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HomeMy WebLinkAbout0039 LEONARD ROAD - Health 39 LEONARD ROAD, HYANNIS 'P 1. t TOWN OF BARNSTABLE LOCATION S9, Lconcxtol Rd_ SEWAGE# 7,07-1 • ZZZ VILLAGE_kLga.n n v S ASSESSOR'S MAP&PARCEL Z L$ • !J INSTALLER'S NAME&PHONE NO. B EXepL.,kL ►on y11.OGS3 SEPTIC TANK CAPACITY f MQ qcJ LEACHING FACILITY. (type) 500 gv►,1t- C2- (size) 13 x 2S x 2 NO.OF BEDROOMS !� OWNER G PERMIT DATE: COMPLIANCE DATE: b°1 1 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 3►+ 42 ' A2. z► '4 ® 3 O . A3' 4z ' 133- 20,S � At4- RFEAR +trKr�; Y � ' No �;Lcl)_OPN— Fee " THE COMMONWEALTH OF MASSA H ETT Entered in computer: C US S Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYitation for MisposaY pst m Construction 3permit r Application for a Permit to Construct( ) Repair(X) 1;k rade� ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 31 Lcanct6 Rand Owner's Name,Address,and Tel.No. �1 qnM S Assessor'sMap/Parcel Kristine, boa • (.q g• 0013 Installer's Name,Address,and Tel.No. 43 d c&k)mklom Designer's Name,Address,and Tel.No. '- $14 4ovk. 13o Sonct io, 508.47•.0,6st QQG tnv�comecwk%\ A06. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ZZ D gpd Design flow provided 3 3 gpd Plan Date sou. Number of sheets Revision Date Title Size of Septic Tank tcibb no, 1000 aQllen Type of S.A.S. (I) $Oo Qa�kon G�%cLt+bgt S Description of Soil fig& pkm U Nature of Repairs or Alterations(Answer when applicable) `(1S�a�� C2� $OQ�p���pn G1r,o,n, �� And d-box, CtanneC*v(\d 6 e)L;5jc:n� 1314—, V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo of Heal gned Date G a Z Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ---------------------- ------------------------------------------------------- -- ------- --------------------------------- - Fee THE COMMONWEALTH-OF..MASSACHUSETTS Entered in computer: �. 1 1 t Yes r _ PUBLIC HEALTH DIVISION - TOWN Of BARNSTABLE, MASSACHUSETTS gp' litation for Misposal Opst> m tonstruction Permit _ Application for a Permit to Construct( ) Repair(j )`*pt-p5ade' Abandon( ) [:]Complete System [7�i Individual Components Location Address or Lot No. 31 L,.e,n no c\ (ZMck , Owner's Name,Address,and Tel.No. - nnns•.� crs Assessbr'sMap/Parcel � `a�C�ane hem 50a 0013 Installer's Name,Address,and Tel.No. cis n n Designer's Name,Address,and Tel.No: `► •s '.." 17.)0 Janet)-nth �C3 . �i��•C>1a5 ✓�3� ,n+J�tUtYipC��i i\ &rrnsiai'lt Ac1 .. Type of Building: Dwelling No.of Bedrooms 2. Lot Size sq.ft. Garbage Grinder,( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 110 gpd Design flow provided 3 3 4 gpd Plan Date 2 U Z t Number of sheets 1 , Revision Date Title Size of Septic Tank[.C�`It l ne kGo o f 0API,n Type of S.A.S. (Z) SC\O o\l,an cv-rt "be: Description of Soil !>p j?. O!ter, J P• ,. � �; tip �,` - ��, Nature of Repairs or Alterations(Answer when applicable) 6,wl (Z) 50f) n ( . a r,cl �- �x �G_unne.c{�nv ��� c�x�°.k�n� �-nr��r•-. . s;.<d,. ,Tr:.: - � r v Date last inspected: Agreement• The'undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this BoA of Heal h/ F Signed Date Co .Z f / - Application Approved by Date 611, Application Disapproved by Date w for the following reasons pp JS Permit No., G- � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 'Certificate of CompriAnce ` THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( ) Abandoned( )by at "A (_e o nc,c- . has been constructed in accordance`�� 1f with the provisions of Title 5 and the for Disposal System Construction Permit No�- —zW_Iated 'to 15 Installer Designer 'D 1)C #bedrooms ,�. Approved design flow gpd The issuance of this ppeer�miiVs/hall nJ�"t be construed as a guarantee that the system witl funot'on"as"d,'eTigned. Date ,{,�`/ q/ Inspect .J / No.9.=-• / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoSal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( X) Upgrade( ) Abandon( ) System located at �jQ Le-n nnrek (4,paA and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must becompleted within three years of the date of this perrhiitt...� Date () d �.�l Approved by f i Town of Barnstable Inspectional Services a°ntrsraBLe, Public Health Division 16 9. Thomas McKean,Director •bssa .� + ° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Z� Sewage Permit# • Assessor's MapTarcel $ 1 Desig ,�; ner: 1 Installer: � v 10 Address: ��� � C� Address: On �qq V i0 � � was issued a permit to install a (d e) (installer) L� CAseptic system at � .Kased on a design drawn by (address) n� • !J �� ''{ �✓ dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes-such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was_,inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations: Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co ce with the to rms of the RA approval letters(if applicable) OF et s� DAVID g. s� (Installer's Signa ) MASON rn . v � No.106Ait— S�o (Design 's ignature) (Affix Des1 ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. \\toa\depts\HEALTMSEWERconnect\SEPTIODesignerCertification Form Rev&14-13.DOC TOWN OF ARNSTABLE LOCATION 1� 4 d� _ S E VILLAGE ASSESSOR S N LO'T �y INSTALLER'S NAME& NE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMUDATE: 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 O n n � � . C1 (® O � .� �v��� ��� ~ �� �/-: • o<b ¢fi -r e.q �i• c)` DATE s/13/o5 PROPERTY ADDRESG 39 Leonard Rd � Hyannis MA 02601 On the above date, th"eptic system at the address above was Inspected. This system consists of the following: 1,1 1-1000 ga Min he/A is . tank., 2., 1-10.00 gaiion ieac.h.ing R.it.� Based on Inspectlon, l certify the following conditions: 3., 7h.is ins a 7.i4i,e Fiv.e SeP•t.ic .rsy-tem P78 Code) 4.i SeR �c .hy� em is n /z2at •the /z 2 h'ent t line. pea woaking oadea a SIGNATURE Name: Robert A. Paolinl ; Company: Ms�mber &Son Inc . Address: P. O. Boxes �� • Cent�INille. Mas 026►� . � . v��� 8 or 508- 412 • Phone.. 33 508 7 IOSEPH P. MACOMOER & SON TankaCe:spooj:Lemchfields Pumped &•:Installed Tows+ gewer•Connebtlons 66 P.O. Box 66 Centerville, MA•0262-00. •77WA10 . 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL FAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION prepwty Address- 39 Leonard Rd Hyannis MA n26n2 OWBW!S Name.. n1 n a-l-d R a r t l e:L t Owner's Add>rem -q a m e Date.of Ion: s/13.105 Nam djuspeetor..(pbaseprlat ;Robert A Paolini CompwyNaow. J_P_Macomber & Son Inc. 1VbMft Adidre= Rn x 66 Centerville MA 02632 Telep Nwi*w-.50.8-775-3338 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 ftmetion and maintenance of on site sewage disposal systems,I{am a DEp approved system inspector pursuant to Section 1&340 of Title 5(310 CMR M000). The system: XXXPses Conditiona}ly Passel Needs Further Evaluation by the Local Approving Authority >♦ ZW"04 Inspector's Sipatwe• Date: The system inspector stall submit a copy of this inspection report to the Approving Authority.(Board of Health or DEI)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 subunit the report to the appropriate regional office of tic DER The original shoxrld be sent to the system owner and copies sent to the buyer,if applicable,and the approving autlmiity. Notes and Comments "~][Ws report an19 desc*es coadWns at the time of won.and under the eouditlons of use at 1halt. dmG This inspection does not address Low the system will perform in the future$ der the same or different conditions of Title 5Inspection Form 6/151200D Paget Page 2 of 11 OFFICIAL INSPECTIONYORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 Leonard Rd Hyannis MA 02601 Owner: nnna1d Rartl Pt-t Date of Inspection: 8.11 'i.j n g; Inspection Summary: Check:A,B,C,D or E/ALWAYS-,complete all of Sectiou,D A. System Passes: NO I have not found any information which indicates that any of the failure criteria described_in 310 CNIIt 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. C mm nts: geptz� woak.iny oadea at .the pae.zenti time_., B. System Conditionally Passes,: NO 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. NO 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: NO 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 obstruction is removed distribution box is leveled or replaced ND explain: NO The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 T.Annarr9 Rd' Hyannis MA 02601 Owner:. Donald Bartlp-f-t- _ Date of Inspection: 3 0 5 C. Further Evaluation is Required by the Board of Health: NO Conditions exist whichsequire 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 manner which will protect public health,safety and the environment: n o Cesspool or privy is within 50 feet of a surface water n o 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: no 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. no The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. no The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. no 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 v c�sua "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: Page'4 of 11 OFFICIAL INSPECTION FORM-NOT TOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART<A . CERTIFICATION(continued) Property Address: 'A A T.anna rr9 Rd Hyannis MA 026-01 Owner: Donald Bgrtlett Date of Inspection: 8 1 3 0 5 D. System Failure Criteria applicable to all systems:. You must indicate"yes".or"no,.to each of the.following.for all inspections: Yes No _ X Backup of sewage into facility or system component due,-to overloaded.or clogged SAS.or.cesspool Discharge or-ponding of effluent to the surface of the:ground or.surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than.6"below invert or available,volume is less than May flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ 7- .Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 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 orprivy is less than-100 feet but greater.than 50 feet from a private water ` supply well with no acceptable water quality analysis.:[This system.passes if the well water:analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates.that the well is free from pollution•from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or.less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this fora,] NO (Yes/No)The system fails.I have determined that one or more�vpf.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 1.0,000 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area @nterim 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. 4 Page 5 of 11 OFFICIAL,INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 r.Pnnnrrl Rrl Hyannis MA 02601 Owner: Donald e t t Date of Inspection: 8 1 3/0 5 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of tho inspection? NIA Were as built plans of the system obtained and examined?(If they were not available`note as N/A) X _ Was the facility or_dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components¢ luding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the.facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of Health: X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL I.NSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE;SEWAGE DISPOSAL;SYSTEMJNSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 Leonard Rd Hyannis MA 02601 Owner: Donal Date of Inspection: 8 1 3 0 5 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual) 2 . DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 22.0 Number of current residents: 4 Does residence have a garbage grinder(yes or no)-.n o Is laundry on a separate sewage system(yes.or no)ao [if yes.separate inspection required] Laundry system inspected(yes or no)n o Seasonal use-(yes orno): no . 2003_97, 500 ga..e.eorzz GOD=267., 12 Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 4 8 2, 5 0 0 ga 2 e o n z G 1O D=2 2 6 02 Sump pump(yes or no): n o Last date of occupancy: ./211 e z e n;t COMMERCIAL/I1USTRIAL Type of estabJ m'ont: NIA Design flow(based on310 CMR 15.203): gpd Basis of disign-Row(seats/persons/sgft etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water.meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Ruml?ed 311-0104 ky a. Nacomkead Was system pumped as part of the inspection(yes or no): n o If yes,volume.pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system n o k o x _Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be 'obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 25 yeazz Were sewage odors detected when arriving at the site(yes or no):ro 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address: 39 Leonard Rd Hyannis MA 02601 Owner: Donald Bart1 Ptt Date of Inspection: 8/1 3/05 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X 40 PVC_dt gr(explain): Distance from private water supply well or suction line: UU+ Comments(on condition of joints,venting,evidence of leakage,etc.): ao.in.tz al2pea2 Light., No 6.ians o4 Peakaga Ven1ted .through house vent SEPTIC TANK:y e J(locate on site plan) 1000 gate. o n Depth below grade: 12 Material of construction:—concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ 'Is age confirmed by a Certificate of Compliance(yes or no):_,(attach.a copy of certificate)'Dimensions: g► 6"X.5 ' 8'X4' 10" Sludge depth: .. .t2 a c e Distance from top of sludge to bottom of outlet tee.or baffle: 2 a e e Scum thickness: n o n e Distance from top of scum to top of outlet tee or baffle:n o n e Distance from bottom of scum to bottom of outlet tee or baffle:n o n e How were dimensions determined: mea.6u2ed Comments(on pumping recommendations,inlet.and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): l um .ta k evwty 2 qeazz., .teens ate in ks noun GREASE TRAP: a o(locate on site plan) Depth below grade._ Material of construction:_concrete_metal fiberglass polyethylene_other (explain)`. Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): G2eaze .taa/2 not /22ezent 7 Page 8 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM �'- PART C SYSTEM INFORMATION(continued) Property Address: 39 LpQnard Rd Hyannis MA UZb01 Owner: nonald BiArtlett Date of Inspection: 8 13 0 5 TIGHT or HOLDING TANK:n o (tank must be pumped at time of inspection)(locate on.site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): Tight o z hoed-ing tanks ate not /22ezen DISTRIBUTION BOX:n° (if present must be opened)(locate on site plan) �. Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Diztaigution &ox tz not paehent... PUMP CHAMBER: n o (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.): Pump cham4e2 i.6 not 12ae6ent 8 Page 9 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 Leonard Rd Hyannis MA 02601 Owner:._Donald Bartlett Date of Inspection: 8/1 3/0 5 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located .see Rage 10.1 Type X leaching pits,number: leaching chambers,number: 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.): Loamy .to medium .sand.. No oa 12onding., ege a .con :cis no2ma of .s ate d2y., CESSPOOLS: n o (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 yr no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ce6.312ooiz ate not 12/Le,6 n PRIVY: n o (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.): paivy .is not paesent 9 Page 10 of 11 OFFICIAL INSPECTION FORK-NOT FOR VOLUNTARY ASSESSMENTS SU,BSURFACE`SEWAGE.DISPOSAL SYSTEM INSPECTION FORM - PART C . SYSTEM INFORMATION(continued) Property Address: 39 Leonard Rd Hyannis MA 02601 Owner: Donald Bartlett Date of Inspection: 8/1 3/0 5 SKETCH OF SEWAGE DISPOSAL SYSTEM Pr' 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. 39 j PSI 10 f Page 11 of 11 OFFICIAL INSPECTION-FORM—NOT FOR VOLUNTARY ASSSME TS SUBSURFACE SEWAGEFORM DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION(continued) Property Address ?o T^^"n-rd Rd 41z^nni c Mn 02603 Owner: Dan^lr7 Rartictt Date of Inspection: R 11 -4/a 5 STTE EXAM Slope Surface water Check cellar Shallow wells. Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: •NO Obtained from system design plgns on record-if checked,date of design plan reviewed: t(2 h Observed site(abutting property/observation hole within 150 feet of SAS) a V"Checked with local-Board of Health-explain: a i Pt aa� no Checked4ith local excavators,installers-(attach documentation) �Le_h Accessed.USGS database=explain ttP t ownr�aanbt a�2e.�ma. u!s You must describe how you established the high ground water elevation: llsed : Ca Re Cod Comm.i-s.ioa !datea 7ag-ea Coritoua.a And l u8.tic Glatea Sup/sEy Veii head noted io•n azeaz ma,?., Se •t 1.995 Vatea aehouaceh o ice ca a co eommidion. Leaching Pit S: 'eet I Groundwater FeetBelow Bottom:of Pit Hi&h Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical.separation distance between the bottom. of the leaching pit and the adjusted groundwater table is feet. • 11 :r•rrns+r�•tsfzsr-•rrsrnramrns+sie•-nrtrmrrsrrr.•sr+•ennrlmtr*er+rrn ns+•+tvr+su•�eerrtse -1'�e•na-a•�.t.+•nt^�„tr.r.�••f TOWN OF BAZNSTABLE - BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTF,M INSPECTION FORM - PART D CERTIFICATION ••TS•t�T•:•S:T��777•'.�T tSP.'ffi'Rtt1f•tT'i7{'.IfR�FSR'T79•Tt�f.'T1•.'S17TR.'ti.77'R17t��'if.R7RM1KHl7lA7Qr7) >f7IRR :.Tt1`TT•T•_If•�••� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 39 Leonard Rd ASSESSORS MAP, BLOCK AND PARCEL # 268-017 OWNER's NAME Donald Bartlett PART D - CERTIFICATION NAME OF INSPECTOR Rogeat Paoiini COMPANY NAME ao aph Jl.. flaeom9eai"S' Son Inc COMPANY ADDRESS Box 66 Centeavt-iie Naas 02632 Street Tovn or City state LIP COMPANY TELEPHONE t 508 075 -. 3338 FAX ( 508 •I790 1 578 >R Ta CERTIFICATION STATEMENT I certify that I have personally. inspected the sewage disposal system at this address and that the information reported is true, accurate, and omplete as of the time of•inspection . The inspection was performed and any recommendations regarding upgrade , . maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: : Systeui PASSED ' The inspection which I have conducted has not found any information which indicates that. the system fails to adequately protect public Health or the environment as defined in 310 CMR. 15 , 303 . Any failure criteria not evaluated are tis stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con acted has found that the system fails to protect the ilublic health and the environment in accordance with Title 5 , 310 CMR 15 . 30.3, and as specifically noted on PART C - FAILURE CRITERIA of this inspe o fo X Inspector Signature Date ' )7ne copy of this certification must be provided to the OWNER, the BUYER where applicable) and the I3PARD OF HEALTH. * It the inspection FAILED., the owner or operator shall up.grmde ' the system. within o'ne year of the date of the inspection, unless allowed or required otherwise as provided in 3.,10 CM.R 16 . 305 , � 'yq y04 CEO c� - 40 04*0, S COMMONWEALTH OF MASACHUSETTS .., EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Zlp t—1 L k Q Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Address of Owner: 7016 INLAND ST.ENGLEWOOD FLORIDA 34224 Date of Inspection: 5/5/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-564-6813 FAX 608-664-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluati B he Local Approving Authority Fails Inspector's Signature: Date:5/13/00 The System Inspector shall subm Ia copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system Is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life:" THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.if"not determined",explain why not. n& 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. D& 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 n& 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 Heath): _broken pipe(s)are replaced obstruction is removed revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS i;5 within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply,well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the .well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less 1,11 than 5 ppm,Method used to determine distance n1a(approximation not valid). 3) OTHER n/a revised 9/2198 - , Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 D. SYSTEM FAILS: You must Indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped t2. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, _ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner: ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X - Pumping Information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable)1 5.302(3)(b)j X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/9$ Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d.fbedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM MERCIALIINDUSTRIAL Type of establishment: n/a Design flow: nla gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1973 Sewage odors detected when arriving at the site:(yes or no): NO ;r revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: nla Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of t t S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 616/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n1a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) nla PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a r revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/5/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (1)5 X 6'BLOCK CESSPOOL Alternative system: n/a. Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE OVERFLOW CESSPOOL IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 2'OF LEACHING LEFT AT THE TIME OF THE INSPECTION.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a tt revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6100 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) IA �jticK � Oak �g R u� DC PA revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 LEONARD RD WEST HYANNISPORT, MA 02672 Name of Owner ESTATE OF JOAN BROWN C/O BOB ANDERSON Date of Inspection: 6/6/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2198 Page 11 of 11 .�,�. - .. - - - _ - sw:��.�e:.., .. ,.r �_. - - - ,_ -� �� __ .. . _ K.' .-� ...<-ec-'s!�.s.r_ . ,.pgt:?:'- - - •`f''. ....Koa.-� .� .a^+s�+►ra^rn: v+wrw...+. rwN•••,.+n¢.. ......_._. .mau,.Mvpr,;• -r .w•-� .wr �.w.K......�+r..............__. ,..N......r.es•es.... _..._...._ - -�--m•.�. -,.�'^�ee' s .. 'yl.l}'•'} Y x. z E2 i' t i a•• _ ! i34t ;! ra l tiri'fltt?I t y �f�y� i n5ta' `r„1 jht .i! r- + '•� I r rGi' !, r e f.{.'� :': Y{;iN!1 _ -O,�, , I'/yl����"`/ ��,�, _ a k�.�,�.fi=:�i[..r � ' '"1 1 =. •+ �' SE"r�r Sys-.t�ril i3a . ••?;-�tJ:�+t! '. ,�r.r ;iBR iliil r1C1t�3t� 1!'IS��'.��:{ :�jlrii a !i.z ;•1SC'f>�20`�Ail1 iS'.54a`!•_t �Z Y, 14Je: u, �r 1i'N .e approval L . . rmiL frr)n1 fire a:)�licahle 0 _ I -�✓ L l �.�""i/ '✓"" U✓J lj��i C,11 � _ t 3r to ins.a!►�r o,�,t .. :r.�A, _rr a :t tcr! r .!_�,se;*�e e \ � � � ! ! ..':Gk }i; z-ir��.� �t�'�1 iat_ f ( L lt� ,:~^-� t !t�rl existing septic t O! 1+slnent ;.• t<'r lc� in5t�iisticr. V� �� �' �� 1V !'!� �` A:!gravity sewer pipiug's to be 4 inch schedule 40 PVC at 1i forL, 3: -. first 2 feet uo*of yTH-.2. distribution box shah k a love!. All Ciping connections to be g!:j,=r. - ,; !A;is septi;-Jes!gn otan is i?:'+t to use ,itil:t�rl for omperty lin•� i.'tr` ^1tr! i :r for,arty other ,r !a r`r i ' t t,, :post{}tiir,A ti, .,the nr;,pss�td septic sytiterr, i vs;allatir+A. 1; t 12 _ all: �tlx' 4 :ornpeA:ent- af6 tta me*'Y i'itie V spei'A`tCatforss. �^. ( � 'i Fa ki*1,shall be i 'Ohttsited o ter ; tle V c.omponertrs unlP:.. ^i: t +7(:to5cit_�. The existing ieaching .i•cr7W-oois st.at+ be per,';}ed and €ilie6 wit.- e;ie1 .1l per Title V ai' wjunment proc-eClestc, t�afhilsg ar:d cesspr;o!Is)and co!std'niilated sc>>;� Within the 1 ;poser SAS ch-4 be ;--moved and replaced with r-=ear+laud fief Title J q),.cOfir_3t!cros. SP lic mmGOj'tepts,are to :%r- 10 'fruit a water se..Rk line. Sewer iiae5 t(i;,:;ng a water l.tl..' :r+ b- sleeved with an si�fd :hedule -'#C)PvC with end,,grouts=ri Thg wamr serv=:L ;} ; I I j r+_•.�;t- ii. lj ,7 0. ;�-a, F sleeve e !1;," r. L.vaM ct!jpS i � �� — i f1 'tE SeA� , r• '!h tt't Ste-.vt� l}_ r1� 3 'iSt%3 , E'er rIJ3F,t' Sri ldE'r t?1(iSfS in fire << re ��, i/� f _ 11 [/� it 15 LO t)P. ..I1t01�A if Che SLm 'S4er-) tS 1Ot "�L./ 2,1'� ✓ ar?Aic A jt ic:,'tr:r1rT}©ti:,t?d gar�AagA e;-{ar', i l t:Tsiaiif'3 !3 te�QonS:bie rJ! x'o,•'at:or'arut;r•,:3 i;i;«ti;�r; _ ill • u. .l�¢ 5t-!•:J�it: .a si�t?�e� 3� •.tr'+ i !!•ti!S i;lir''r'�t+ 'i-`•" t"r ;fi�S� ' St' 1!C r^ �`{ ` t'' ;►.; �:r•ly re}�rastr : 'hoc a septtr s+�ster~E=art t>< i,s4alsA�li on it ' '�r r',eetint?Title v `1 e rm fir' 1 10 I'" y� �.�. � teGUir �.s +'tct r/u } ? property owner chal; rrrYiew design tr iterie to apppr7)vp tl­ to zza! nurnt,or of bedroorni s ant 7AJe / de>ign flow. h'istaliation of the sepbr_system as proposed and receipt of po,anent for the de,,igi- ! /�i'�N f g i ! ha l be dee-lied approval of 0 ! d. ign.ritcf;¢ ov the properly ou r►e. o .,,:._r:t of. _��t>' �� �, � •� � ���,�ie, , -1.� 'i;ie vaiirliiy of this elder 031i expire with the expiration of tf,?tiib�.iA irrtaUatr.)!' permit issueA: Fr ! plan or the valid t)�3t .'Aait �j4*1t1? :?r)the e1xpira#'tt;:. "1'• r' . iicate of Crtmplia n( - } If Af"'rr- .211 '✓sled for utsi=ilia;! w -ri; A:l :h�5 '�� t'` t IN ------------- 4 W 0 t.. egI L 1UUL"7 _1 I ito 57, - !r7t� i' �NQFM -A X 12t 711 - c DAVID Y,B. >) NO.1066 �.O �.„p �...a+fKKw..r..-..a+a<: - -.-.:n...:wac:.. ,.ar,:..-, -,>.a. ems• .��..;, .o-tw-....._ww�rsw�rrrrarx•rw�.::x.::.:. . . ::3 TIE r AEO f D t•= r. _.._r' a.• �� m