4 �Rar•'r op +io�se � D-Box a*eo 0 3J+Jo' L c-J:3a• ❑ SAS a 8-s:a7' C-J:3"•6•. p(�aewn.y Ob STO"E a 1SA LE.JE � ' it TO)&N OF'BARNSTABLE L LOCA��'ION 3 ��� ► SEWAGE VILLAGE ill ti 0 "?i" ASSESSOR'S MAP & LOT 2 k 7-'d qO INSTALLER'S�NAME&PHONE NO. Jo �" � �� Z SEPTIC TANK CAPACITY LEACHING FACILITY. (type)_ (size) NO. OF BEDROOMS BUILDER OR OWNER / ' ` PERMIT DATE: ® �' G C' COMPLIANCE DATEV ?' /9"0 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) Feef Furnished by Z M T � 1 N r S �l. u ' s _ t I j Ni.i 2 oy 2-0 y Fee$s 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYtcation for ]Dtopoml Opgtem Com6tructfou Vermtt Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 73 Isclene Rd. , W Hyannisport Paul. Finlay Assessor'sMap/Parcel "A6 37 Nettles Blvd. , Jensen BeachFL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Dan Johnson P 0 Box 1089, Centerville 1804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingR„s; ,a,..,*4—R 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 11 —4—0 2 Number of sheets 1 Revision Date Title subsurface sewage disposal System Size of Septic Tank Type of S.A.S. Description of Soil medium sand Nature of Repairs or Alterations(Answer when applicable) replace failed s a s with 2 leaching drywells ( 25 ' L X12 'W X 2 ' H )— relocatepre—existing 1000 gal. septic tank ( see plan ) 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 by this 5ard,9f Health. Signed Date Application Approved by Y 4j. Date Application Disapproved for the following reasons Permit No. -)Do;L—0 7 Date Issued _ ,+N �2 0o 1:. 0-7 �. a. ' Fee$50 .a: t Entered in computer: �✓ �;BtIC THE COMMONWEALTH OF MASSACHUSETTS ., Yes HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS - Zipprication for Mt!5poga1 *pMem Cow6tructton Permit � Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. � 73 Isglene Rd. , W Hya�nisport Paul Finlay Assessor's Map/Parcel -Z . G 7 U 37 Nettles Blvd. Jensen BeachFL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '+4 Wm. E. Robinson Septic Service Dan Johnson A P O Box' 1089, Centerville 1804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) - Other Type of Building-as;,a r.r,#=; i No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 1 1-4-0 2 Number of sheets 1 Revision Date Title- subsurface sewage disposal System Size of Septic Tank Type of S.A.S. Description of Soil medium sand Nature of Repairs or Alterations(Answer when applicable) replace failed sas with 2 leaching drywells ( 25'L X121W X 2'H )- te6ocate pre-existing r-ga . septic tank see plan 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 by this BoTdqf Health. - Signed Application Approved by Date 7-- Application Disapproved for the following reasons Permit No. )Uo -0 7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Finlay Certificate of (Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned(( )by Wm. E. Robion®o Septic Service at 73 Tsolene Rd. , W Hyannisport has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2yo-7-U-7 dated /—,?-o Installer Wm. E. Robinson Sr. Designer 'Dan Johnson The issuance o this ermit shall not be construed as a guarantee that the systeill fun tion as d�ijr­ Date Inspector 1 J IV- + I No. 2oo.? -0 -7 Fee$50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS .Finlay Migogal *pgtem Con0truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 73 Isolene Rd, W Iyannisport , . 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 thi errgit. Date: 0 Approved by � o a TOWN OF BARNSTABLE LOCATION �J S �' s``''L SEWAGE #aD� '� VILLAG ASSESSOR'S MAP & LOT 7`:Qqo INSTALLER'S NAME&PHONE NO. s' 7 7 -2Z SEPTIC TANK CAPACITY LEACHING FACILITY: (type) O A— av o (size) NO. OF BEDROOMS BUILDER OR OWNER..,elt�/ 0` A PERMIT DATE: 2 G COMPLIANCE DATE:V 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 F 'shed by i 4 a 3� f-iun r r � a 5MI01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated o , concerning the property located at ?3 /S.4�E^��r sr CC�nITLwic�� meets all of the _. following criteria: This failed system.is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and'the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface,)Elevation (using GIS information) 3.9 B) G.W. Elevation /Q. +adjustment for high G.W. �^'►x — DIFFERENCE BETWEEN-A and B SIGNED : DATE: / a NOTICE Based upon the above information, a repair permit will be issued for 'bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health Folder.percexmp =, TOWN OF BARNSTABLE LObimoN 3 ill _ �Ee.V SEWA n � e �� GE�# VILLAGE6)49,S/2 � ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.igr-/V/©4. ,.SEPTIC TANK CAPACITY /j 00Q ''TT LEACHING FACILITY:(typeLo' ��/�n jrs (/6 .,(size) NO. OF BEDROOMS PRIVATE WELL FOR �WAT-ER BUILDER 7�W- DATE PERMIT ISSUED: DATECOMPLIANCE ISSUED '" VARIANCE GRANTED: Yes o -�. w �� . o� s _ � .� w 9s 9-� s �> . �> �, rJ % / /J�tf ///V/� APPROVE[) �LP�4n ��— Fw s.............................. s abt�"C�irise�vatlart department THE COMMONWEALTH OF MASSACHUSETTS ELOARD OF HEALTH Signed Dato TOWN OF BARNSTABLE Appliration for Di-nVoott1 lUork,6 Tomitrnrt"ion "unfit Application is hereby made for a Permit to Construct ( ) or Repair .(X) an Individual Sewage Disposal System at: J-�•S,•4-t_�`'.e1L' c�"-------------•--•----- �' ` ' Y._ .�.......S:�crrt;�_ -' Locatiou-Address or Lot,No. ........ ........ 7C ¢-. .. Owner �J Address W Fo3C ✓� /Llit i ' Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------------ ---------- ....Expansion Attic ( ) Garbage Grinder ( ),- aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) -' Q' Other fixtures -------------------------------- - - W Design Flow.....................___________..gallons per person per day. Total daily flow..-_.-.-_-___-___ ��__________-_--gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter._.-...________ Depth............... x Disposal Trench—No. .................... Width-------------------- Total Length-------------_---- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit--------............ Depth to ground water..................... L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R,J -----------------------------•------•-----------•--....------.._....--------.._..-•-----•-----------......................................................... 0 Description of Soil........................................................................................................................................................................ x W --- ................................................................----•-•-•---...•-------••-----•-----------•----------•----•------=-----•--••---•--••---•--••------------------------- U Nature of Repairs or Alterations=Answer when a licable._._�_4-....___ lac 0 Ti----- -----_ _ -;, (-56....`:_....__....................----..-....1 r-!•L.........4 .4'.........--._..... L1.. ►a/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance be n issu d by board of health. Signed . ....... . .. . ......... .. .............. .©---- ........... ------ ` , �... �`� Application Approved By ---- - -- -- ----- --- -- - ---------- -- ....... .....- .......... M �------- Application Disapproved for the following i tuns: --------------- ------------------------ -------------------------------------------------------------------------------------- .................----------------- ---------------------------------------------------------......... .. ® � ................Date....... Permit No. ..... .... ................. IssuedD ..(�.... .. THE COMMONWEALTH OF MASSACHUSETTS OF HEALTH TOWN OF BARNSTABLE Appliration for Bi-nVatial Wor1w Towitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 2,:3 - Sit G r. ,:f S_ (.. j. 1_Y .....r.� Location Addr�esss� ` or Lot No.".. /l!� 1�1� J�d�1 � t!� /�t�( /✓ %�Z� n..�.,_.�l ______________•--•---- ------------•---- .............. ......---........ ............. •----•----...-------- ...........................................`r owner Address W �Jl C o�i7 C0 ST-•------•----��--�--- -•--•- --G4./A/� %_-----••`_'�--•-----•--." �-:_/� /LL� J Installer Address U Type of Building Size Lot............................ Sq. feet I-, Dwelling—No, of Bedrooms------------ _--_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- -------------•-•------------••---••••-----------•----------•. W Design Flow..................:.J 5..._.__.__._.____gallons per person per day. Total daily flow-----------------33 _.___________.gallons. WSeptic Tank—Liquid capacity------------gallons Length_______________ Width-__._-..._-_-__- Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a 04 Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ 0 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 0 a •-----------------------------------------••-•--•----------•-•-•----•-•-•-------••-----•--------•--•......................................................... Description of Soil....................................................................................................................................................................... W U •--•--------------------------------------•------•-------------------------------------------------------------------------------------------- ...................---•---•----------------------•---•---- W U Nature of Repairs or Alterations—Answer when applicable._-- ( � iC i -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance$h7a- be•n issu d b`y,the board of health. Signed ........... ....... r" ...'r - //`S�S� Application Approved B '.l� ✓PP PP Y V — ----------�....� �. ............... ...... . .--�.�---- r Dace Application Disapproved for the following y�nr- --------------------------------------- !-------.......------------------------ ........................... .......... . - - �" Dare Permit No. ---............._ ----------------........ Issued f Dare, _t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of 011omplianre THIS IS TO CERTIFY That.the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -------------------------------...----------------------------....._....---------------- 1wal , at ..............................._----------------------- ............... E_ J. ----- ---------------:� --------l�/1a-lr--J S- - --- ......._....... has been installed in accordance with the provisions of TITLE of The St t nvrronmental Code as described in the application for Disposal Works Construction Permit No. 15�.'T...`-� E---..... dated ......-....._.._.._._-----.._.__.--_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTO Y. .� , ram.DATE.........._� . ....'...�.�/.'r......._.. ---------- -- --------- Inspecto�,,_ ----- -------..----- ---- ------- ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS fly �7 0 7 BOARD OF HEALTH 7 TOWN OF BARNSTABLE No............... FEE........................ Disposal Works Tonotrurtion "Vrrntit Permission is hereby granted_-------_-------- GI G LG---- J..............................................................�tCi%!G to Construct ( ) or Repair (X) an Individual Sewage Disposal System ......................................... `S' , y � r !.at No. -------•----------•----•---•---------------• -- --- . ....................•-•-••--- l� Street E as shown on the application for Disposal Works Construction Pef"mit o:____7_____________ Da,ed_.._____-_-----___-_--__n__....______..__ .'� Board of Health DATE---------------- -= ;----------------------------•••-- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS � �� � ��� C �/S f E 1500GALL0NSEPTiCTANK / ) ✓ ( 'INSTALL 15t�0 GALLON -- SEPTIC TANK IF MODEL T K 15001SHEA CONCRETE) (OR EGUIVALENT) TEST PIT DATA GALLON SEPTIC TANK: FINISHED GRADE S NOT ._ ._..f ,._�..r'"�•./...._..m...--• __�..f,.r•-•�,,,•-'•^••..,f-'_.,,��� .,...� ,....,t�,••-'- Y y x b �1.. � /oo,00 STRUCTURALL'` 24"DIA - 24"DIA. C51MIN) 24"DIA Performed By: Daniel B. Johnson SOUND DURING RELOCATION - - ,• 3" H 10 Date: November 12, 2001 t TP-1 (EL. = 99.3) ELs9,,3 Ex'ir��6- P��•E4ISTIN� - 4"SCN 40 10 FLOW LINE 14., BABEL FILTER A-100 TAr�1K 0" 9" A, 10YR4/3 Loamy sand ! -SEPTIC TANK TO MEET t�AILeD� CTD gE -F-t-OCi4r� � " `• ! i REQUIREMENTS OF ES ti 9 - 2 9 Bw, l 0YR5/8 Loamy sand 4"SCH 40 TEE �a'LIQUID LEVEL ` T i GAS BAFFLE 310CMR15.226FOR 29" -132" Cl, 2 . 5Y7/3 Medium sand 2 . 5Y8/3 ; 4"SCH a0 � v�'ATER TIGHTNESS. TEE ET_ } No Observed ESHWT I No Observed Groundwater ALL WALL S LE EVE S/GAS KE T S p o __-- MECHANIG4LL'Y �. SHALL BE CAST IN PLACE OR o 6" (MIN J p o COMPACTED PERCOLATIONt TEST DATA INSERTED AT FACTORY. CRUSHED STONE STABLE LEVEL BASE <=3I4"DIA. Date: NOvember 12, 2001 SEPTIC TANK DIMENSIONS. 1t]' 6"L X 5 B"W X 5'8"H nr LACTC. ,PEC K-o a oc4reo ass: ass I (0. 74 G/SF)Soil C1 FEc C1. oze reEl.ocarfo ,: �,� U0 ,gt,tvH Perc Rate: < 2 MPI (TP-1 ) DISTRIBUTION BOX H -20 dLBfT S�vvC�`- /o, 7-4NK Depth of Perc Test 29"+_ 4 1,ALL 4000TLET LATERALS � _.._-.L_�_ CSEE gor8 ,$�Lo�� � "�" REMOVABLECOVERSICH DISTRIBUTION BOX TO MEET l SHALL BE SET LEVEL FOR A ER f WO SCHEDCrLE OF ELEVATIONS REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST O I ��r r/n /r N>��5� 15.232(WATERTIGHTNESS FEET AND CONNECTED TO Inv. Out Foundation CONSTRUCTION,ETCI WITH SOLID EACH ISCHI440PVCPIPE 96. 90 4"SCH 4o7 °o r ot,,�t � Inv. In Septic: Tank 96. 70 NO OF OUTLETS 2 co E= o t Inv. Out Septic Tank 96. 45 0 o c o -- MECHANICALLY CRUSHED 93.13 Inv. In Distribution Box 95 . 97 000 (MIN) 0 � � ® STONE 3/4"DIA.) I Inv. Out Distribution Box 95 . 80 STABLE LEVEL BASE 0 oInv. In Leaching Dry Wells 95 . 75 q"SL+4 k a a f Bottom of Leaching Dry Wells 93 . 75 S:, o► Bottom TP-1 (No obs GW/ESHWT) 88 . 3 �pn r�l _ . ._._ -. ---- __�_ �_ LEACHING DRY WELLS -500 GALLONS 99t1 _.... 99�`I "END"CROSS SECTION -- Existing Contour - - 98 - - - MODEL SHOREY PRECAST CONCRETE FINAL,GRADE TO BE STABILIZED � 99 Proposed Contour I r.•- � .__.. � Q - FINISHED GRADE(SLOPE - ' I -- _ .__. Test Pit r'(MIND H-20 y'e i� ��(lA-4 L �. �^ ,� LEAcHi,vU ��N vl�tlj �� 4"i��ti� (r+-i �) LEACHING /4" 1/7-DOUBLE s' ot r�'r� 0,4 �LL Finished Floor Elevation ; 4"11WWX71"H WASH PEA STONE 4.Basement Floor Elevation �' `� � �_ 4 I I ' OVERALL LEACHING AREA 3/4",1 1I2"DOUBLE r 'l}412 W X 1'H t ' 2'1" ' c '' WASHED STONE i Water Line C= A"54N40 Gas Line LEACHING CHAMBERS TO MEET THE er 611' - ---- REGUIREMTNETS OF 310 CMR 15.252 , ( 4 q I �I17 I �. f.5... R`� yS•P QQ��� y� �`` .1LOpE.� Q '4��~ ,' `._ 1L `L H' )uMOWCyI GF [J N to - R LE �o f tt9 }�t Pi PIPE ?: f,v,vt°v Ncx 5 iE I �} • yGf0. 2 Pu77ER Ca 1 A '•? J S ��^•o O t•- %q�'AV sr y ENE St ru q } e e h y y� +z r r A SHCReNOM •Vo4YS� i I C �� �Y b CHAAAv <K o ' N CRA1GVrLLEr9[ACH :Ra. .._ 1 . All construction methods shall Conform to the Title V { 310 . �' %A r= Wo � �,�,Y 1 ' CMR 15} and the 8arn3table Board of Health Regulations . l a, e-EA Jr -577RZ -1- APLE y YA N N 15 i There are no known private or public wells within .., 0 /Jro a ' PORT feet./4Q0 feet, respectively, from the proposed leaching St y (,oLF area . A < CLUB 3t { 3 . Existing gas to be pumped and removed prior to y FORFS� a4K 1nstg1ling the relocated/new septic tank. D < < 4 . No changes are to be made in the field without the approval L)P' ILL 0 jE(ll y 76- l I B"L" I of the Board of Health and the design engineer. c ,4 Lt . AS S 400 q^i o I `A 5'5 Sub ~ o 'J vErvT - 5 . Proposed leaching area is not designed for use with i � AC74 ST garbage disposal . t 6. © notify 3447233 Contractor � e 72 hours prior to construction (BOO - EusTrntb- Ga�•oE 3 �r11�•� too 7 . Property line information taken from Deed (Book 10460, Page I 345 and the subdivision Plan for Isalene Street . Septic 6- Plan not to be used as a property line survey. CALIt IATIONS Ilia 3 Bedrooms (Existing) ,�4 ala, rtrJEtij ---' /C PC d�OF 110 GPD/Bedroom X 3 Bedrooms - 334 GPU �,p,.,4yF. �-....-__ zS _....� Percolation Rate - < 2 MP? (TP-1 ) 47 _ Sail Class : class I (0 . 74 G SF) 7r 9b 15, PROPOSED LEACHING AREA: ! 96,7fl i Leaching Dry Wells: at 25' L X 12'W X 2' H Side Area: 148 SE' X 0.74 G/SF - 149.3 GPD 9S 90 Bottom Area: 340 SF X 4.74 G/5F - 222_ 0 CPL 9q 9 yy ( Total Leaching Capacity: 331 . 5 GPI) 6144 �t �tSTR 8�17/oA/ 93,75 -�"lo� AAV wEcx.S , 9� /ooa cS-,4�tvn� s Ia'w X N I seP 7•�L r�,�rK a s. � Ix CO J E`/Z/4 Z.L•� f z ` !j io ILL " ExrSrinl� �o GfiLL0(q a 4 SC�TiL 7,qr./� ,G f,-&V_rvA-All� x 9� o N � /Po 6AAi Lor!/ X`rp/ c w SE P%t L 74044, /n i r,�C S 2 BEt. i r�c.�Sf -i73,)a� rN p�T4�T ,,� _t I %"�"' � =S �, SUBSURFACE SEWAGE DISPOSAL SYSTEM ,� ONIEL o SDANIEL j L 73 Isalene Street, Centerville �@ q.g 1- °lE N+D Oib� I SCALE: DRAWN BV.-_--_ _--- a c.10'lN,:' '. N fL9 s. *IS1711� APPROVED BY jj o p 6f a s#v r Nio.1077 - Aa_s own y C41 DATE 1/4/02 Dar._al 8 Johnson D H. Johnson a APrepared Paul Finlay W Y For. 105 Seth Goodspeed Road, Qatarviil MA 02655 65 dspaed a a dt�o Ot3a Ot'� O*S"Q /r2o _ '. ` �' -/ Prepared M04ZSTIC SEPTIC DESIGN INC (508) 420-1904 DRAWING NUMBER `z 0f00 Afro 0t6v O+7o o*d� p+-310 �tao /t�ty " /f/�/ /\ ✓ { ^, '' By 804 Main Street. Suite B, Catervillo, NA 02655 J-735 A , D