Loading...
HomeMy WebLinkAbout0016 IYANNOUGH ROAD/RTE 28 - Health IV , ° / ROUT . 343-016 HV_ANNiS i un 221406:03p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner owner's Name information is y required for every Hyannis MA 02601 6-19-14 page_ Cdyrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Imngoutf rms A. General Information `\\`\ INQF S �/ fillip out forms d�gtunuglr on the computer, S� ` �J-., S 11� use only the tab 1. Inspector ?� key to move your �' JA M E S 'v' cursor-do not James D.Sears = use the return - — _9: Sr?Q—i key. Name of Inspector C_a_pewideEnterprises LLC Company Name ` 153 Commercial Street i�1111111rgl`1 In It NS�ll", Company Address Mashpee MA 02649 Cityrrown State _ Zip Code 508-477-8877 S1623 _ 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 pursuag4, Sectio"5.3400 of Title 5(310 CMR 15.000).The system: , Passes ❑ Conditionally Passes ❑- ails ❑ Needs Further Evaluation by the Local Approving Authority w 6-21-14 ' �spoes Signature Date rn The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "'"This report only describes.conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. . / T t5ins•3113 9 5 Mad lnspealon Form.Suysu face Sewage Disposal System-Page I of 17 J Jun 2214 06:04p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: i ® 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. i Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain'-. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5lr4-3113 Tide 5 Official Inspection Form Subsurface Sewage Disposal Syslem•Page 2 of 17 Jun 2214 06:04p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481yannough Road Property Address Terry Flaherly Owner Owner's Name information is Hyannis MA 02601 6-19-14 required for every � page. Citylrown 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 16.303(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 t5irm=3/13 Tide 5 Otfidal hspection Fu m:Subsudace Sewage Disposal System-Page 3 or 17 Jun 22 14 06:04p p.4 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 page_ CRY/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 60 feet of a private water j 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 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 depot in aeaspag is less than 6"below invert or available volume is less than%day flow,-4&4C111mC 151ns•3!13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 f Jun 2214 06:05p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owners Name information is required for every Hyannis MA 02601 6-19-14 page. Citylrown State Zip Code Date of Inspection B. Certification (cost.) 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 coliiform 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,OOOg pd. © ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or'no"to each of the following, in addition to the questions in Section D. Yes No t ❑ ❑ 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 Sectiora 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 t5ms 3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 77 e f Jun 2214 06:05p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 481yannough Road Property Address Terry Flaherty Owner owner's Name information is required for every Hyannis MA 02601 6-19-14 page. CitylTown 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 NIA) ® ❑ 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): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3113 Title 6 Official Inspection form:Subsurface Sewage Disposal System-Page 6 of 17 Jun 22 14 06:05p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 481yannough Road Property Address Terry Flaherly Owner Owner's Name information is Hyannis MA 02601 6-19-14 required for every y page. Cityrrown State Tip Code Date of Inspection D. System Information Description: The system is three tanks,two septic tanks. One G.T.tank. D Box and field. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 2012-2,700 Gals 2013-1,300 Gals Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial Flow Conditions: Type of Establishment Shop Office Design flow(based on 310 CMR 15.203): NA Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc.): NA 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: NA t5im•3113 Tide 5 Official Inspection Form:SubsuAace Sewage Disposal System•Page 7 of 17 Jun 221406:06p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owners Name information is required for every Hyannis MA 02601 6-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Irate I Other(describe below): General Information Pumping Records: Source of information: ' NA i Was system pumped as part of the inspection? ❑ Yes IR No If yes, volume pumped: ganons 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): G.T. 15ins-3N3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8of 17 Jun 22 14 06:06p p.9 Commonwealth of Massachusetts WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont:) Approximate age of all components, date installed (if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: Net Material of construction: ❑ cast iron ®40 PVC ®other(explain): t Distance from private watersupply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"orange burge,4" PVC SCH 40 and 4" PVC SCH 20. Septic Tank(locate on site plan): Depth below grade: 8,.feet Material 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: Both 1000 Gal.Precast Sludge depth: t5ins•313 Tide 5 Offidal Inspection Fonrc Subsurface Sewage Disposal System-Page 9 of 17 Jun 22 14 06:06p p.10 Commonwealth of Massachusetts _ Title 5 Official ;Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Properly Address Terry Flaherly Owner owner's Name Information is required for every Hyannis MA 02601 6-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness WV Distance from top of scum to top of outlet tee or baffle NA i Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tape-Past Report Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Two 1000 Gal.Tanks, Both have steel inlet cover's, outlet cover's under black top. No inlet tee's or baffles. Both have outlet baffles. No sign of leakage or over loading.Tanks are piped in line. Grease Trap (locate on site plan): { Depth below grade: 811 feet Material of construction_ ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: 1000 Gal. precast Scum thickness 1/2 Full Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: NA Date t5ins•3/13 Title 5 01fcia1 tnspadion Form:SubsuAace Sewage Disposal System-Page 10 of 17 Jun 22 1406:07p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is Hyannis MA 02601 6-19-14 required for every y page. Citylrown 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.): 1000 Gal.Precast G.T.tank. Steel cover on inlet. Outlet under black top. Tank is 1/2 full of water,inlet tee. Note: BLDG was a rest. in the past. G.T. not in use,look's like line is caped off. s i 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 i 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 t5in5 3113 Title 5 Oflidel Inspection ion Form:Subsurf&ce'Sewa e 0 g Isposal System•Page 11 o117 Jun 2214 06:07p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 page.. Cityfrown State Zip Code Date of Inspection D. System Information.(cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or,out of box, etc_): D Box is 16"x21"-22"below grade w/steel cover at grade. Box is clean and solid w/four lines out. No sign of over loading°:or solid carry over. F 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: 15ins-3113 Tale 5 Official Inspection Forts:Subsurface Sewage Disposal System•Page 12 of 17 _s i Jun 22 14 06:07p p.13 Commonwealth of Massachusetts �vTitle 5 Official Inspection Form Subsurface Sewage Disposal..System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 page. GWrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. i ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ® leaching fields number, dimensions: 4@22 — ❑ 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.): Leaching is a four pipe field. Field is four @ 22'long, pipe field under black top lot. No plan on file. Ck D Box and camera all line's in field. No sign of over loading solid carry over or holding water. Cesspools (cesspool must jbe pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins-3113 Title 5 Official tnspedion Form:Subsurface Sewage Disposal System•Page 13 of 17 Jun 2214 06:08p p.14 ` Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherty Owner Owner's Name information is required for every Hyannis MA' 02601 6-19-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): 15 ns•3113 Tille 5 Official Inspection Fomr Subsutace Sewage Disposal System.Page 14 of 17 Jun 2214 06:08p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherly Owner Owner's Name information is required for every Hyannis MA 02601 6-19-14 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 0 13-1 Is'T 43 Aa= a1 0 0 3 P 6 �3-� $f � -V f3-V= 33"-6 15im-311 a We 5 Olfiaal inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Jun 22 1406:08p p.16 Commonwealth of Massachusetts a_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road Property Address Terry Flaherty Owner Owner's Name information is required for every. Hyannis MA 02601 6-19-14 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: feel — Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date,of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: See Attpage and letter on file at B.O.K. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspedion Form:Srbsratace Sewage Oispcsal System•Page 16 of 17 Jun 22 14 06:09p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 48 lyannough Road' Property Address Terry Flaherty Owner Owner's Name information Hyannis MA 02601 6-19-14 required for every _ page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•3l13 TNIe 5 OMalel Mspeoon Form:Subsurface Sewage Dispose]System•Page 17 of 17 Jun 221406:09p p.18 June 6,2000 Ms. Donna Miorandi Barnstable Board of Health,Agent. 376 Main.Street Aorsley&Witten, Inc. Hyannis, MA 02601 Sextant hill 90 Rom GA Re: 48 Iyanough Road, Assessors Map 343, Parcel14 Sandwich.VIA' 02563 Dear Donna, 15o81 833-6600 On November 11, 1999 a Title 5 septic system inspection was conducted at 48 Fax;5001 833-3150 I,vanough Road by Mr.James M. Ford, report enclosed. Mr. Ford concluded that the-estimated seasonal high groundwater elevation was 0.10' higher than the distribution box outlet invert and therefore judged the system to fail the inspection. Mr. Ford used the Frimpter tilethod to determine seasonal high groundwater. We note that the Frimpter Method is not designed to work in t fill, in wetlands or glacial till. Based on the February 15, 2000 deep observation hole and percolation test, (performed by H&W and witnessed by you),standing water was observed at seven-feet four-inches below ground surface. The deep observation hole indicated that'the existing property is situated over a four feet, eight-inch thick fill laver. The allowable-alternative methods for determining estimated seasonal high groundwater in accordance with 310 CMR 15.103 (The State Environmental Code Title 5),are annual.observed high water,mottling,or the Frimpter method. The test pit was not conducted during annual seasonal high water.levels,mottling was not observed, and the Frimpter method is not designed to work in fill: In order to determine a more accurate estimate of the seasonal high groundwater elevatior.,.a one-inch monitoring well was installed,to identify maximum rise of the groundwater during the'spring months: Elevations are based on an assumed datum of 100 feet located at the top of the concrete walk near the Northwest corner of trie structure. The results are indicated below: Date Depth to Water from top PVC Elevation :Water of PVC " .: Elevation . 3-15-00 9.35 101.06 91.1 3-29-00 9.11 101.06 91.95 4-18-00 9.19 101.06 91.87 4-25-00 . 8.42. 101.06 1. 92-64 5-24-00 9.00 101.06 9206 From the elevation survey conducted by H&W,and the assumed datum used, the distribution box outlet invert was located at.elevation 96.83'. The Jun 221406:09p p.19 Ms. Donna Miorandi June 6,2000 Page 2 distribution box has four outlet pipes to make up either a trench or a leaching field system. Since the leaching system is presently,under a paved area (and was not excavated for inspection),we feel that a reasonable assumption can be made to estimate the bottom elevation of the leaching area. Based on the fact that most leaching fields and leaching trenches have a mazimuni of two feet of stone below the invert of the outlet pipe. We concluded that the bottom of the . leaching system is at elevation 94.83.feet. The criterion for failing a septic . system with respect to seasonal high-groundwater is the leaching area intercepting groundwater. Based on our survey and observed groundwater i elevations through the spring season,we conclude that there is at least two feet separation distance between the bottom of the leaching area and estimated seasonal high groundwater. Therefore, we conclude that the current system located on the property'is not a failed*system. We respectfully request you review this letter and endorse our findings that the existing septic system is in compliance with 31C CNIR 15.303 (g). Thank you for your assistance with this project, and please call if you have any questions. Sincerely, HORSLEY&V=N,N.C. dward L. Pesce,P.E. Senior Enviror nmental Engineer ELPJcek cc: Mr. Terry Flaherty Horsley&Witten,Inc. TOWN OF BARNSTABLE • BABNSTABLB, M5 LICENSE APPLICATION G� New Application +679�A� �p PO Box 2430,230 South Street RECEIVIEW Hyannis,MA 02601 Transfer 508-862-4674 $ Other OF SARNSTAKC AUTHORITY ♦ NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES => Please type or print/bear down through (4) copies Date: _---.-., `D ...........••-•-•------••---- i 1)Nameofapplicantfcorporation:.... . L....,, !..:..------•---•---•...............I........... Home phone MI i'--•---. Address of applicanUcorporation:..-.--..?42-...S�6�-f -f�................... Business phone#: 5.?W...1Y ................... ....................... ................................................... ----•-...............................-----.................--------.......------............... 2 DIBIA .......41,9,e.....>t ao.... - .............. Business phone ............�90=: Business location: 4 ...-r r9 arJos ..../As1..---..�i �-.. - .. •Sj p..y<s�...i'r�fJ:.....d.aL¢ ------------------- ---- •. Business mailing address: ...... .............................. ................................................. ................ Local business address: Ty dfi6sy• /'' .....` - ... L ��....... �66�..... ............. ...... .. .`l Local mailing address: ........ 4_ t�`%y��' /.y� .......�e.� .^".,/.......e 0i' 7f......!s 3.. ........................ HOURS OF OPERATION: ...... ........................ FID#:............... ............ License type:....-_S'T:x -...mac ......------. -•------ . ----- Assessor's map/parcel#: Map ! ------ Parcel 4/. ------ Annual CD Seasonal Name of property owner: ..... 7.... 3)Name of manager: 4,G /�,3,.` Local mailing address: .......-...�---- --•------------ ----------------------- -----------•--- ............................................................. •c-P//0,0 --/l9sf -. � y ...............•-. . • • ...... Permanent mailing address: ................................................ .... ........... ..............•--------- -----........... ------------. ------................................... Home phone#: /3'�/ Business phone#: dye - q 7 d 0 ........ Any flammable substance or hazardous waste used in business (specify): /yQ Applicants must contact the Building Commissioner's office, (508) 862-4026, the Board of Health office, (508) 862-4644, and the appropriate 're District office to schedule inspections. Signature of applicant ................................................................................................................................................................................................................................................... For Town use only ♦ APPLICATION MUST BE SIGNED BY TAX OFFICE TAX COLLECTOR'S SIGNATURE/PAID IN FULL PAYMENT AGREEMENT IN EFFECT ON IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES O NO O INSPECTORS APPROVAL Capacity set by Building Division....._.._...... --._........ Building/Zoning ...................................... Date ............................ Board of Health........---- I................... Date .---------. . ----........ Wire ..----_---•...... ......... Date ----------------_------- Plumbing ................ Date .........................--- Gas Date ......................... Fire District .......... ............ ..._ Date --- Comments:... . ........................... ..... ..................................... ........................ ........... ............................... White-Licensing Authority Green-Tax Office Canary-Health Division j Gold-Building Commissioner Pink-Fire Department TOWN OF BARNSTABLE �HAM ❑ New Application 6 �,�' LICENSE.APPLICATION Renewal PO Box 2430,23,0 South Street Transfer Hyannis,MA 02601 508-862-4674 El Other NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE,ON THE PREMISES Please type or print/bear down.through (4) copies Date: .'"` 1)Name of applicant/corporation: Home phone# '" :.•! st"r'.. ... . Address of applicant/corpo ration:........ '+ -.. _ Business phone#: '..- �:. ° .. . ........................... ... ...... .----- ...... .. . ----... .... 2).WEIIA .. r`.. .. Z.......'r. P ear -----¢ .... Business phone ---.... ... 3 Business location: �r .......✓s++-".t?,�:`�.. ✓'r"..r7'........ A/K" 1 tr ... �. t ' r.. a. :.:. . .. , !...:. Business mailing address: . -------------------- - --- ............... -- ............. Local business address: �. -------------------------------------------- . Local mailing address: ....-- '.....4Z---- "�" ` r . ... r '> r . ,_�.f, .. .. ......... HOURS OF OPERATION: ---- . s .....-- ---- FID#:...:. : License type: . . {':.- ..!.... ................. . ...:. ' Assessor's map/parcel#:- Ma Parcel /.4....... Annual O Seasonal Name of property owner: ! 3'. fir.......... ---- -- 3)Name of manager: �`,�;-_ ;r��;� , s Local mailing address:.... . .... ... ..... ........ . .....--------- . ....... .1< Permanent mailing address: -- Home phone#: r Business phone#: v ........ ..... ---.... .. ....... Any flammable substance or hazardous waste used in business (specify); A,4) Applicants must contact the Building Commissioner's office, (508) 862-4026, the Board of Health office, (508) 862-4644, and the appropriate Fire District office to schedule inspections. Signature of applicant ' ................................................... ..................... ...... ...... ......... ......... ......... ........ .. ................... For Town use only ♦ APPLICATION MUST BE SIGNED BY TAX OFFICE TAX COLLECTOR'S'SIGNATURE/PAID IN-FULL PAYMENT AGREEMENT IN EFFECT ON IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES O NO O INSPECTORS APPROVAL Capacity set by Building Division:- Building/Zoning---.. . .- Date .... Board of Health::... ... Date ........................ Wire ------ .. Date - Plumbing ........ Date :. ......... -- Gas .....: ...... . ... .....:. Date ............. ... ......... Fire District ... ...........:............ . .. Date ...: -- Comments:..........: .. ..... . ............. ..... ... White-Licensing Authority Green-Tax Office Canary-Health Division Gold-Building Commissioner Pink-Fire Department y�THE Tp� The Town of Barnstable t BAHa9T i Department of Health, Safety and Environmental Services MA6& o 9�.��� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health July 6,2000 Mr. Terry Flaherty 74 Iyannough Road Hyannis,MA 02601 r RE: 48 Iyannough Road,Hyannis Dear Mr.Flaherty: The staff of the Barnstable Health Department had their weekly meeting on Friday,June 16,2000. During the meeting the septic inspection reports regarding 48 Iyannough Road,Hyannis were discussed. y. It was agreed upon to accept the report of Horsley and Witten dated June 6,2000,and accept the current system as passing. My apologies for the delay in this letter and thank you for your patience in this matter. Sincerely yours, Q � Donna Z. Miorandi,R.S. Health Inspector Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection One VAnter Street, Boswis MA 02108 (61 n 292-5500 TRUDY COXE ARGEO PAUL CELLUCCI DAVID B.STRURS Goverwr CommissiMM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 49Iyarough Ro&A Rte,28.Hywwts, MA Name of Owner: Joe Urchman Address of Owner: Date of Inspection: November 11, I999 Name of Inspector:(Please Print) lanes M.Ford I am a DEP approved system inspector pursuant to Seetton 15.340 of Title 5(310 CMR 15.000) Company Name: LMU M Ford Mailing Address: P.O.Box 49,Osterville.NA 0265S-0049 M� Telephone Number: (5708)862-940a + � CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the inforatatlon reported below is true,accurate and cornplete as of*e time of inspection. The inspection was perforwcd based on my training and experience in the propel function and maintena=of on-site sewage disposal systems. The system_ Passes Conditionally Passes _ Needs Further Eval y the IJocal Approving Attthotity ✓ ails Inspectors Signature; Date: November 23, 1999 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thiM(30)days of completing this inspection. If the system is a sbated system or has a design flow of 10,000 gpd of greater.the inspector and the system owner shall submit the report to the appropriate regional office of the Depattrnent of Emnronmmtal PMtocdon. IV original should W sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COUNTS AtI ED JUN F - 8 2000 i. y TO�oF� .� H�CD►°�T'�1F a revised 9/2/98 pageloPll j Pdmod on Rocydod Paves' 0 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 481yanough Road,Rte. 28, Hyannis, MA Owner: Joe Lirchman Date of Inspection: November 11, 1999 INSPECTION SUMMARY: Cheek A B, C, or P. A. SYSTEM PASSES: 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. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need w 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 in9tarees. If"not determined",explain why not. 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 exRltration,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. 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 pipes)are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumpuq more than four titres a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): brokw pipe(s)are replaced obstruction is mmoved revised 9/2/98 pap 2ofkr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 bwwugh Road, Rte. 28.hf amis. MA Owner: Jae litdrmpvt Date of Inspection: November 11, 1999 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 15.303(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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a suit 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 to 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 cogform bacteria and volatile organic coapottnds indicates that the well is free from pollution from that facility mid the presenoe of ammonia nitrogen and nitrate nittogm is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Pap 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 481yanough Road,Rte. 28,ht awls, MA Owner: Joe lilchnw Date of Inspection: November 11, 1999 D. SYSTEM FAILS: You must indicate either"Yes"or"No"as 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 ✓ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. ✓ Discharge or pending of effluent to the surface of the ground of 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'A day flow. ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(&). 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 Rater 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 wares 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,armnionla nitrogen mad nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria wily 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 w public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply T _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in;a nitrogen sensitive area Mmerim Wellhead Protection Area-IWPA)of a mapped Zow H of a public water supply well The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Pteam consult the local regional office of the Deparmtent for Anther information. revised 9/2/98 Pap 4of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 48 lyarwagh R=4 Rte. 28,,Hyannis, MA .Owner: !oe Uld ntan pate of Inspection: November 11, 1999 Check if the following have been done: You must indicate either'Yes"or"No"as to each of the following: Yes NO ✓ Pumt►ing information was provided by the owner,occupant,or Board of Health. ✓ _ 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. n/a As built plans have been obtainod and examined. Note if they are not available with NIA. ✓ The facility or dwelling was inspected for signs of sewage back-up_ ✓ 'Ilse system does trot receive non-sanitary or industrial waste Bow. ✓ The site was inspected for signs of breakout. ✓ All system compormos,excluding the Soil Absorption System,have been located on the site. ✓ 'Ilse septic tank manholes were uncovered,opened,and the interior of the septic tank was impocted for conditions 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 Systems on the site has been determined based on: ✓ Existing information, For example,Plan at B.O.H. ✓ Determined in the field(if any of the failure criteria telated to Part C is at issue,approximation of distance is unacceptable) (15.3t}M(3)(b)). ✓ The facility owner(and oocupwa.if different from owner)were provided wtdt Information on the proper maintenance of StbSSlttface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 Iyanough Road Rte. 28,Hyannis, MA Owner: Joe Litchntan Date of Inspection: November 11, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: _g.p.d,/bedroom. Number of bedroom(design): Number of bedroom(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system)(yes or no): If yes,separate inspection required Laundry system inspected(yes or no): _ Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): Last date of occupancy: COMMERGIALI)NDU Type of establishment: ,Retail Am 0~bry shop) Design flow. n/a od(Based on 15.203) Basis of design flow Unbrawtt-nor fon file at Health beat. 0weer says it ad to be a sandwich shoo years age. Grease trap present. (yes or no) Yes Industrial Waste Holding Tank present (yes or no) No Non-sanitary waste discharged to the Title S system: (yes or no) No Water ureter readings,if available: Una►aUable Last date of oocupancy: C}trre b ooamied ( R: (Describe) Last dame of ocmgm cy: GENERAL INFORMATION PUMPING RECORDS and source of information: Xow on file-Per?Matmenr AW, System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic=Wdistribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if arty) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of Wormation: UNvtowrt. Sewfte odoes detected when arriving at the site: (yes or no) N revised 9/2/98 Page6Of11 r SUBSURFACE SIsWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 lyaaotngh Road, Rte. 28, 16annis, MA Owner: Jae Ud iiam Date of Inspection: November 11, 1999 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: 2- tanks (locate on site plan) Depth below grade: 6" Material of construction,: ✓concrete _metal Fiberglass _Polyethylene other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dinvosions: 8'6'x 4'I0"x S'(1000 gal.) Sludge depth: I' Distance fmm top of sludge to bottom of outlet tee or baffle: 30" Scrum t1ackness: I" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of sauin to bottom of outlet tee or baffle: 13' How dimemions were determined: Measrorne stick Comments: (raoonwxmdatiat for pumping,co"tion of inlet and outlet tees or baffles,deptb of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Both tanks had n*tnnat WgW—sands Only the inlet covers were awastble GREASE TRAP: Yes (locate on site plan) Depth below grade: Even Material of cottsauuiore ✓ ootng[ete metal F6erglass Polyethylene other(explain) Dimensions: Scum thiciaaess: - Distame from top of scum to top of outlet tee or baffle: Distance from boawm of scum to bottom of outlet tee or baffle: Date of last pumping: - Con awa: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural iategrity, evidence of leakage,etc.) M grease tank has not been used in nary years There was nos or sands nrese nt T fte ttgth was% revised 9/2/96 Pege?Of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48lywwugh Rand,Rte. 28, llyannts, MA Owner: Joe Iftchman Date of Inspection: November 11, I999 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Deptb below grade: Material of constriction: concrete metal _Fiberglass Polyethylene _other(explain) Diare�ions: Capacity: gallons Design flow; gallows/day Alarm present: Alarm level: Alarm in working order.Yes_ No Date of previous puttying: 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: even Cortina: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) _ I w D-box xac_levet and there we no stm of soM or leakage. The aoyer w as w-grade. PUMP CHAMBER: Nate (locate on site plan) Pumps in working order: (Yes or No) Alarms in working ceder: (Yes or No) Comments: (note caorrdition of puma,chamber,condition of pumps and appurtenauoes,etc.) revised 9/2/98 Pap Sof11 P SUBSDRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (coiatinued) Property Address: 48,tyanough Road, Rie. 28, Hyannis, MA Owner: Joe Litchman Date of Inspection: November ll, 1999 SOIL ABSO1.tP'I'1;ON SYSTEK(SAS); ✓ (locate on site plan. if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Asphalt covers the entire leaching system and there is no information an file at the Health Department. Type: [caching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,rmtnber, length: leaching fields,number,dimensions: 4 overflow cesspool,number:. Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,datttp soil,condition of vegetation,etc.) There are 4 otalet pipes in the D-bar The size of stone bed or field is wyMo►m CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note cotWition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (Wrote condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) revised 9/2/98 Pap 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 481yanough Road,Rte. 28, Hyannis, M�4 Owner. Joe Utdnnan Date of Inspection: November 11, 1999 Map: Lot. SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanem reference landmarks or benchmarks locate all wells within 100' (Lmate where public water supply cornea ima house) t'sttws� STcel covvS revised 9/2/98 par-10of II SUBSURFACE SEWAGE DISPOSAL SYSTEM IINSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 481yanough Road, Rae.28,Hyannis, MA Owner. Joe Litchman Date of Inspeetlon. November 11, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Welts checked Groundwater depth:Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 8.5 Feet Please indicate all the methods used to detetridne High.Groundwater Elevation: Obtained from Design Plats on record ✓ Observed Site(Abutting property,observation hole,basement sunv etc.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Cbeck local excavators,instaUets ✓ Used USG3 Data Describe how you established the High Groundwater Elevation. 1(�Vlust W completed) ,Band augered down to groun&wer which was 8.5'below grade. Using a transit, the separation between the groundwater and the outlet pipes in the D-baz was 5.2'. The high groundwater adjustment for this site(MIW 29 Zone C 9199)was 5.3'- 7he outletpipes in the D-bmc are in the high growtd a rer level by.1'. Not accounting for the stone bed in the leaching field. This report has been prepared and the system inspected and falled as of the date of inspection. Vus report is not a+wrranty or guarantee that the system wiU f l nctlon property in the future. There have been no+wrm des or guartwtees, either expressed, written or implied, relating to the system, the inspection andlor this report. revised 9/2/98 Pagetlof11 Permit Number: Date: Completed by HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. . . . . . j�PI /� date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A) Appropriate index well . . . . . . B) Water-level range zone STEP 3 Using monthly report"Current Water Resources Condit.ions" determine current depth to water level for index well . . . . . mo yr STEP 4 Using Table of Water-level Adjustments for index well STEP 2A , current depth to water level for index well (STEP 3) , and water-level zone (STEP 2B) determine water-level adjustment . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . ... . . . . . . STEP 5 Estinate depth to high water by subtracting the water- ; level adjustment (STEP 4) from measured depth to water y level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/06/2000 15:58 508-790-1065 CAPE AUTO PAGE 02 06/06/2000 15.17 5050333150 HORSL,EY + WITTEN PAGE 02 �: }7 LUJurte 6, 2000 Ms.Donna Miorandi Barnstable Board of Health Agsxtt Horsley&Witten,Ine. 376 Main Street Hyannis,MA 02601 S��brn H�II 90 kuur 9A Re- 48 Iyanough Road, Assessors Map 343,Parcel 14 sVewiad MA ama Dear Donna, 1501433Q0 On November 11,1999 a Title 5 septic system inspection was conducted at 48 Iyanough Road by Mr.Jaiztea M.Ford,report enclosed. Mr.Ford concluded that the estimated seasonal high groundwater elevation was 0.10'higher than the distribution box outlet invert and therefore judged the system to fail the inspection. Mr, Ford used the Frimpter Method to determine seasonal high groundwater. We rote that the Frimpter Method is not designed to work in fill,in wetlands of glacial I.� f - j Based on the 4,2000 deep observation hole and percolation test, (performed by H&W and witnessed by you),standing water was observed at seven-feet four-inches below ground surface. The deep observation hole indicated that the existing property is Qituated over a four feet,eight-inch thick fill layer. The allowable alternative methods for determining estimated seasonal high groundwater in accordance with 310 CMR 15.103(The State Environmental Code Title 5),are annual observed high water,mottling,or the Frimpter method. The test pit was not conducted during annual seasonal high water levels,mottling was not observed,and the Frimpter method is not designed to work in fill. In order to determine a more acmirate estimate of the seasonal high groundwoter.elevation,a one-inch monitoring well was installed,tv identify maximum rise of the groundwater during the*Spring months, Elevations are based on an assumed datum of 100 feet located at the top of the concrete walk near the Northwest miner of the structure. The results are indicated below: Date Depth to Water from top PVC Elevation Water of PVC Elevation 3-15-00 9.35 101A6 91.71. 3.29-00 9.11 101.06 91.96 448-00 9,19 101.06 191.87 4-Z5-00 ! 8.42 101.06 92.64 - 5-24-QO 9.00 1101.06 192.06 From the elevation survey conducted by Fi&W,and the assumed datum used, the distribution box outlet invert was located at clevation 96.83'. The 06/06/2000 15:58 508-790-1065 CAPE AUTO PAGE 03 06/0612003 15t:7 5059333150 HORSUN + 4J.TTEN PACE 03 Ms.Dome Miorandi June 6, 2000 Page 2 I distribution box has four outlet pipes to make up either a trench or a leaching field system. Since the ieachng systarn is presently under a paved area(and was not excavated for inspection),we feel that a reasonable assumption can be made to estimate the bottom elevation of the leaching area. Based on the fact tf it most learbing fields and leaching trenches have a maximum of two feet of stone below the invert of the outlet pipe. We concluded that the bottom of the Ieaching system is at elevation 94.83 feet. The criterion for failing a septic system with respect to seasonal high groundwater is the learbinS area intercepting groundwater. Based on our survey and observed groundwater elevations through the spring season, we conclude that there is at least two feet separation distance between the bottom.of the leaching area atui estirrmted "axonal high groundwater. Therefore,we conclude that the current system located on the property is not a failed system. We respectfully request you review this letter and endorse our findings that the existing septic system is in compliance with 310 CMR 15.303(g). Thank you for your assistance with this project,and lease call if you have an Pr'ol P Y questinr►s. Y Sincerely, HORSLEY Sc WITTEN,INC. i dwieA an L.Peace, .1r. Senior Environmental Enoeei ELP/cek cc- Mr.Terry Flaherty i ►orsley&Witten,Inc. a6 z Town of Barnstable P# , . o.,THE rp� �P� o Department of Regulatory Services D , ate f� U STABBARN : Public Health Division MASS. u �c� i639, 1�ro 200 Main Street,Hyannis MA 02601 plf0 MP't b , t ' G Date Scheduled� 3 8 � Time_�U /9'� Fee od L t Pd. Soil Suitability Assessment,for Sewage Disposal Performed By: HA TOW �- (, �'�1 Witnessed By:' LOCATION GENERAL INFORMATION Location Address uf Owner's Name [06 A Sl�Ivtrt�✓�jr'1 V / )F/ Address Assessor's Map/Parcel: 3 _ o(� i Engineer's Name$Q w.Jt NEW CONSTRUCTION ` REPAIR Telephone# / : �°'-3 Land Use '�r�1 1orw tm* Slopes(%) Surface Stones Distances from: Open Water Body 2 ft Possible Wet Area ft Drinking Water Well i-100 ft Drainage Way. -"Q ft Property Line (® ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to.holes) i % 16 _rr,_,�Tr Z CAM -6ASt^1 S Parent material(geologic) ` J ��'A4 4 Depth to Bedrock ® +)Depth to Groundwater: Standing Water in Hole: 3 Weeping from Pit Face Estimated Seasonal High Groundwater r If Aoyf gX&V DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: `� 1�— 001 C CX. if Depth Observed standing in obs.hole: A¢ in. Depth to soil mottles: NIA 10 in. Groundwater Adjustment Depth qto weeping frm side of pb�.,hole: ?, st C Index Well#�-i— ReadingDate:� Index Well level O Adj.factor Adj.Groundwater Level f�a a� Z PERCOLATION TEST Date Time Observation Time at 9" Hole# Time at 6" Depth of Perc Start Pre-soak Time a Time(9"-6") INLOT- End Pre-soak ' Rate Min./Inch Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y Y a'1 Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTH/W P/PERCFORM I DEEP OBSERVATION HOLE LOG Hole# Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(ln.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 9 ansistencv,%%Gravel .. . f9LL 3 JOY9 2 0 7+ I I I C 1 SAT.-ID i oar o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon .Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) C) cy: H 4o ?3O CI ` " ct& a 1 o M c� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No-?�' Yes Within 500 year boundary No Yes Within 100 year flood boundary No—)� Yes Depth of Naturally Occurrinsr Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? — ►� If not,what is the depth of naturally occurring pervious material? 1.� 4Z Certifcatt°° I certify that on 'hr". (date)I have passed the soil evaluator examination approved by the Department of Envirbrun6ntal Protection and that the above analysis was performed by me consistent with the required tra' ' pertise and ce descr' CMR 1.5.017. Date Si r Q:H EALTH/W P/PERCFORM L _ _ Commonwealth of Massachusetts { Executive Office of Environmental Affairs Department of Environmental Protection e One Winter Street, Boston MA 02108 (61 n 292-5500 9 s - 343 1 `�- -:' _f , ``TRUDY COXE 1�_9. Secretary ARGEO PAUL CELLUCCI a DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 481yanough Road, Rte. 28, Hyannis, MA Name of Owner: Joe Utchman Address of Owner: Date of Inspection: November 11, 1999 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: Telephone Number: (508)862-9400 Lot: 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: Passes Conditionally Passes _ Needs Further Eval io By the Local Approving Authority ✓ ails Inspector's Signature: Date: November 23, 1999 The System Inspector shall submit 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 revised 9/2/98 Page 1of11 Primed on Recycled Paper r f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 Iyanough Road, Rte. 28, Hyannis, MA Owner: Joe Utchman Date of Inspection: November 11, 1999 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 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. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. 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,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. 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 _ 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 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 481yanough Road, Rte. 28, Hyannis, MA Owner: Joe Litchman Date of Inspection: November 11, 1999 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 15.303(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 a surface water Cesspool or privy is within 50 feet o`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(W and:the,SAS is within 100 feet to asurface 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 1 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 (approximation not valid). 3) OTHER revised 9/'2/98 Page 3of11 - o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 481yanough Road, Rte. 28, Hyannis, MA Owner: Joe Utchman Date of Inspection: November 11, 1999 D. SYSTEM FAILS: You must indicate either"Yes"or"No" as 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 ✓ 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 'h 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 wittin 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. 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" as 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 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 48Iyanough Road, Rte. 28, Hyannis, MA Owner: Joe Litchman Date of Inspection: November 11, 1999 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No ✓ — Pumping information was provided by the owner,occupant,or Board of Health. ✓ — 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. n/a As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ 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 conditions 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. For example,Plan at B.O.H. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)l ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. r-10.. revised 9 '2 / Page 5 S / /98= s ofll y .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48Iyanough Road, Me. 28, Hyannis, MA Owner: Joe Utchman Date of Inspection: November 11, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: _g.p.d./bedroom. Number of bedrooms(design): Number of bedroons(actual): Total DESIGN flow Number of current residents: _ Garbage grinder(yes or no): Laundry(separate system)(yes or no): If yes, separate inspection required Laundry system inspected(yes or no): _ Seasonal use(yes or no): _ Water meter readings, if available(last two year's usage(gpd): - Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Retail Shop (Jewelry shop) Design flow: n/a ¢vd(Based on 15.203) Basis of design flow Unknown-nothing on file at Health Dept. Owner says it used to be a sandwich shop years ago. Grease trap present: (yes or no) Yes 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: Unavailable Last date of occupancy: Currently occupied OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: None on file-per Treatment Plant. System pumped as part of inspection(yes or no): 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information:-` Unknowit Sewage odors detected when arriving at the site: (yes or no'. No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 481yanough Road, Rte. 28, Hyannis, MA - Owner: Joe Litchman Date of Inspection: November 11, 1999 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,etc.) SEPTIC TANK: 2- tanks (locate on site plan) Depth below grade: 6" Material of construction: ✓concrete _metal _Fiberglass, _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) . Dimensions: 8'6"x 4'10"x 5' (1000 ga1.) Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How dimensions were determined: Measuring stick 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.) Both tanks had minimal scum/solids. Only the inlet covers were accessible. GREASE TRAP: Yes (locate on site plan) Depth below grade: Even Material of construction: ✓ concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle: - Date of last pumping: - Comments: (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 grease tank has not been-used in nwm years..-There.was no scum or solids present. The tank was;/full: ..... ... ............ . _:. _.:.-_ a __.,. _..._. __._. _ ... __..... revised '9/2/98 Page!of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM. INFORMATION (continued) Property Address: 48Iyanough Road, Rte. 28, Hyannis, MA Owner: Joe Utchman Date of Inspection: November 11, 1999 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: _gallons/day -. Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: 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: even Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The D-box was level and there were no signs of solids or leakage. The cover was to grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 41Iyanough Road, Rte, 28, Hyannis, MA Owner: Joe Utchman ; Date of Inspection: November 11, 1999 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Asphalt covers the entire leaching system and there is no information on file at the Health Department Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length:. leaching fields, number,dimensions: 4 overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) There are 4 outlet pipes in the D-box. The size of stone bed or field is unknown. CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (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.) I revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Iyanough Road, Rte. 28, Hyannis, MA . Owner: Joe Utchman Date of Inspection: November 11, 1999 Map: Lot. 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) A 5�cue. GCc.as%� O sT«I ���5 • revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Iyanough Road, Rte. 28, Hyannis, MA Owner: Joe Utchman Date of Inspection: November 11, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 8.5 Feet 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.) i Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps ' Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Hand augered down to groundwater which was 8.5'below grade. Using a transit, the separation between the groundwater and the outlet pipes in the D-box was 5.2'. The high groundwater adjustment for this site (MIW 29 Zone C 9199)was 5.3'. The outlet pipes in the D-box are in the high groundwater level by.]'. Not accounting for the stone bed in the leaching field. This report has been prepared the m i ailed o the date o r warranty p p pa and system inspected and failed as f f inspection. Tfus report is not a wa anty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,• written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 l Date: � TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: ZT MAILINGADDRESS: S/fAjz Mail To: TELEPHONE NUMBER: !�Yf �L Board of Health 9 L Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: / 3 Hyannis, MA 02601 TYPEOFBUSINESS: �twc Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO !� This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: I TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons,yd ocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel ti (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS V es prRd a ro�cr y kd "� ; =.m rd <D Uos a c 2.a 1 -y P N an a/t Uaker Rd ro n2m r Zlm '•'dam•. O l N y y. IO Oi cn2 °y Z N * ~ ...PFJ a C- s is? z�,,,... elQ mont ar D a Stevens e on s n 6r "6 off ° o w. m:n m 3 ewton tbhell 5\ea0 c Co asy g m a AvB A o Ny. x a e C ee w \I N m v _y n 3 m ��i,� m o ,. Pb.. '�a m m m m� O Rtl d/e �C, n� 3 c ! P•. . �= 2 �'Aryl '�r.. o m m � � �ttn)`oL � ❑ •<m O w d\ �c m utD, °.o yU1 U r/mn m H/n°k/e A �` 4 .m Id f w o d a J\d 05 P Lo s St n Ga' a0 sJre Breakwater ys!tP° Rd _ 2 oG y a \o° m. Ce is asje a\Qet B Winter r t m 3? m �S cP e� N o J retutN` o'Grov ar rn rn ti � '9a �I e s a- e0 a er -o�o� - Es e au un0 0. k mr 9'�o 0 e� "o°J tS cn N - �' t alUe1sua A.ICD s\ on \te J }S2L op ' an N 10 Kin s hfgd ke m r n y�. d ?on ® utyseM ( B ay A e eno�, y is p02 ym o �g Rd tyOa Av ? S` Rd a \ati `C a Ma Dun C'm WaYOu m t W nfo� m a� t'>'i` m. t'qr'"� � g 1 O n•< s w 'Rtl \O o m t, .p �. t x l � ° -a IaN v �t� ��, yyT rn .a•.'; Ce er. P� t ?_. ! :. C 7 i itlt'�v ♦ �� � �� . c'. Lansin o' 1 D Z�.. Molla^N °s Z a� 1 G� �..u:tit ': h���i� m � �' ro'if� rOV •�D to ,K ° � L O � i Ym `�♦ _ O° .. .. O ti r7w•.�� �.9a �tdwlhf.�at� �i��. �r�n'a + r 'Oar � r o..' i �� � � f f •s, ',3t t � t � S��a er!� a tip 9 ' �c -. tr tnt :.Drews a y �� ���' Le ao�,,.x� , ,�,•, '��� ° �" k�h Yf'«dlrZt sF" at �" •,i7w a c ��3�� w.,. / c ;,o. d;`" 2 r\' � y� i .. a ... °ye\�i c "nSh rt We 0 f r. �pti o o d o and o c a �`N CD nj r� ;'��,k t k �' r �z \d W 9 �•'_d x 1 1S I N 7 ��I f 1 r r x r �+� ,-t` � � 1S Jm t loud a »- P � � rn:�-. .°•c mP We0 '•07 f g pf� ReM p a- °eC aM Ave off' o ya I P a � � Gleason Avea V7 ,;a � h'e 53 . , cv 3 m a tie6 3 m v sR m n r. m Gr � m '"t"' "b p J 07. 1 Pk! a4a �y - CT7 oPoaul ^� f b a (nn t ry s ti �N fp f CDC y� shy a�0. ensW ~� o, qa�e, I a x m� PH. ual srr! ma ° r•°Usw der °°4 SO -O °Wo 90 Vic±' y o Q c°, 'b�9 r ti y kaiV! se ¢° SOW;. RaAr° ° a Be amen «.Mn/°Y Wa N �3 � 'd-Tech a 2'r�f rt F rh s !i°G'9U R/9Vo a �c �9Ue. 4 oS. ao. �O b're qt m° " 3 ye s m0 yea hornton o ° m �� - l - O7ea 6 A � � � M m •nr � U1� h m. . ,m': moo.-. m o• o ° zM .4, wm °j` ° °pier ha°damp Ra 6 6 a °TC d aye a� ya, 7$? °° a, o O. °PooPbi Bar and y Ana , q,�ddt'>>. ct°it'� ..� �y are• r. k, ycn ei a �Q05 b +� ' c READ 41 Q+ib4 /. WWWW /' p to e ° 9 I -� / �• O U �•� r H , I 1 . I ' � �.� .N...S'�- �, :��}r�•,'_,r §'.ix"e � - '�Sz'��3-r. � e�<'+' c—f��'`s max?" .:� _ ��r = c *3.-, ��x'',�.*tn ..'w�'�.�w� �'S`•r-� �� ,�'�.•'� c�"�'�'' �``+�„r s` a` `tea` ,�{� , y i NOISIAI>, �. S � ;� 91 JV hvi;