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HomeMy WebLinkAbout0049 OAK HILL ROAD - Health 49 OAK HILL ROAD ' -�- '� A= 248—072 1 a -- Hyannis 14 a t 4 .0 a gq e i 0 a a z RECEIVED P- 071 TROY WILLIAMS SEPTIC INSPECTIONS JUL 1 3 2001 Certified by MA Department of Environmental Protection LfHEO�'LTH DEPT.N BAR Nb (508) 385-1300 19 t-Iwnmel Drive South Dennis,D4A 02660 COMMONWEALTH OF MASSACHUSEI"I'S � XF.CLJTIVF; OFFI('E OF' ENVIRONMENTAL AFFAIRS o DEPAR'I'MI;NT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM --- NOT 1.OR VOLUNTARY ASSESSNIt".N TS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ("ERTTFICA'I'ION Properh Address: 49 Oak Hill Road Hyannis, MA Owner's Nanic: Thomas&Geraldine Conaty Owner's Addres..• 49 Oak Hill Road Hyannis, MA 02601 O Dale of Inspection: July 2, 2001 U Name of Inspector. T Company Name: roy M. Williams Com Mailing Address: Troy Williams Septic Inspections 19 Hummel Drive Telephone Number: South Dennis, MA 02660 (508) 385-1300 CERTIFICATION STATEMENT I centfy 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 ks as performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I all, a I)Ep appro%cd system inspector pursuant to Section 15.3.10 of l itle S(310 CNIR 15.(100). -rhe systcm l'asscS Conditionalk Paswc Needs I urthcr I valuation b) the Local Apptovntg Author its Fails Inspector's Signature: , � Date: 713 Aj t _ The system inspector shall submit a copy of this inspection report to the Approving Authority(hoar(I of I lealth 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 DER The original should be sent to the system owner and copies sent to the buyer;if applicable, and the approving authority. Notes and Contmcnts Although systern meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •`••This report only describes conditions at the time of inspection and under the conditions of use at that time. 1 his 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 pace I Page 2 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Oak Hill Road Hyannis,MA Owner: Thomas&Geraldine Conaty.. Date of Inspection: July 2, 2001 Inspection Summary: Check A,B;C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that anv of the failure criteria described in 310 CM 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to a replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Bo of Health,will pass. Answer yes. no or not determined(Y,N,ND)in the for the following stateme . If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank( ether metal.or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure i ' minent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved b he Board of Health. •A metal septic tank will pass inspection if it is structurally noun 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 ou r high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or neven distribution box. System will pass inspection if(with approval of Board of Health): bro pipe(s)are replaced o truction is removed distribution box is leveled or replaced ND explain: The system re ed pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if th approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 s Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Oak Hill Road Hyamtis,MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2,2001 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. I. System Hill pass unless Board of Health determines in accordance with 310 CMR 15.303 (b)that the system is not functioning in a manner which will protect public health,safety and the vironment: 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 arsh 2. System will fail unless the Board of Health(and Public Wa Supplier,if any)determines that the system is functioning in a manner that protects the public b th,safety and environment: _ The system has a septic tank and soil absorption stem(SAS)and the SAS is within 100 feet of a surface water supple or tributary to a surface Ovate upply. _ The system has a septic tank and SAS d the SAS is within a Zone 1 of a public water supply. — The system has aseptic tank an AS and the SAS is within 50 feet of a private water supply well. _ The system has a septic t , and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well" ethod used to determine distance "*This system passe ' the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and vola ' organic compounds indicates that the well is free from pollution from that facility and the presence o monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure Grit a are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 r Page 4 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 49 Oak Hill Road Property Address: Hyannis,MA Thomas&Geraldine.Conaty Owner: July 2, 2001 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes. No/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates 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.] /VO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as de>cribed in 310 CMR 15,303. therefore the system fails. The system owner should contact the Board of Heal►h 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 desig ow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria a ve) yes no the system is within 400 feet of a surface drinking wa supply _ the system is within 200 feet of a tributary to a s face drinking water supply _ the system is located in a nitrogen sensitiv area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any questio Section E the system is considered a significant threat,or answered "yes"in Section D above the large syst has failed. The owner or operator of any large system considered a significant threat under Section E or fled tinder Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should ontact the appropriate regional office of the Department. 4. I L Page 5 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B. CHECKLIST Property Address: 49 Oak Hill Road Hyannis,MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2, 2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the follow.ine: Yes No information was provided by the owner. occupant, or Board of I lealth 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? v _ 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: Yes no Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Oak Hill Road Hyannis,MA . Owner: Thomas&Geraldine Conaty Date of inspection: July 2, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): S..; Number of current residents: -3 Does residence have a garbage grinder(yes or no): No Is laundrN on a separate sewage system (yes or no):No_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): ou /o uo0 Sump pump(yes or no): wo Last date of occupancy: e :L�t COMM ERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 syste yes or no):_ Water meter readings, if available.- Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: -,C �_ b_ •, . �: .r t ,�a.�. Was system pumped as pan of the inspection(yes or no): nro If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TY E OF SYSTEM Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool (,(E; _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe):. Approximate age of all components. date installed(if known)and source of information: dke�-J( 1 "y- u • 4 • -- I I -h �^)a • < 4' ).{ LA /e., ,► -T.) -z, i I K -4 O., I Z /II / I i` 0 t t-,.., Were sewage odors detected when arriving at the site(yes or no):_uo 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oak Hill Road Hyamiis,MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2,2001 BUILDING SEWER(locate on site plan) Depth below grade: �. 3•�y 'e Materials of construction: _cast iron /40 PVC o (explain):)ther( lain �`'"' 16, /' ` u t �L p oYNH -� i/.- A -A E01.a ' ��o .t S Distance, from private water supply well or suction line: ^CIA c`>sh�� -S ,) t Comments(on condition of joints, venting, evidence of leakage,etc.): IN Si.a / Cu. ccrti � t � a�. [� S h.;�(•t,� :,l � h w s c.,. c A 'T 'n c, ..�1 c �c c r c.... � - I - ' k :�7 0✓- �r r-+ A -I-) o f s fir. c_ �u.,. SEPTIC TANK: (locate on site plan) Depth below grade: I / Material of construction: v 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: 'k 9 '.� L ' /�uu��4 Sludge depth: 3 ' Distance from top of sludge to bottom of outlet tee or baffle: of '/b Scum thickness: Distance from top of scum to top of outlet tee or baffle: C Distance from bottom of scum to bottom of outlet tee or baffle: IY " How-were dimensions determined: ?'V6— Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): ,t.,.t_ 1 h.L✓x- 7LU...n'� �. w_���1 .:, < e �4 '� •( L./�. � ...�♦ /t /lA i.. �- h/c f h�. '�' �.. N r [%l U �'/t)./ h � ��y + 1 " GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass olyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outl/ba :Distance from bottom of scum to bottome: Date of last pumping: Comments(on pumping recommendatioee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of , 7 r Page 8 of)l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oak Hill Road Hyannis,MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2, 2001 TIGHT or HOLDING TANK: (tank must be pump;attimeof pection)(locate on site plan) Depth below grade: Material of construction: concrete metal fib _polyethylene other(explain): Dimensions: Capacity: gallons Design Flo��. gallons/day Alarm present(yes or no): Alarm level: Alarm in workin der(yes or no): Date of last pumping: Comments(condition of alarm an oat switches,etc.): DISTRIBUTION BOX: v1 (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 carrygver, any evidence of leakage into or out of box etc.): t�" t>LX- 1�•a-J "�✓.. �" 1 C 1i�. � G1-r...r' v� c�./u �ln u1�cA or PUMP CHAMBER: —(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condifl�iat of pumps and appurtenances,etc.): 8 i • Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Oak Hill Road Hyannis, MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2, 2001 SOIL ABSORPTION SYSTEM(SAS): V1(locate on site plan,excavation not required) If SAS not located explain w•h) Type a� leaching pits, number: 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.): Iw,N. —J' 1 O.✓ c,,-- . :.C./W aiT. /a. ..J.+.. Li.<,f u r :i a. �•...�a� ,G.:�<(�. �'�•'t !! J G -7Ci 1,, G✓ ro �c.c»,S �ti �,.� ra u-, .� , b y•� �, 1 , S a o+ =. 5i.i s�.-w..+c.c wc�r:���M ,f-a, V,h -1Zt �-i+rc .roils•.. y G �r�� . V:.l o c�.SS/�e�i i/u✓ �' '6f6 Ccs)h.,�, jsJc, r� CESSPOOLS: ( / J )(locate on site plan) 7 s C.I.A. Number and configuration: dr. {S Depth—top of liquid to inlet invert. Depth of solids layer. 3 " Depth of scum layer. Dimensions of cesspool: Materials of construction: C- s;" 61<;c t2, Indication of groundwater inflow(yes or no): ^'&N,r Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, //etc.): t-<- 4.J c.�ri .�- a-S a.., I' a. e>✓t.i ��..a/ 10- fya I yy !ry Y'CL.✓( t 4>1-'—' it' s �ota Ace. , C G4 � I 1 1 k•c Y I-C.� a-4 . -.� I to.ii.•. ✓�� c.a.ry ..� .J�..�...,.�,.,Y-7 PRIVY: (locate on site plan) ash Materials of construction: _ Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failuZf ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 Oak Hill Road Property Address: Hyannis,MA Thomas&Geraldine Conaty Owner: July 2, 2001 Date of Inspection: 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. vps}p..V) 7 I IpuO C 19 O u 10 Page 11 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Oak Hill Road Hyannis,MA Owner: Thomas&Geraldine Conaty Date of Inspection: July 2, 2001 SITE EXAM Slope Surface water Check cellar ✓ Shallow wells Estimated depth to ground water j 5-t feet Adjusted high ground water elevation — feet Please indicate(check)all methods used to determine the high ground %kater elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: p.. I ����, ;, fig Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: _U S C, s llit w . You must describe how you established the high ground water elevat ion: � u r� .>1 ...✓ s-✓ 4 u (,t -c ,. ✓G.• u t.,.- S It v...+ At f-:✓ lC.+.c-l: y ,,..../ :,,G) f c.� /c✓�i oy Pc. � l �.. r� h a— 4 -4)�►, . 11 i Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street'Boston Ma. 02108 John Septic D.E.P. Title V Septic inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor 12 ARGEO PAUL CELLUCCI 1 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ? PART A O CERTIFICATION Property Address: Aak Hill Rd.Hyannis New System Address of Owner: Date of Inspection: 1117198 (If different) Name of Inspector: John Graci Mrs.Richard Bowman I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: +Cj 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 This Inspection Is based on criteria defined in Title V Condition II Passes code 310 CMR 16.303.My findings are of how the system Is Y performing at the time of the Inspection.My Inspection does _ Needs F/rthi Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Fails septic system and any of Its components useful life. Inspector's Signature: Date: 21ts198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. 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 defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revisedM797) i One Winter Street • Boston,Massachusetts 021108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 40 Oak HIII Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:2117199 _ Sew.acte backup or,breakout or hiah.static water level observed.in.the distribution b.ox is due to a broken. or obstructed pipe(s)or due to 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: 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ 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 in facility or system component due to an overloaded or clogged SAS or • - cesspool. A Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revleed 01Q7)87) „ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 Oak HIII Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:2H7I98 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is 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. 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) n 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 0&7TJ97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 40 Oak Hill Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:2117199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 00V97) f - �k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 Oak Hill Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspectlon:2117199 FLOW CONDITIONS RESIDENTIAL: Design flow: = g•p•d./bedroom for S.A.S. Number of bedrooms: J Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): Na Sump Pump(yes or no): No Last date of occupancy: Na COMMERCIAL/INDUSTRIAL: Type of establishment: Na Design flow:g gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: Na OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped three years ago. System pumped as part of inspection: (yes or no)No If yes,volume pumped:u gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy 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 Information: Installed In 1992 by Macomber Sewage odors detected when arriving at the site: (yes or no) No (revlaed04R71971 ' 1 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Oak Hill Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:2117199 SEPTIC TANK: x (locate on site plan) Depth below grade: 16" Material of construction:x concreate_metal_FRP_Polyethylene—other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: t.e'6"H5'7"w4'10" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:"' ' Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are stnrcturelly sound.Recommend pumping septic system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_m eta l_FRP_Polyethylene_other(explain) Dimensions: rya Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:We Distance from bottom of scum to bottom of outlet tee or baffle:roe Date of last pumpingril— 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.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 2' Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction linePwn Diameter: 4"_ Qjmments: (conditions of joints,venting,evidence of leakage,etc.) (revised 041 27197) s � a{ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Oak Hill Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:7117199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Ne Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: Ne Capacity: Na gallons Design flow: Na gallons ay Alarm level:_Na Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Ne DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid Is levelwith bottom of pipe. Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) The distribution is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Y.s Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.) Na (revised 04127l97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 Oak Hill Rd.Hyannis New System Owner: Mrs.Richard Bowman Date of Inspection:2N7199 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: rda Type: leaching pits,number: 1A=gallon leach pit leaching chambers, number:rue leaching galleries,number: nla leaching trenches, number,length: rda leaching fields,number,dimensions:nia overflow cesspool,number:ma Alternate system: rda Name of Technology._rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit le atructurary sound and functfonfng properly.It had t•of water In it at the time of the inspectlon. CESSPOOLS:_ (locate on site plan) Number and.configuration: Na Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: rda Dimensions of cesspool: nia Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: Na Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rVa I Ireylesd 007/87) ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 Oak Hill Rd.Hyannis Old System Mrs.Richard Bowman 2117198 S' 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 s c) 0- boo 0 I C flA �y L V6 3s Pay ! o! 30 j (revisedOWT197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 40 Oak HIII Rd.Hyannis New System Mrs.Richard Bowman 2117/99 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation'. Obtained from design plans on record. 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 X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and charts i (revised04)27197) 162111 10 0[ 10 s Commonwealth of Massachusetis Executive Office of Environmental Affairs ON Dept. of Environmental Protection John Gt•aci • One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector P.O. Box 21-19 . Teaticket, MA 02536 (508)564-6813 WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI Lt.Governor / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a p g� PART A 9 '' a y0 CERTIFICATION W Property Address: 99,,,ak Hill Rd.Hyannis Old System Address of Owner:Date of Inspection: 98 (If different) o� Name of Inspector: John Graci Mrs.Richard Bowman I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.009) Company Name,Address and Telephone Number: C 9 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 P855e5 This Inspection Is based on criteria defined In Title V code 310 CMR 16303.My findings are of how the system is Conditionally P sses perforningat the time of the Inspection.My Inspection does Needs Fu the Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the septic system and any of Its components useful life. Fails Inspector's Signature: Date: 2118198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. V! The original should be sent to the system owner and copies sent to the buyer,if applicable 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 defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of — Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Oak Hill Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of Inspection:7J17f98 _ Sewage backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to 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 CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than.5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: 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 in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to(he Surface of Ille ground or surface water due to an ovelloaaded of clogged cesspool. SAS is in hydraulic failure. ,._ (revleed01127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 oak Hill Rd.Hyannis Old system Owner: Mrs.Richard Bowman Date of Inspection:2117199 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is 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. 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water,supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall 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. (reyleed04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 49 Oak Hill Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of Inspection:2117199 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. X_ The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)]15.302(3)(b)] (reWeed0412INT) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Oak Hill Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of Inspection:2117199 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 0 9 P Number of bedrooms: 3 Number of current residents: I Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n1a Last date of occupancy: nla OTHER:(Describe) ma Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection:(yes or no)_No If yes,volume pumped:0 gallons Reason for pumping: rva TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x Single cesspool x Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) IUA Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 30 yeah Sewage odors detected when arriving at the site: (yes or no) No trevised 04r17l87J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Oak Hill Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of Inspection:2117198 SEPTIC TANK: (locate on site plan) Depth below grade: rda Material of construction:—con create_metal_FRP_Polyethylene—other(explain) If tank is metal, list age ra . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: rva Sludge depth:rda Distance from top of sludge to bottom of outlet tee or baffle: rda Scum thickness:rde Distance from top of scum to top of outlet tee or baffle:rda Distance form bottom of scum to bottom of outlet tee or baffle: rda How dimensions were determined: rda 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.) Na GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain} Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rda 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.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 4' Material of construction:_cast iron_40 PVC other(explain) Distance from private water supply well or suction lineP- Diameter: 4" Q;mments:(conditions of joints, venting,evidence of leakage,etc.) (reylsed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Oak Hill Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of inspection:2117199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade:a Polyethylene_other(explain) Material of construction:_concrete—metal_FRP_ Dimensions: We Capacity: nd gallons Design flow: Na �lallo arm nday working order? Yes_No Alarm level:-rda Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nh DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rVa } (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Oak HIII Rd.Hyannis Old System Owner: Mrs.Richard Bowman Date of Inspection:2►»►98 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: rda Type: leaching pits,number: rda leaching chambers,number:Na leaching galleries,number: rda leaching trenches,number,length: nla leaching fields,number, dimensions:rva overflow cesspool, number:6'x6' Alternate system: nra Name of Technology:_we Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The cesspool was empty at the time or the inepectlon,It la structurally sound. CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert: Depth of solids layer: 3" Depth of scum layer: Dimensions of cesspool: Materials of construction: block Indication of groundwater- none inflow(cesspool must be pumped as part of inspection) n!a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The main cesspool le structurally sound recommend pumping system every year for maintenance. PRIVY: (locate on site plan) Materials of construction: nla Dimensions: nla Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) flla x n f x (revised I)4l27l91J- F ... .r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 Oak Hill Rd.Hyannis Old System Mrs.Richard Bowman 2117198 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) ao � AA tb 3`6 • - Pap• ! of 10 (ravia 11 ad04f27197) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 Oak Hill Rd.Hyannis Old system Mrs.Richard Bowman 2117199 Depth of groundwater 12- Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. 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 x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts I III page 10 of 10 (revised 04127197) TOWN OF BARNSTABLE �C LOCATION /yC)atA G SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 672 INSTALLER'S NAME & PHONE NO.L ,� l�?�� der+Sa i Ln,c. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) & NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERv'wt DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No .�� fi 4 ly • � �� �" O �02 j r P 1 No.. .. :. .:... F.R$.$...39,.00.... I, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLB Applirati n-For Elhipaoal Workii Tomitrurtion firrut'd Application is hereby"ri ade for a Permit to Construct ( ) or Repair P) an Individual Sewage Disposal System at: 49 Oakhill Road Hyannis ................__..-..__..........--.--•-•-------------•-----------------------.....---------- ------------------------------ -....... ------------------- --------------- ---------------- .......... Bowman Location Address or Lot No. Owner Address W J.P.Macomber Jr. a ..........•---------------------•••---•-----............._.........---••••-••...------...•--.-•-•• -------•-•-----------.........••----•...••-----•-•......--•-----......._••--....---- ------_..... 1 Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling 7 No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers a yP g ---------------------------• P ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------------------------------------------------------------------------------------------------------------•---• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank 1 Liquid capacity...laa0 allons Length................ Width................ Diameter--.............. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... Diameter....-6........... Depth below inlet....72.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date.=...................................... W 1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of,Test Pit...:................ Depth to ground water--..................---. P ---•----•--------------------------•----...--------------...-------••-•--•----....-•---•------................................................................ 0 Description of Soil...............................................................................-------------------------------------------------------------------------••------------- x Sand & Grave.l ................................................. v - -- W UNature of Repairs or Alterations—Answer when applicable...l_-1M---9,allon tank 1-distributiQn box- 1-1000 gallon- leachint pit packed in stone with Pea stone ................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli. ce ha b9en issued by t e bo d of health. Signed'i? -�� 17-a 12/28/92 ------------------------ Date ApplicationApproved By ..... - ............ ....... ........ ......©----------- -- --- ---- ---- ---- ....... ----- ------ ..............------.. .--......---- Date Application Disapproved for the following reasons- ---------- ---------------------- ------- -- ------------------- ------------------- ..................................... .......................................................M . ---...............--- -------- --....----....--------------. --------------- O Date Permit No. Issued - ........ ........... -'-" Date ---.... ......... No.--r--�-...»_. ,� Fps_....._............_...._.THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, .\), ),TOWN OF BARNSTABLE Application for Disposal Works Tonstrurtinn Errant Application is hereby made for a Permit to Construct ( ) or Repair {�X) an Individual Sewage Disposal System at: 49 Oakhill Road Hyannis ........ »»»»»»................... . - ............»........... --------------------------------------------- Bowman Location-Address or Lot No. W J.P.Ma e o mb e r Jr Owner Address Installer Address d Type of Building Size Lot--------------------------Sq. feet U DwellingX No. of Bedrooms___________ ________________ _____Ex anion Attic a — -----_--- p ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) Cafeteria ( ) QOther fixtures -----------------------------------------------------•-------------------------------------------------------------------•-------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank 1 Liquid capacity...19a. allons Length---------------- Width................ Diameter________________ Depth________________ x Disposal Trench—No_____________________ Width....................Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No......1------------ Diameter..... '__._______ Depth below inlet___7?.......... Total leaching area------------------sq. ft. Z Other`Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date-----------------------------•---------- Test Pit No. 1___________'____minutes per inch Depth of Test Pit____________________ Depth to ground water_____________________-_ f=, Test Pit No. 2................minutes per inch Depth of.Test Pit-------------------- Depth to ground water_-______________________ a --------------------------------------------------------------•.....--------........---•---•------•-......................................................... 0 Description of Soil...............................................................................-------------------------------- rSand--&__Grave---------------------•-----------•-------------------------------------------------------------------•----------------------------- W U Nature of Repairs or Alterations—Answer when applica.ble___1-10K--gallon---tank--- 1--di_stribut Qn box 1_-1000 Balton leachinn pit packed in .stone _with tea stone•_.ca ------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has,been issued by the bo d of health. Signe � ZI--•---. 12/28/92 Application Approved BY �f - �? d /� 1- -- ---- --- --------------------- ---------------------------------------- Da[e Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------- -------------------------------------- ............. ---------------------------.--- -- - ... ---._ _ Permft No. ......... ----- .. ---_ -- Issued ------� _. --------------- THEDa[e - COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (geriffir xte of Gulptian.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by J.P.Macomber Jr. - - ---- --------------------------- --------------------------------------------------------------------------------- ------------------------------------------------------ Installer 49 at . .....Oakh .11----Road....Byann ---------------- ------------------------------------------- ------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 f e Staee�"yaronmental Code as described in the application for Disposal Works Construction Permit No. ...._.._ '�.(.... -'mated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B9&NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------I-- 1 Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE # 30.00 No.--•..................... FEE........................ Disposal Works Tonstrurtiaan tIrrmit Permission is hereby granted J.P.MB COm------ Jr.------------------------------------------------------------•-•---------•---------------- -----r -------- to Construct ( ) or Repair (XX)X an Individual Sewage Disposal System A at No 49_-Oakhill Road »Hyannis----------------- _.------------------_-_--- /'n Street � as shown on the a lira 'on for Ijis osal Works Construction P t No — ��! 7 -------­--------- q q�_ ------ ------ Board of ealthl DATE---------------/- FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS k