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HomeMy WebLinkAbout0037 MEGAN ROAD - Health (2) 7 Megan Road Hyannis ' A=292-258 0 a9c2 c Commonwealth of Massachusetts Title 5 Official Inspection FormYI , 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '- 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is ✓ Ma 02601 9/5/18 required for every Hyannis page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information Sly+ r3a�g filling out forms on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. _ - 35 Content Lane Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9/5/18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is Hyannis required for every Y Ma 02601 9/5/18 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1000 Gallon septic tank as well as a concrete distribution box and 2 500 Gallon chambers in stone. 2) -System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally,sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is H annis Ma 02601 9/5/18 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): I ❑ 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): I i i ❑ 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): �I i I 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing!to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® Sta i tic 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A'copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10i'000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,s� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / »� 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Da te of Inspection C. Inspection Summary (cont.) If you have answered yes to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the Y large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example:.110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 219 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the.Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 I' Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tail k, distribution box, soil absorption system ❑ Single cesspool i ❑ 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. i ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Installed new leach field 10/29/14 I Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 p g feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition'of joints, venting, evidence of leakage, etc.): System is vented at the roof line i II i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 2.5 Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended if not pumped in last three years t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 37 Megan rd V Property Address Craigville Realty Owner Owner's Name information is Hyannis Ma 02601 9/5/18 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts ,P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Megan rd V Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): Box is level and like new. No carry overobserved l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is Ma 02601 9/5/18 required for every Hyannis page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order; ❑ Yes ❑ No* Alarms in working order ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): �I * If pumps or alarms are not in working order, system is a conditional,pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching i trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No damp soil. No ponding or break out 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �u a 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 9/5/2018 Assessing As-Built Cards TOWN OF BARNSTABLE LOCATION `��I iQr ' SEWAGE 4 VILLAGE �y�tir�vr ASSESSOR'S MAP&PARCEL 9e;'2 INSTALLER'S NAME&PHONE NO. �►�pl`�/r �- 070 7 SEPTIC TANK CAPACITY c y Cwll LEACHING FACILITY:(type)-Co-�� *AfP,?A size)-I.?X..rxg " NO.OF BEDROOMS 3 OWNER �r?1L!►�/$.fly PERMIT DATE:-' /O/� COMPLIANCE DATE:/o^ �70 /fi Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 47 Feet Private Water Supply Well and Leaching Facility(If any wells exist on / site or within 200 feet of leaching facility) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �J� �� ©�Gfi I I II, i �cA,P i i 3_s`•� �_ 36 � y_ 37 hftp://www.townofbamstable.us/Assessing/HMdisplay.asp?mappal 292258&seq=2 1/2 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 10/28/14 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Megan rd Property Address Craigville Realty Owner Owner's Name information is required for every Hyannis Ma 02601 9/5/18 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 0 _ TOWN OF BARNSTABLE LOCATION `� ' /�/1' SEWAGE# VILLAGE /r ' � ASSESSOR'S MAP&PARCELaZ INSTALLER'S NAME&PHONE NO. ����`�'� �-�" ®��7 SEPTIC TANK CAPACITY e- LEACHIl i G FACILITY: (type) NO.OF BEDROOMS OWNER PERMIT DATE:-'O COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Oe? Feet Private Water Supply Well and Leaching Facility(If any wells exist on site of 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 BY1 - 6® l- ,37 1� TOWN OF BARNSTABLE LOCATION 17 SEWAGE# ' VILLAGE /ASSESSOR'S MAP&LOT ,INSTALLER'S NAME&PHONE NO. , -�-- ? .SEPTIC TANK CAPACITY - // 1.&J�zc 7/a/L, t LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER PST DATE: _ �� COMPLIANCE DATE: Separation Distance Between the: y Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � . 1 � � ® � O ;�, PCs �.- - 1, TOWN OF BARNSTABLE LOCATION 37 In E GoN SEWAGE# �s1LLAGE I �� ASSESSOR'S MAP& LOT ,2 9-1—; - I INISTALLER'SINAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) DPIT (size) /00 p CAL size NO.OF BEDROOMS BUILDER OR OWNER PERMI TDATE: COMPLIANCE DATE: Separation Disltance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet,of leaching facility) Feet Furnished by } 4 A 7 5 1 S rt A r O O i� y r . r 1. /00 No.9 1�/ P Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Misposal 6pstrut Construction 3pPrmit Application for a Permit to Construct( ) Repair(grade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. c� �y �, c//X-d Assessor's Map/Parcel �/ � " � �� Insta er's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms rZ 6JV. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 4X 40., No.'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided /� gpd Plan Date J 8C —"�f�' Number of sheets /� Revision Date Title Size of Septic Tank �s'Xi�l�T�/y 149 O4ype of S.A.S. CB Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealth. S' ed Date �a4 9 Application Approved by _ Date Application Disapproved by Date for the following reasons Permit No. Zol 10 Date Issued l Fee THE COMMONWEALTHOPMASSACHUSETTS Entered in computer: 6101, Yes PUBLIC HEALTH DIVISION -TOWN OF-BARNSTABLE, MASSACHUSETTS Rpplication for ;Disposal .6pstem Construction Vermit Application for a Permit to Construct( ) Repair(grade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. zj" 7 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Insts er's Name,Address,and Tel.No. . Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms G`r. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building :�V 4tP. No.of Persons Showers( ) Cafeteria( ) Other Fixtures �i q Design Flowt(min.required) gpd Design flow provided gpd Plan Date •J o --~r�S'✓ Number of sheets / Revision Date Title y ,�..,,qq Size of Septic Tank �) 1� 6"'..Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: } The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealth. S' �- Date �a ed Application Approved by /r Date e�M?/Z 'N Application Disapproved by Date A for the following reasons Permit No. 7 0I u- 910 Date Issued b I Zq I Zfl 14 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Qtertificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded Abandoned( )by 17��/yl ',�0� �'/� •1'G`f®��G j�6"C at j�'�.q� lre&1 /� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No - 1/V dated /9 L Z_0 Installer 05nJ .��.�o�G/r - Designer 4!!?.A 49 105 r✓''a #bedrooms Approved design flow 3 � / „� gpd The issuance of this permit shall/pope cordtruediw a guarantee that the system w'll iffinction}ass designned. f Date o / Inspector �/ J� U No.(o(�I— 1 IU Fe` C/wr c. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -isposat 6pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( /< Abandon( ) System located at 7 .�����✓"r yi4 J"/"�-� 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 be completed within three years of the date of this permit Date /n 1211 lip/V Approved by OCT/31/2014/FRI 09:20 AM FAX No, P, 001/001 Town of Barnstable Regulatory Services .� R hard V. Scali,Interim Director r ■naraseaaE& AH& ��$ Public Health Division ann a Thomas McKean,Director 2001V[ain Street,Hyannis,MA 02601. Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification For Date: 1D $I Sewage Pern!'t#-'tp/� Assessor's Maffarcel Designer: I Irrstaller: 1 iv�l l Address: Address: ,gyp lb /G 9— �14k � wv was issued a permit to install a On (date) 0 taller)) septic system at J "� "f tVb sed on a design drawn by (address) M*akl �i dated t (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations, flan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' nee with the terms of the I1A approval letters(if applicable) I k�OF p4 L 4 e� Y DA�VID 1� �i (Installer's ignature) n YtASON r `t �o�s•r��`�, No,106 (Des finer afore) (Affix Desi � Here) PLEASE RETURN TO BARNSTABLE.PUBLIC HEALTH DIVISION. 09RTIFICA,TE OF COMPLIANCE WILL NOT BE LSSUED UNTIL BOTH TMS FORM AND AS- BUTLT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH]D ISION. THANK YOU. Q\Sept clpe$iper Certifccatioo Form Rev 8-14-tB doc I Town of Barnstable P# —/ Department of Regulatory Services BARNOr"M : Public Health Division Date na39 200 M i Street,Hyan 's A 026 1 AA rfU AAA'1 A Date Scheduled — Time Fee Pd. Sail Suitability Asses went,fog- Sew 's ® a r Performed By: Cn th, t)w Witnessed By: LOCATION& GENERAL INFORMATION Location Address ��.���' Owner's Name-.4�a- CJ1/,W,'Zz Address ��145 2r n Assessor's Map/Parcel: Engineer's Name��y'd NEW CONSTRUCTION REPAIR Telephone �? P lJ,r— Land Use Slopes(30) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) 1 J C3` o �5 � t"3 _n E i cr, rs� Parent material(geologic) De th to Bedrock r _ . Depth to Groundwater. Standing Water in Hole:_ Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to Soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.thetor m a Adj.Groundwater Level, v PERCOLATION TEST Date_._� Time.��, Observation 1 Hole# Time at 9" t Depth of Pem Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak / a Rate Min./lnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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 Conselrvation Division at least one(1)week prior to beginning. Q:ISEPTICU'ERCFORM.DOC DEEP.OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. Y i onstency %Gravel) 7. DEEP OBSERVATION HOLE LOG Dole# Depth from Soil Horizon P Soil Tex ture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) ]SEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Graveh DEEP OBSERVATION MOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency, 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 Occurring Pervious Material Does at least four feet of naturally occurring pervious ma orial exist in all areas observed throughout the area proposed for the.soil absorption system? �. If not,what is the depth oI lly occurring pervious material?_! '' Certification I I certify that on bo (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training,ex rtis n p rience described in 10 CMR 15.017. Signature Date �0 Ze 7 l Q:WEPTICkPERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS u EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION !Q yob qM Ne I 350 MAIN STREET / �i WEST YARMOUTH,MA 508-775-2800 6�ri' f TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM' PART A CA CERTIFICATION MAP 272—PARC 258 `~ C,X Property Address: 37 MEGAN ROAD HYANNIS.MA 02601 Owner's Name: ARCIBALD',DAVID ; Owner's Address: 37 MEGAN ROAD HYANNIS,MQ 02601 • tsl Date of Inspection JULY 13,2005, Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 12ain Street West Yarmouth,MA 02673 Telephone Number: 508•775-2800 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 inspectiou was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 1 Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system o),Nmer shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments III "•""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 I 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: JULY 13,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer_yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Healthy' broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 r , Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: DULY 13,2005 C. Further Evaluation is Required by the Board of Health:N/A. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 31.0 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. Svstem 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: a The system has' 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 public water supply. � Y P P The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "* This system passes if the well water analysis,performed at a DEP certified laboratory,for 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: I Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 37 MEGAN ROAD HYANNIS,MAI 02601 Owner: ARCIBALD,DAVID Date of Inspection: DULY 13,2005 D. System Failure Criteria applicable to all systems: N/A 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 4 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 pit is less than 6"below invert or available volume is less than%day flow —� Required pwnping 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water 4, supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed atl 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 or less than 5 ppm,provided that no other failure criteria are to Bred. A co of the analysis must be attached to this form. gg copy y ) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310ICMR 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"non to each of the following: (The following criteria apply to large(systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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 31.0 CMR 15.304. The system owner should contact the appropr late regional office of the Department. Title 5 Inspection Fortn 6/15/2000 4 Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: RMY 13,2005 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected far signs of break out? ✓ Were all system components,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3xb)] Title 5 Inspection Form 6/1512000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: 37 Iy1EGAN ROAD FLOW CONDITIONS RESIDENTIAL✓ Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003—45,000.GAL/94,500 GAL Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(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: N/A NOTE:MAINTENANCE PUMP AFTER INSPECTION. Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) hmovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: N/A Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: 37 MEGAN ROAD BUILDING SEWER(locate on site plan): ✓ Depth below grade: 16" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 22" 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: 1000-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or battle: 15" How were dimensions determined: ASBUILT&TAPE Cotmments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL,INLET BAFFLE—OUTLET BAFFLE. NO SIGN OF LEAKAGE OR OVERLOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): o 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.): Title 5 Inspection Fonn 6/15/:2000 7 i I Page 8 of 11 OFFICIAL INSPECTION iFORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 MEGAN RO HYANNIS,MA ;02601 Owner: ARCIBALD,DAVID Date of Inspection: 37 MEGAN ROAD TIGHT or HOLDING TANK: N/A (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/dayl Alain present(yes or no) Alarm level: Alarm in workiI g order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): I DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Continents(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.,): f PUMP CHAMBER: N/A (locat 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.): II� i i I Title 5 Inspection Form 6/15/2000 8 I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: 37 MEGAN ROAD SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil;signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,30"WATER STAIN LINE AT 3'. NO SIGN OF OVERLOADIN&OR SOLID CARRY OVER. CESSPOOLS: N/A .(cesspool must be pumped as part of inspectionX locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or.no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCIBALD,DAVID Date of Inspection: 37 MEGAN ROAD SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Lv �.`7 O Title 5 Inspection Form 6/15/2i)0�,, 10 �.y 5 ay Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 MEGAN ROAD HYANNIS,MA 02601 Owner: ARCJBALD,DAVID Date of Inspection: 37 MEGAN ROAD SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 14 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation 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: TEST HOLE AT 14'NO WATER. TEST HOLE 4' BELOW BOTTOM OF PIT. BOTTOM OF PIT AT 10' BELOW GRADE. /o Per No c��Tr,L Title 5 Inspection Form 6/15/2000 11 ' I COMMOti�-EALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t2I / 1 ONE WINTER STREET.,BOSTON. MA 02108 Fl -292-5j00 1w\ ` !� B WILLIAM F.WELD roil �� �`-TRUDY COXE Governor 350 MAIN STREET s�To� Q Secretan WEST YARMOUTH, MA ti99� f I ARGEO PAUL CELLUCCI bi► I OFerr c��vID B.STftF Lt.Governor508-775-2800 f9e Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A �_ g - CERTIFICATION MAP 272 PAR 258 PROPERTY ADDRESS: 37 Megan Road ADDRESS OF OWNER: DATE OF INSPECTION: February 12, 1998 Ute Haugh NAME OF INSPECTOR : James D.Sears I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) I COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street; West Yarmouth, MA 02673 TELEPHONE NUMBER: (508)775-2800 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 EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: February 17, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has�a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applic'able and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310.CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: i B SYSTEM CONDITIONALLY PASSES: N/A 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 b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). 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 is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DER on the World Wide Web:hftp://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 B]SYSTEM CONDITIONALLY PASSES(continued) 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). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A 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 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 salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and 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 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 and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97). Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 D]SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. 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 over- loaded 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 '/z 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 surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: 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: N/A 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 mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 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. N/A 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, including 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 The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X 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)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 1 Garbage grinder(yes or no): NO Laundry connected to system (yes or no): ? Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): AVERAGE 1,100 CU.SQ. FT PER QUARTER Sump Pump(yes or no): . NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no): Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 4-90 BARNSTABLE PLANT System pumped as part of inspection:(yes or no) If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/Soil absorption system Single cesspool Overflow cesspool ` Privy f Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed(if known)and source of information: AGE UNKNOWN l Sewage odors detected when arriving at the site: (yes or no) NO (revised 04/25/97) Page 5 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 BUILDING SEWER: N/A (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: X (Locate on site plan) Depth below grade: 22" Material of construction X concrete metal Fiberglass Polyethylene other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST 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: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How dimensions were determined TAPE 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.) TANK AT WORKING LEVEL, OUTLET BAFFLE,TANK AND COVERS 22" BELOW GRADE. GREASE TRAP:N/A (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: (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.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 TIGHT OR HOLDING TANK: N/A (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: Design flow: gallons/day 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:N/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) PUMP CHAMBER:N/A (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 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 1 leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number, alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 1,000 GALLON PIT, 12"WATER IN PIT, PIT AND COVER 40" BELOW GRADE. CESSPOOLS:N/A (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:N/A (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.) (revised 04/25/97) Page 8 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12,,1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) I I I II j R£AR I I �6 o �9 I 3� I o • 4 (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Megan Road, Hyannis Owner: Haugh, Ute Date of Inspection: February 12, 1998 Depth to groundwater feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record X Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) NOTE: HOUSE AND LOT HIGH, NO WET BASEMENT, NO PUMP, NO SIGNS OF GROUND WATER PROBLEMS. M (revised 04/25/97) Page 10 of 10 I i ASSESSORS MAP : _ TEST HOLE LOGS _... PARCEL: Z I) The installation shall conil.:, wills Title V tutd Town or�vp4bjollrtl of. ' I leullh Regulations. 1 V1G�� FLOOD ZONE: A-15✓ ;r'P61 SOIL EVALUATOR:��U1 !- � �^ �' y '_'� 2) The installer shall verify the location of utilities,sewer inverts and septic ' WITNESS: . REFERENCE: �,!✓^j, �j components prior to installation and setting base elevations. _.__ .- Z ZZ 1 DATE: I , .� - -- - -- -- I 3): All gravity septic piping to be 4 inch Sell 401 VC at 1/8 per flool.The first PERCOLATION RATE.--� /m1 / two feet out of the d-box to the leaching shall be level. � �O�' 4) This plan is not to be utilized for properly line determination nor any other ��7 purpose other than the proposed system installation. 7 TH-2 P P P P Y 5 5) All septic components must meet Title V specifications. All l rt t A fl t 6) Parking shall not be constructed over 1110 septic components. 7) The property is bounded by property corners and property lines. �, � �•j �Jl, lD 1 S) The property owner shall review design considerations to approve of total ,L� design flow and number of bedrooms to be considered for design. Receipt LOCATION MAP of payment for[lie plan and installation based on the plan shall be deemed IT, approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. �0` � A �0 ,� 10)System components to be 10 feet from water line. Sewer lines crossing Cite II o 5a oE; water line shunt be sleeved with 4 inch SCI 140 I'VC with ends grouted if l � �o applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place SEPTIC SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility of the : owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE 1 exists. 13)The installer shall verify.the location, quantity and elevation of the sewer BEDROOMS AT t, GAL/DAY/BEDROOM -W GAL/DAY lines exiting the dwelling`prior to the installation. 14)This plan is representative only that a system can fit on a property meeting SEPTIC TANK Title V requirements. �� '''•� a,_GAL/DAY x 2 DA I S - GAL USE GALLON SEPTIC TAHICK�'�FTIWO t IL4ABSORPTION YS EM --- -- _ V00 o VI sa N p SIDE AREA. 2 Z ( �, No.Ioss BOTTOM AREAL %� ��� �Z57.-,27 `�o/sra��Q t N SEPTIC SYSTEM SECTI011 oo'�p Pk b I. / Z ✓� _..__ (,pg7'�j4fr`lc �j 5 U1 ' N44 n� ---- - _ 49, �lc'viol I p 91 --V11,15-r;-, sw--_4 9 I - D GAL Z tl T Ir e SEPTIC TANK �f�G Gt!id lk��� ► Z _ S ZZ. I SITE AND SEWAGE P L LOCAT 10N ffA" PREPARED FOR : JIM P T SCALE' = Y DAV I D B . MASoN,P�5 DATE: _ DBC ENVIRONMENTAL DESIG143 EAST SANDWICH . MA DATE I HEALTH AGENT I ( 5 Q 8 ) 8 3 3- 2 17 7