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HomeMy WebLinkAbout0371 MEGAN ROAD - Health 371 MEGAN RD. HYANNIS - _ A = �I a f - Il. ago- o?_q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 page. Citylrown 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 51 w j5 0q1 filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 City/rown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification Icertify 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 App712/15/2020 uthority 4. ❑ Fails 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 ppider the same or different conditions of use. t5insp.doc•rev.V2612018 Title 5 Official Inspection Form:,Subsurfaos Sewage Disposal System•Page t of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments g 371 Megan Road Pr v operty Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/15/2020 required for every y page. City/Town 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 371 Megan Rd Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box, 1000 gallon precast leach pit and 2 precast leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 or 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is H annis Ma 02601 page. CitylTown 12/15/2020 required for every 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): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The, system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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.7126P2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts IFTitle 5 official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments O 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/15/2020 required for every page. City/Town 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.aseptic 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 El ® 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 rdle 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 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/15/2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® 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- 10,000 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 r ❑ ❑ the system is within 400 feet of a surface drinking water supply i ❑ ❑ 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 Forth:Subsurface Sewage Disposal System•Page 5'of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposaIS ystem Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/16/2020 required for every State Zip Code Date of Inspection page Citylrown 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 GA above the 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 aH 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.7126l2018 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 -VZ5,9 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every H annis Ma 02601 12/15/2020 page. Citylrown 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 gpd Description: 3 Number of current residents: 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No current Last date of occupancy: Date \ i t5insp.doc•rev.7t2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owners Name information is required for®very Hyannis annis Ma 02601 12/15/2020 page. Cityfrown 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: 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.7l26=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/15/2020 required for every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all-components, date installed(if known)and source of information: original system, leaching chambers added 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1.5 Depth below grade: feet Material of construction: 0 cast iron Z 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): Joints in.good condition, no leakage, vented through roof. t5insp.doc•rev:7/2WO18 Title 5 Official Inspection Fonn:SubsuAace Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road � Property Address Paulo De Oliveira Owner Owner's Name information is Hyannis Ma 02601 12/15/2020 required for eve y -- every page. City/Town 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) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc-rev.728J2018 Title 5 Official Inspection Forth,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 371 Megan Road u Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 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 El metal El fiberglass ❑ polyethylene Elother(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.): 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 1 t5insp.doc-rev.?(26M18 Tide 5 Official inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form k�zvl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner owners Name information is required for every Hyannis Ma 02601 12/15/2020 page. City/Town 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): 0° Depth of liquid level above outlet invert y 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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 or 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 page. Cityrrown 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.): 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: Type: ® leaching pits number: 1 ® leaching chambers number: 2x500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7282018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts p Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 8.0 - 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 page. City/Town 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.): original leach pit was left connected when system was repaired. This pit was found full and failed. Two precast leaching chambers were installed in 1999.-The leaching chambers were video inspected and found with 6"standing water and no signs of past overloading 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 J ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.T72612018 Title 5 official Inspection Form:Subsurfaoe Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) 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.71260018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts MOWER Title 5 Official Inspection Form Subsurface Sewage Disposal System'Fonn-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owners Name information is required for every Hyannis Ma 02601 12/15/2020 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 6` O cr u. t5insp.doc•,rev_U2612018 Me 5 Of dal Inspectlon Form:Subuirface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts -Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address _ Paulo De Oliveira Owner Owner's Name Information is required for every Hyannis Ma 02601 12/15/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water. Ej Check cellar ❑ Shallow wells 12'+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this inspection Report,please see Report Completeness Checklist on next page. t5insp.doc•rev.7128/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts UTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Road Property Address Paulo De Oliveira Owner Owner's Name information is required for every Hyannis Ma 02601 12/15/2020 .�_ page. Citylrown 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 4 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/WO18 Idle 5 Official Inspection Food:Subsurface Sewage Disposal System-Page 18 of 18 N --P N f-+ D --I of °2 rn 3 � n C � ( T N T O D W 0 � r m 0 z 0 ! 1 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every 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 A. General Information When filling out forms on the I computer,use 1. Inspector: only the tab key to move your Darrell Stone cursor-do not Name of Inspector use the return key. Cape Cod Septic Inspection Company Name PO Box 1466 Company Address Harwich MA 02645 risen City/Town State Zip Cade 508-240-2500 S14995 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passe onditionally Passes ❑ Fails -71 N s u j g Aority® er E 9-30-12 sp r.-i_S ignature Date - The system ins or shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ��Jjt5ins-11/10 Title S O(fiaal Inspe on bsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M •�''� 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown ' State Zip Code Date of Inspection B. Certification (cont.) . Inspection Summary: Check A,B,C,D or 1=/always complete all of Section D A) 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: f 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. A" 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): . l t5ins•11110 ; Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts rs U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Subs g p y ry I 371 Megan Rd Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is MA 02601 9-28-12 required for Hyannis, tY every page. Ci /Town State Zip Code Date of Inspection B. Certification (cont.) a) system concunronany-Passestcont:):- ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System,will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 44 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in.a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure'criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owners Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board.of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 I I of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-11110 Title 5 Official In spection Form:Subsurface Sewage Disposal System•Page 5 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No 4 ® ❑ 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? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined'based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 r t5ins•11 10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name - information required forte Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 3 Bedroom residential dwelling Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 141.40 GPD 9 ( Y 9 (gPd))� Detail: 2011 -41,888 gallons 2010-61,336 gallons Sump pump? ❑ Yes ® No Last date of occupancy: 1 year ago Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owners Name information is Hyannis,required for MA 02601 9-28-12 q _ Y every page. City/Town .• State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped spring 2012 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy vY ❑ 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 t ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owners Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed if known)and source of information: 1999 D-box and Chambers, original tank and leach pit Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 10"+/ feet Material of construction: ❑ cast iron - ❑40 PVC ®other(explain) SCH 20 Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: fl11 eet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 17" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is MA 02601 9-28-12 required for Hyannis, every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle P or, Scum thickness 6,' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Normal liquid level No sign of leakage - SCH 40 outlet tee Recommend maintenance pumping Recommended maintenance pumping every 2-3 years Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: _ gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 S•, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0ir 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.): Garde to box 18" Normal liquid level No sign of leakage 2 Outlets with speed levelers No scum No sign of failure 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® leaching chambers number: 2 ❑ 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.): 1 (6x6') pit with stone Grade to pit 21" Bottom 106" Dry 2 (500 gallon)chambers with 4'stone Grade to chamber 27" Bottom 61" Dry No sign of hydraulic failure 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 t5ins•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name Wormrequired is Hyannis, MA 02601 9-28-12 required for y every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i i I7 A B 2 yi Z a1- � 3 - to Lf5 - 4 0 Z �_ Z g t5ins•11/10 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ti Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is required for Hyannis, MA 02601 9-28-12 every page. Citylrown State , Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water. 20.1 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Form on file completed by Joseph P. Macomber Jr. dated 8-23-1999 stating the following: Top of ground surface Elevation (using GIS information) 37 G.W. Elevation 10+the MAX. High G.W.Adjustment 7.1' i DIFFERENCE BETWEEN A and B 20.1' Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I III Commonwealth of Massachusetts gw�, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 371 Megan Rd. Hyannis, MA Property Address Joseph and Suzanne Vozzella Owner Owner's Name information is Hyannis, MA 02601 9-28-12 required for Y , every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 _ 11/6199 NOTICE: This Form Is To Be.Used`'For t+he Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL. WORKS CONSTRUCTION PERMTT (WITHOUT DESIGNED PLANS) I, Joseph P.Macomber Jr . , hereby certify that the application for disposal works construction permit signed by me dated 8/2 3/9 9 concerning the property located at 371 Megan Road- Hyannis ,Mass . meets all of the Mowing criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 37 B) G.W.Elevation+the MAX. High G.W. Adjustment./ f _ % DIFFERENCE BETWEEN A and B SIGNED : DATE: 8/2 3/9 9 (Sketch proposed plan of system on back]. q:health folder.cat TOWN OF BARNSTABLE CATION 3 71 ,M e C/9,u R SEWAGE # QAq ,vTi LAGS Yle A.itIAII S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ��IO- /4 A C O /m ig eg f^ X o't/ SEPTIC TANK CAPACITY �.D �lO�- /d/ !�/�D6d — 0"L41, LEACHING FACILITY: (type);( (size) NO.OF BEDROOMS J BUILDER OR OWNEFJ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -� E) .,� / � ��c� i � ' � � � � � ! � i� � � / � , ,i � - No. �13;p_ r Fee 5 0.0 O/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppltcation for Migpogaf *pgtem Cow5truction Permit Application for a Pemut to Construct( )Repair(X X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. M e g a n R o a d Owner's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 Hyannis ,Mass . 02601 J.P.Macomber & Son Inc . Assessor's Map/Parcel , ;2-- 574!!v l t 7 Box 66 C e n t e r v ille ,Mass . 02632 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. Box 66 Centerville ,Mass. 02632 Joseph Vozella J.P.Macomber & Son INc . 14 Northern Spy Road Type of Building: ' Mass. 02038 Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A d d i n g t w o a d d i t i o n a l 5 0 0 g a 11 o n chambers packed in 4 ' of stone . 1000 gallon tank and box and one 1000 gallon leaching pit are now present. 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 t to place the system in operation until a Certifi- cate of Compliance has been is ed by this oar of He lth. Signed4 Date 8/2 3/9 9 - J� Application Approved by Date 8.12—99 Application Disapproved for t e follo ing reasons Permit No. Date Issued .. .•,.r4 ., .. _ `rr �a^r2.-4.`:�� .•. '.'�. �. 1.. .'.a..s1' .. '-,.. .1 �•���,� t. it .-_ No. Fee 50._•O,O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS a. Rpplication for,bizp gaf *pztem Construction Permit Application for a Permit to Construct( )Repair�XX)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address orLot No.3 7 1 Megan Road Owner's Name,Address and Tel.No. 5 0 8—7.75—3 3 3 8 Hyannis ,Mass. 02601 J.P.Macomber & Son Inc . Assessor'sMap/Parcel '1- 9O/ Box 66 Centerville ,Mass. 02632 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. Box 66 Centerville,Mass. 02632 Joseph Vozella .P.Macomber & Son INc . 14 Northern Spy Road Type of Building: .: F.Lalikiiii' 02038 Dwelling XX' No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons. Plan Date Number of sheets Revision Date ' Title- Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n g wo d i' i—anal 500 gallon chambers p-a c-kd--'3-n- -af- e ..QAa©-�' o.n�r a nk �a n d .box and o n e 1000 gallon leaching pit are now �Tesent. b, I Date last inspected: � t' v _ 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 t to place the system in operation until a Certifi- cate of Compliance has been is�ed by this -yoar of`H'e 1'th"" Signed Date 8/2 3/9 9 Application Approved by Date _ Application Disapproved for Ve foll9ving reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,'MASSACHUSETTS (Certificate of (compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal"System Constructed(, )Repaired�X X)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. N." at 3 71 Megan Road Hyannis,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�9- 1:M dated InstallerJ.P.Macomber & Son Inc. DesignerJ.P.Macomber & Son Inc. ' o The issuance of this e . 't s 11 construed as a guarantee that the s ste wil function as deeslgned Date Inspectorti�' � �G�'� if --------------------------------------- No. s3 Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1witpogaf *pztem Construction Vermit Permission is hereby granted to Construct( )Repair f X)Upgrade( )Abandon( ) Systemlocatedat 371 Megan Road Hyannis ,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by Q . ktik4 jt/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L Jo s e p h P.Macomber Jr . , hereby certify that the application for disposal works construction permit signed by me dated 8/2 3/9 9 concerning the property located at 371 Megan Road Hyannis ,Mass , meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 37 B) G.W. Elevation _+the MAX. High G.W. AdjustmentDIFFERENCE BETWEEN A and B J SIGNED : DATE: 8/2 3/9 9 [Sketch proposed plan of system on back]. q:health folder.cat I �.. w Q !• `� Q Q �"`c"�"�.+ x W S7 L - f, TOWN OF BARN AB E LOCATION 371 114 eC,4-y R SEWAGE ii g VILLAGE /yyANi10'S ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. / /VI A C O ,o e t' X aAl SEPTIC TANK CAPACITY Z•D d O- / T�/�©BD O ? L LEACHING FACILITY: (tyPe)•�-i"lQey-c�,�/ff 16P `S (size) . '�'ov. NO.OF BEDROOMS .� BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: a Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 3 -. Private Water-Supply Well and Leaching Facility .(If any wells exist on site or within 200 feet of leaching facility) Feet F Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �y ! i �-`- 3 7 L O,CATION SEWAGE PERMIT NO. Yf9 CAN A 14 y Ah i1 . VILLAGE S N�� I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED .sue � �' �`�' ,�- �'. / � � � �-. � ~r�--� �. S l�� , �' .• � �f w �'}. 1� ANY,/ NO. .............................. THE, COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town..................OF..........B .............................................. Appliration for Uhipwial 10jarkti Towitrurtion "pamit Application is hereby made for a Permit to Construct (X ) or Repair an Individual Sewage Disposal System at: ................................................ ............................Lgl..3........................................................ ............................Egg�ka..Eoad ..... Loc tion Address or Lot No. ................. ........ .... .......... ........... . .... .......... .. Owner A dress s JA 1 ............... ... E ....................................... .............................. ............................................................... ................ Installer Address Type of Building At c H Size Lot.:1.0.)..000........Sq. feet U Dwelling—No. of Bedrooms............ 3 (no)--------Expansion Attic Garbage Grinder a4 Other—Type of Building ......................... No. of persons.......................... Showers Cafeteria Otherfixtures ......................... .. ............................................................ D.esign Flow................5.5.......................gallons per person per day. Total daily flow------------------3-3-0...............gallons. 1% Septic Tank—Liquid capacityl.Q.QQ..gallons Length---V.6.11.. Width-41.1Q.7- Diameter--__--_--__-___ Depth...14.. .... Disposal Trench—No. .................... Width..._........______.. Total Length_._...__.._......... Total leaching area....................sq. f t. Seepage Pit No..__1-------------- Diameter...!Q-t......... Depth below inlet....A!......./.. Total leaching area...2.6.7......sq. f t: Z Other Distribution box (X) Dosing tank oe-o" Percolation Test Results Performed b3CaP-a--jQ-Q.d---SUr-Y-Qy----QQas.u1_tan.t.SDate.......L/Z3/79............. Test Pit No. 1......2-------minutes per inch Depth of Test Pit----3-2.1......... Depth to ground water..no-na----------- Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..__.._.._...........__. ............................................................................................................................................................. 0 Description of Soil... ...laaa._&...sab-ad.1...... ...Me.d.....b.ro.wn-.Eand,....7-..Q:MI2..O.. v me.d.. whil.e.. ............................................................................... ....... .................... .5..a]jd...................... M . �k OF Miss ..................................................................................................................................................... ........................ ........... �Zi U Nature of Repairs or Alterations—Answer when applicable._________ ---- -------- -- -------------- RN'W�k* c' ......................................................................................................... ------ ---------------------------------- .... ------------97, rM Agreement: CHAPMAN a The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in (4 1%W2VCbll the provisions of 5 oft State Sanitary Code—The undersigned further agrees not to pl tF operation until a Certificate of Co�mpliance has been issued y the board of health. ONAL Sig . ................................................................... ............. ....I.......... Date Application Approved By..... 4 2n ..... ­Ogal..2------­-------------- ....3---- ------------9X-------- Date Application Disapproved for the f6llowin�,'reasons:............................................................................................................... ................................................. ......................................­*----------------------------------------------------------------------------------------------*"-,*------- 7 Date '7 ... ...................... ............ Permit No......................................................... Issued........ e � 4 a, f /' �► FRs...���r ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' wta...................OF....... .R$.L.MStAtle............................................... Apparation for Disposal Works Cnnnstrnrttnn tirrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal jrSystem at: ................__......_.Megan Road. ....ZQt..3----- ......... r. J Location-Address ) { or Lot No. Ef(1,PR� �� f i 14'•y' � !f fJ '�`i ) ..................)::..li........_..___.._.'_'......__.•...__•__..... _.....e:.r_"___.._....__'_.,....1.___.....:...........:.._..._:...._...._....................._._ .. Owner Address .................... -••----------- Installer AddressPQ 00 d Type of Building �1 ; Size Lot............................Sq. feet Dwelling—No. of Bedrooms......................_.._......_......_...Expansion Attic ( ) Garbage Grinder PO) '4 Other—Type of Building ' "" ............. No. of ersons...._....................... Showers — Cafeteria a YP g ------==------ P ( ) ( ) dOther fixtures ..........^-"':"�:------_.-.. W Design Flow................`5........................gallons per person pier day. Total daily flow__...............•33-0.................gallons. W Septic Tank—Liquid*uid ca acit allons Length Width-...�.9.._. Diameter................ Depth .-_ .. P q P �-----------g � P �k x Disposal Trench—No. .................... Width.................... Total Length...............•.... Total leaching area....................sq. ft. Seepage Pit No.... .............. Diameter...1 1......... Depth below i .._ ....... Total leaching area---26 ......sq. ft. z Other Distribution box (X) Dosing tank ( ) �""" F Ak-o 7,leY aPercolation Test Results Performed byCAR &-od..-eS.urmay QoTIsultallt.sDate.......1/ 3/79------------- Test Pit No. 1...... ...._..minutes per inch Depth of Test Pit...12.1......... Depth to ground water-mane Test Pit No. 2----___.____•_-_minutes per inch Depth of Test Pit-,.....: .:....... Depth to ground water........................ .................................................................................................._..... --•.....•--------••------...._......---.•••-- O Description of Soil._&—n rQJOc'im...gC-• uhulls--1,0:n7-+ ..ae'd..:_._ W (3F IIry ' med -------------------------------••-•-•-- ..... ---•--`,e -man--- ---- --;.,::-----------------------------------�--...-----... - �. ....-------- 90 UNature of Repairs or Alterations—Answer when applicable..........:.......... ........... .. ..._..:..> Qz...RF�vv11C ..-•........................•--.......-------•-•-•-••-•----•----•-•---------•--•------•--------.......•--•--..._------ .--- . .. 8:.:.... Agreement: , CHAPMAN v L ' iVo. 27654 O c, The undersigned agrees to install the aforedescribed Individual Sew ge hisposal System in I ° ce wit�w the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place operation until a Certificate of Compliance has been issued by the board of health. ��NAL C �},�.n 31 j�, z. Date a Application Approved BY...... F = D �rl Date Application Disapproved for the following reasons:-:------- -------•-------------------------------•-------•-...---- .................................................... -------------------------•-•--------........---------............................................................................ .....................................-------------- ---------------------- P *. Date Permit No............................... Issued .. Date _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. ........... . ....:.....OF........... ....................................... (Intgf hate of Tnntpli anq "~ THIS IS TO CERTIFY, That the Individual`Sewage Disposal System constructed ()�) or Repaired ( ) by . !.. ....-••--••--_... . ..•... ....•-••...... .................................................................. Installer, at.... 1+ t') E -'4 r . !_.. ' r Al Al x i - -------------------------------------•---•---------------- has been installed in accordance with the provisions of T T„ ,3 5 f The State Sanitary Code as described in the application for Disposal Works Construction Permit N ______ ____ ............. dated_....,'_. ----I---- ---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F_ NCTIQN SATISFACTORY. ' �� g DATE................ 1---•---•----............ Inspector..... i THE COMMONWEALTH OF MASSACHUSETTS 1 , BOARD O. HEALTH ?'� N061 , ..:.:...... .._ FEE ......... .......... Disposal lVorb TFAnntrnrtuan , rrnttt Permission is hereby granted................ 1 `�-Q-I�YA.--... to Construct ( �J, or Repair ( ) an Individual Sewage Disposal System atNo......L..e 2 Al P�". Alf_ i`.Ali-.............................................................................................................. Street as shown on the application for Disposal Works Construction Perini No................... ated ' �'-:s_- 7.�----------.. .................- t Board of Health DATE-------::�---1}----29-:---------------••-----•--------....... , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ,w SOIL LOG ,,—,.,1.,.,,,,T,..l„t --- 2"PEA9TONE LOAM 6 FILL 12° MAX i I 4" C. 1, IOX a I'.�,,�s• t ° ° e a 1000 I 1000 GAL. 1O'MIN. GAL --� I��• .• PRECAST OR oF` 24 ° ° • I MIN SEPTIC I; ..,,•. BLOC I • ° . �;.,. TANK K 6 I�°mo.o SEEPAGE ; � a •. : i �, �� PIT • ° ° , Y?.d 20' MIN. ''FOUNDATION I t •4t� r..'=K. 1 /2 WASHED STONE 1 - -----�" ELEVATION SKETCH PERC. RATE SCALE I" = 4' TEST BY TOWN INSPECTOR BACKHOE OPERATOR:- TEST MADE ON : --- ? 4; 'L I fn �ZA IN 1 �'• F� \.4 1 i ca i o t,iiL-14r14 43 4 S as G ./rUr►i 7 �*�I?'1,57ar. ��v,... h,'�`�.1a i.�iJ o�� �=�:,cs Fv ,co� T,•�"..r S�"r Try.r7 s>o �vus z ,►� s, >< �, r�./sue 4.7;a ej,041zroy f ELEVATION SCHEDULE - PROPOSED SITE PLAN I. INV. AT FOUNDATION = �'- a SEWAGE SYSTEM DESIGN 2. INV INTO SEPTIC TANK � ON 3 1 NV. OUT OF SEPTIC TANK = 98 97 L� r ig �a� -14w l 4 INV. INTO DISTRIBUTION BOX = SCALE 1 {19 5 INV OUT OF DISTRIBUTION BOX = '7Q C 6 INV INTO SEEPAGE PIT = CAPE COD SURVEY CONSULTANTS ROUTE 132 7 BOTTOM OF PIT = a�` 40 HYANNIS ,MASS.