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0023 OLANDER DRIVE - Health
23 OLANDER DRIVE,HYANNIS A= 270 217 Town of Barnstable Barnstable Inspectional Services Department AlMmeftaC j w BARM,rAOLL 9 ��� Public Health Division Prfi°"kD�s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1999 June 7, 2019 SPENCER, PHILLIP L P.O. BOX 232 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 23 Olander Drive, Hyannis, MA was inspected on 11/01/2018 by Troy Williams, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline,period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH o as_ cK#an O Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\23 Olander Drive Hyannis Second Notice.doc ro }, r7 y r n-�,_ .. •%1 f/i.. ,.� fit' �+�.- Town of Barnstable A' {, U.S.POSTAGE>>PITNEY BOWES Public Health Division 1 Maw. a 200 Main Street A i � { m0 60 Hyannis,MA 02601 "' ± / / ZIP 02601 4t0 7015 1730 0001 4987 9354 02 4n� ��16.S7 0000336455 NOV. 16. 2018. f SPENCER, PHILLIP L , P.O. BOX 232 HYANNIS, MA 02601 i s.F3 l Fs �!I :' fl F F'l:: :F ;,_ .i F :z �ilF�.3• � ;i. il��.-ti F .:' _ i .�? 1l.:. tjl.�� 'j.ifli f i `I j ® Complete items l°2,and 3. A. Signature ® Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ; M Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1. Article,' ' —` —` D. Is delivery address different from item 1? ❑Yes 4 If YES,enter delivery address below: ❑No SFICER, PHILLIP L ! P.O. BOX 232 HYANNIS, MA 02601 I I�III�I III ICI I II I I II I I III II ICI II I II I I I 3.IJ❑dullSignature 0 eMT II Express@ Signature Delivery ❑RPriority egis eyed Mail Restricted 9590 9402 3759 8032 3745 31 rtified WHO ,p slivery Certified Mail Restricted Delivery a :turn Receiptfor ❑Collect on Delivery `Merchandise 2. Article Number(TrarlSfer from SerViCe label)_ ❑Collect on Delivery Restricted Delivery El Signature Confirmation*^' -- -I ❑Signature Confirmation 7 015 1730 0001 4987 9354 l Restricted Delivery Restricted Delivery i ►� Y PS-Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt t is Town of Barnstable Barnstable Regulatory Services Department 1 e;caC ft sAEN5rADUL, , MASS.: ,�� Public Health Division prF°µkb 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9354 November 14, 2018 __SPENCER,_PHILLIP P.O. BOX 232 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 23 Olander Drive, Hyannis,MA was inspected on 11/01/2018 by Troy Williams, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH om McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\23 Olander Drive Hyannis.doc of'"E rc Town of Barnstable I!' 1 '? U.S.POSTAGE>>PITNEY eowEs P p _Ca A==== '® Public Health Division BARNSTABLE. ` 0: ✓ �.�,i� -Q MASS 200 Main Street 02 4YY Hyannis,MA 02601 :�' S. ZIP 02601 .L, $ 006.800 - ' y �. 0000336455JUN. 07. 2019. 7015 1730 0001 4988 1999 SPENCER, PHILLIP L f P.O. BOX 232 HYANNIS, MA 02601 i; �+ • • .dako-� x. G:;il � a �A. Signature ® Complete ite ,2 and 3. 0 Agent I ® Print your nam` nd address on the reverse X El Addressee i I so that We cai5 turn the card to you. B. Received by(Printed Name) C. Date of Delivery I i { 10 Attach this car to the back of the mailpiece, or on the front if space permits. n_Lq delivPry address different from item 1? ❑Yes r delivery address below: ❑No i� SPENCER, PHILLIP L I+ P.O. BOX 232 i I HYANNIS, MA 02601 I! r I III�III�II�III�IIIIII�III�IIII�III�I�IIIII IIII . .ig ❑RegiteredMEil'" @ I ❑Adult Signature ❑Registered Mail'" ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted Certified Mail@ :livery 9590 9402 4798 8344 8739 19 Certified Mail Restricted Delivery :turn Receipt for Merchandise ❑Collect on Delivery � Tm I t n ❑Signature Confirms o --.: -�Collenton Delivery Restricted Delivery g y � ail ❑Signature Confirmation I 7 015 1730 0 0 01 4 9 8 8 19 9 9 ail Restricted Delivery Restricted Delivery I �) I Domestic Return Receipt PS Form 3811,July 2015 PSN 7530-02-000-9053 yp�.1ME Tp�'l, Town of Barnstable Barnstable P Inspectional Services Department AD-Amw;cC j BA ABLE. MASS, Public Health Division AjE0 200 Main Street, Hyannis MA 02601 200 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1999 June 7, 2019 SPENCER, PHILLIP L P.O. BOX 232 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic asystem located at 23 Olander Drive, Hyannis, MA was inspected on 11/01/2018 by Troy Williams, certified Title V Septic Inspector for the State of Massachusetts: The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: C Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\23 Olander Drive Hyannis Second Notice.doc �%ETbtaZA Town of Barnstable Barnstable Regulatory Services Department nWcaCky 9 BARNSTABM " ,� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9354 November 14, 2018 SPENCER, PHILLIP L P.O. BOX 232 HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 23 Olander Drive, Hyannis, MA was inspected on 11/01/2018 by Troy Williams, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. l You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH om McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\23 Olander Drive Hyannis.doc ���S►+e rgyy Town of Barnstable • �srner.E, 9�A "" ,�� Regulatory Services Department tfD MA't a ..Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Cod -44 and Title V: 310 CMR 15.000) x r 11 n I E I L I 1 1, 1 is the fai e criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Dischar e or ondin o the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ackup of sewage into the house due to an overloaded or clogged SAS or cesspool E ON (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts io Title 5 Offollcial Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 23 Olander Drive, Hyannis '� _ _ M -270 P-217 _ Property Address -+ h Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is 610 Oxford Court Raleigh NC 27615 November 1, 2018 required for 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:When filling out forms A. Inspector Information E j.f- /EJ4S? on the computer, use only the tab Troy Williams key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections _ use the return Company Name key. Hummel Drive Company Address South Dennis MA 02660 Citylrown _ State Zip Code =--- (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority - 4. ® Fails November 1, 2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts A Title 5 Official .Ins.pection Form Subsurface Sewage Disposal%System Form -Not for Voluntary Assessments 23 Olander Drive, Hyannis _ M -270 P-217 _ Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is 610 Oxford Court, Raleigh NC 27615 November 1, 2018 required for every page. Cityrrown 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: 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.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection:; Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 23 Olander Drive, Hyannis M -270 P -217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 _ page. CityrFown 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Olander Drive, Hyannis M-270 P-217 Property Address Phillip Spencer c/o Lolita Spencer _ Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 .— page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tanK and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ® El clogged 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 99 P t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. ,u 23 Olander Drive, Hyannis M -270 P -217 _ Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, g Ralei h NC 27615 November 1, 2018 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 ❑ ® 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). 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 ❑ ❑ 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �. � 23 Olander Drive, Hyannis _ M-270 P-217 _ Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC _27615 November 1, 2018 — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cort.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and Location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official . Inspection form Subsurface Sewage-Disposal System Form - Not for Voluntary Assessments 4� V � 23 Olander Drive, Hyannis M -270 P-217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): --- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x.#of bedrooms): 330 gpd Description: Number of current residents: 4 --- Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A 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 ears usage d 17=128,000 gals. g ( y g (gpd)): 16=153,000_gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 23 Olander Drive, Hyannis M-270 P-217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sa.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A Last date of occupancy/use: N/A Date Other(describe below): NIA 3. Pumping Records: Source of information: No pumping info available. Was system pumped as part of the inspection? ❑ Yes El No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: - — t5insp.doc•rev.7126/2018 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 23 Olander Drive, Hyannis M -270 P -217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is 610 Oxford Court Raleigh NC 27615 November 1 2018 required for every 9 , 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: Tank, d-box and leaching were installed on 4/1/10 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18 - --- feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): - ---- Distance from private water supply well or suction line: feet ---_-- Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System. Form -Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P-217 — Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: 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: 6'X10.5'X6' 1500 gallon Sludge depth: 6" — Distance from top of sludge to bottom of outlet tee or baffle 2' 8" --- — Scum thickness 4" -- Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle 20" How were dimensions determined? probe/measured Comments (on pumping recommerdations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tees were found present. No evidence of leakage or damage was found. Water level was above inlet and outlet lines. Tank was in need of pumping at this time. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts 1p Title 5 Official l-ns.pecti-om Form'. Subsurface Sewage.Disposal.System Form -Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P-217 Property Address — Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court Raleigh NC 27615 November 1, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A -- Scum thickness N/A — Distance from top of scum to top of outlet tee or baffle N/A _ — Distance from bottom of scum to bottom of outlet tee or baffle N/A —_ Date of last pumping: N/A 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.): N/A 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A ---- ------- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A--------- -- -------- Capacity: N/A gallons Design Flow: N/Agallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 0 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 23 Olander Drive, Hyannis M-270 P-217 Property Address Phillip Spencer c/o Lolita Spencer _ Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A *Attach copy of current pumping co-itract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert above Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was full at the time of inspection. Evidence of solid carry-over or backup in the past was found at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts _ Title 5 Official Inspection Form � Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P-217 _ Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh h NC 27615 November 1, 2018 page. City/Town 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.): N/A * 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: — --- ® leaching chambers number: 10 infiltrators _ ❑ leaching galleries number: — — ❑ leaching trenches number, length: --- ❑ leaching fields number, dimensions: --- --- ❑ overflow cesspool number: — -- ❑ innovative/alternative system Type/name of technology: — ---- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �M- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P -217 Property Address Phillip Spencer c/o Lolita Spencer _ Owner Owner's Name information is required for every 610 Oxford Court Raleigh NC 27615 November 1 2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers were in hydraulic failure at the time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A _ Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form Not for Voluntary Assessments 23 Olander Drive, Hyannis M-270 P-217 _ Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Ralei9 h NC 27615 November 1, 2018 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A - ---- Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A • t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts -:. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P-217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1 2018 page. City/Town 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 511-C Vt . TO z oil I Y 3y ' 0 5 3 3" y� t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 z , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Olander Drive, Hyannis M -270 P -217 Property Address Phillip Spencer c/o Lolita Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh _NC 27615 November 1, 2018 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10.0'+ 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: 3/3/10 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 13.0'. Bottom of leaching at 4.0'was found not to be located in the high groundwater elevation at the time of inspection. System installed to plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts - Title 5 Official: Inspection., Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Olander Drive, Hyannis M-270 P-217 Property Address Phillip Spencer c/o Lolita_Spencer Owner Owner's Name information is required for every 610 Oxford Court, Raleigh NC 27615 November 1, 2018 page. City/Town 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION a��� � SEWAGE# ��T VILLAGE j ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. OQ766-i h SEPTIC TANK CAPACITY J t f)o LEACHING FACILITY:(type) 4he (size) NO.OF BEDROOMS OWNER h S ' PERMIT DATE: d COMPLIANCE DATE: 1 D S S eparation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY co VI %clA No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. I PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for ]Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. lgerL' Na7me,Address,and Tel.No. Assessor's Map/Parcel 0 — 211 7 Installer's Name,Address,andd�Tel.No. Designer' Name, ddress,and Tel.No. Type o uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 230 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ,yy� ^ Size of Septic Tank �j y Type of S.A.S. Description of Soil - r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenan of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code an of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date Application Approved by ov DateRo Application Disapproved by Date for the following reasons Permit No. Date Issued No. Fee tiTHECOMMONWEALTH OF MASSACHUSETTS Entered inctw �,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Wiration for joi!wsal 60stem Construction Vermit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. er's Name,Address,and Tel.No.c;?3 01�w4lele ; Assessor's Map/Parcel (`� 2, 1-7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: 4 Dwelling No.of Bedrooms 6-2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( )'Cafeteria( ) Other Fixtures Design Flow(min.required) ���D gpd Design flow provided -s�3� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. /O Description of Soil h. Nature of Repairs or Alterations(Answer when applicable) Q Date last irispected: Agreement: The undersigned agrees to ensure the construction and maintenanc of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and%/tto place the system in operation until a Certificate of , Compliance has been issued by this Board of Health. S v L Date Application Approved by �`- n / Date Application Disapproved by Date for the following 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( �pgraded( ) Abandoned( )by at ©I has been const cted in accor an ` with the provisions of itle 5 and he for Disposal System Construction Permit No "� ed Installer r Designers c/.2 t/ _ _14/l/ #bedrooms 2s Approved design flo �/j;�j gpd The issuance of his permit shall not be construed as a guarantee that the system wi fun �+o�as des ned. Date 4 3�/c� Inspector , / �- -- -f----- ------------ ---- -- --- --_- No. / � Fee V `� `� (((���THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �,vo� Misposal �&pstem Construction 311Prm[t Permission is hereby granted to Construct( ) Repair( ✓}/ Upgra e rMfAy� ) System located at ,1 ,? 4 , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. -4 Provided:Constru io mus e completed within three years of the date of this permit. Date _ Approved by / 4 oF� Town of Barnstable P# ) v� Department of Regulatory Services Public Health Division Date -Z//C) 1639. �� 200 Main Street,Hyannis MA 02601 Date Scheduled M dv 3, Zv 10 QQ Time 1 Fee Pd. d U '— Soil Suitability Assessment for Sewage Disposal Performed c:B , S `M� tom..i y Witpessed By: S'i'd K �u1-L LOCATION& GENERAL INFORMATION Location Address Owner's Name L Address Assessor's Map/Parcel: Z?a -Z t 7 Engineer's Name�U LD` NEW CONSTRUCTION REPAIR Telephone# Land Use Ji4r a Slopes(%) Surface Stones . 1'Vty fl,l Distances from: Open Water Body A ft Possible Wet Area /j' ft Drinking Water Well wp ft Drainage Way-ft Property Line ft Other" ft SKETCH:(Street name,dimensions of lot,exact 1 ations of test holes&perc testHocateyetla7ds in proximity to holes) � Udo J� o . �_ LINC L c tt t, Parent material(geologic)� $1?/t/d) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: " J Weeping from Pit Face U Estimated Seasonal,HighrGroundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: / Depth Observed standin s. o1 � !Diu, Depth to soil m �/� t`/� Depth to weeping side of obs.hole: ro In. Groundw djustrnen fi. Index Well# ading Date: Well1evcl Adi, ar AdJ.Otw venter level PERCOLATION TEST Wtv 3 !D Thne Observation Hole# 2/Qs Time at 9" b Z Depth of Perc d ��/ Time at 6" Start Pre-soak Time @ / U 7` - Time(9"-6") v f'1 13 End Pre-soak ` Z /Z'/ Z , Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. ravel 6� lG /Q ZF3 Gsr�n IPI 2 S6 .48 . o a� e ✓�Z,/3 oG. � DEEP OBSERVATION HOLE LOG Hole# Z' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) 'All •�� 22y� �aAJI " 6 �� ivY2 Y��- /v/-1 e7 V DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi en Flood Insurance Rate Map: / Above 500 year flood boundary No_ Yes 4� Within 500 year boundary No= Yes Cam? Within t00 year flood boundary No, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pzr*k'qvs material exist in all areas observed t oughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring p rvious material? w tom"' �\ Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of E*ironte�lal Protection and that the above analysis was performed by me consistent with the required training,ex ertise and a erie d cribed in 310 CMR 15.OY7. Signature t Date 3 3 /b Q:\SEPTIC%PERCFORM.DOC Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of [RECEIVED Environmental Protection o e VAIIlam F.weld DEC 2 2 1995 GOY°m°' HEALTH DEPT. Trudy Secretary,EO%EA TOWN OF IBARNSTABLE David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 0 w� G CERTIFICATION oe4t Property r � �� Address of Owner: Date of Ins 'coon: /' /5 9 (If different) Name oflnSpector: W.E. Robinson Sr. Company Name, Address and Telephone Number: W.E. Robinson Septic Service P.O. Box 1089 CERTIFICATION STATEMENT Centerville MA I certify that I have personally inspected the sewage disposl s�sCerh�t this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: [!Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: y' a,,�,.�- Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYST PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1S.303. Any failure criteria not evaluated are indicated below. 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, 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 S/15/95) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(611)M-5500 0 Printed on Recyded Paper i 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:o2-3 Owner: Date of Inspection: t �L t S V 4j B] SYST CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed.in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER LUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditi ns exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public ealth, safety and the environment. 1) SYSTE WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHIC WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water esspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WI L FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTE IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONN NT: _ he system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. T system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ Th system ha> a septic tank and soil absorption system and is less than 100 feet but 50 feet'or more from a private water s ply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is f e from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pm. D] SYSTEM F I have determi ed that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this deter nation is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. ckup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Dis harge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or ces pool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) / Property Address: 2 0!!51 Owner: e Date of Inspection: D)SYSTEM AILS(continued): 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). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within,50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for co liform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM F ILS: The followin criteria apply to large systems in addition to the criteria above: The design fl w of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the envi onment because one or more of the following conditions exist: t system is within 400 feet of a surface drinking water supply the s tem is within 200 feet of a tributary to a surface drinking water supply the sys em is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a publi water supply well) The owner or operat of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 MR�5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95),"' 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1r,p Owner: �P/fG Date of Inspection: Check if the following have been done: _imping information was requested of the owner,occupant, and Board of Health. _414'ne of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with N/A. ✓fhe facility or dwelling was inspected for signs of sewage back-up. _LT e system does not receive non-sanitary or industrial waste flow_LX e site was inspected for signs of breakout. _LA.system components, excluding the Soil Absorption System, have been located on the site. _LAe 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. Vhe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. �yfhe facility ov,ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15f/951; 4 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �J Owner: � C. ? -e Date of Inspection: /-ji— FLOW CONDITIONS RESIDENTIAL: Design f1ow: 8,gallons Number of bedrooms: Number of current residents: Q Garbage grinder (yes or,no): A-- Laundry connected to system (yes or no): Seasonal use (yes or no):47 Water meter readings, if available: 1i/4 Last date of occupancy: ? COMMERCIALIINDUSTRIAL: Type of establishment: Design flow:__gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and s rce of information: System pumpe6 as part of inspection: (yes or no)_ If yes, volume pumped. gallons Reason for pumping: TYPE OF SYSTEM -5eptic tank/distribution box/soil absorption system Le Sp�' gle cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: )` S ) Sewage odors detected when arriving at the site: (yes or no)�f/ (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cont fued) Property Address: a2 3 6� 9e bw- 0/� S. Owner: �- ceorll-e_ /( A, Date of Inspection: .. SEPTIC T _ (locate on site an) Depth below grad Material of constru 'on: _concrete_metal _FRP other(explain) Dimensions:. Sludge depth: Distance from top of sl dge to bottom of outlet tee or baffle: Scum thickness: Distance from top of cum to top of outlet tee or baffle: Distance from bo m of scum to bottom of outlet tee or baffle: Comments: (recommendation for mI .g, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of I akage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP_other(explain) Dimensions: Scum thickness Distance from top of scu o top of outlet tee or baffle: Distance from bottom of fru . t, hottom of outiet tee or bathe: Comments: (recommendation for pumpin , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) t (revised 8/15/.95),¢ 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contjnued) Property Address: �Q� /`�� � '0� � ��j Owner: 1- - (f 7r'Q'f 19 Date of Inspection: TIGH ,OR HOLDING TANK:_ (locat on site plan) Depth low grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: allons Design flow: allons/day Alarm level: Comments: (condition o inlet tee,.condition of alarm and float switches, etc.) DISTRIBUTI N BOX:_ (locate on site %lev Depth of liquid )above outlet invert: P qComments: (note if level and diution is equal, evidence of solids carr�'o•,cr, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump c mber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continyied) Property Address: � 3 D/✓�f�k. 10 Owner: 19-.cew-lk-e. /l Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: ^ Comments: (note condition of soil, signs of hydraulic failurS,level of ponding, condition of vegetation,etc.) CESSPOOLS: v (locate on site plan) t Number and configuration:�r Y-/0 Depth-top of liquid to inlet invert: C� Depth of solids layer: 1 W j Depth of scum layer: C ` Dimensions of cesspool: Materials of construction: %r) S Indication of groundwater: inflow (cesspool must be pumped as part of inspection) I7/t L; td/ G ct Comments: (note condition of soil, signs of hydraulifailure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) I (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: �3 6-7 ���b e r- 0/Z �'Yi�i9/ S Owner: Date of Inspection: 1,�71—/S—? SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 17 0 ° J 47�G)z A G J�- i DEPTH TO GROUNDWATER Depth to groundwater: _feet method of determination or approximation: 9(n 13A z'i 5 <� (revised 8/15/95) 9 a Rte 28 b Den Nt �'�' Br 4�q` 1061h LOCUS ° my 2r yG Floor Plan NIF N/�, N.T.s. N/F stapechem Gaide Map 270 Parcel 1-9AJmona.. Oda Map 270 Parcel 013002 Map 270 Parcel 158 Fnd CB/PH Top Bnd 42.48) Map 270 Parcel 013001 N 3577'50" E Fad CB/DH NOTES' 'i' 308.23' Top find 43.59) Parcel is located in Zone U Contribution so (43.4) Zoned Abandon Existing Cesspool RB-ASP Pump, crush and sand fill Per Title 5 ✓ Owner of Record Phillip L. Spencer Deed Reference �R3�J Obs Hole Cart Proposed Cart. 105943 & 81066 Vent obs port 031.25 D—BOX Plan Reference 5 87' Proposed 1,500 L.C. 10614T 40' Gal S-=1'ank� Lot 125 i r Fema Map Ref. �/�bs Hole Proposed SAS #2 3o 250001 Pe Zone C A Test�4� o �4<v,�J o �� wLot 125) s) ) A8B�510W jW 270 LOT 217 ('45- a' o N/F 55 391- S .Ft. 7) MY EL = 44.62 Harrington �' Deck ( op or ea Map 270 Parcel 218 Be lays► I (ag 6) r�4'�J Map 270 Parcel 281 ' Bldg , Septic Upgrade Repair Plan 2 Bdr TCF 44.89. in '� (k A Barnstable, MA Gra vela off D/ ! Located At r¢ °J 23 0 lander Drive Hyannis, MA 02601 Fad CB DH Applicant `9J Fen 1) �a Top Bad 43.76) P12illip .L� Spencer o (FCC S 35 0 #r 23 0-Jan der Drive Hyannis, MA 02601 Cobb le ✓ Map 270 Parcel 282 Pj SCALE' 1 � = 30' DATE. March 16 i V , 4 �9 OF Mq6 yv �` ���ZH OF�49 PREPARED BY ° DAVID c� EDVIIARD ` EAS Survey, Inc. �LAH N 100.Do' r 44.sa) e j A. �° 141 Rte 6A P.O. Box 172 S 3504448" A' 1 ST Sandwich, MA 02563 N 121 (508) 888-3819 S 1 s T E CaNIF rno T gN17AR N Sg• Map 270 Parcel 136 N/F ®1 i L „�+..� , nGRAPHIC SCALE �� Crocker 30 0 15 30 60 150 Map 270 Parcel 143 ( IN FEET ) sat 1 of 2 I inch = 30 ft. V;W. y7022.d-g TOP OF Raise covers to,-a thin 6" of FOUNDATION =� EL 44 62 finish grade install risers as needed Ohs Port with Screwtop to grade Vent GROUND SURFACE EL_ 43.0-, !fiddle of last Proposed unit on both rows To 42.85 D DB3 Box P -------_"_'- 1 3 7' 42.29, 2"MIN-3'VAX B&FAIL INVERT EL 41 BI / �a fzsE c 39.33 TOP EL and Pent Existing 14" 14" 41.61 pp TO INVERT EL ',y INV EL .� 13/41- CTIVE 16° Remain v INSTALL ::.:::::::: aYALL BAFFLE 39.17 e•=Aa Bsse, c,JJi Bot El 37.27 INV EL 9.00 38.92L Proposed Q� 112' DOUBLEINV EL INV EL T'g- Rows of Five (H-20� ED STONE High Capacity Infiltrators(with no stone or filter cloth)Proposed (34" x 75 x 16') o �ff' BOTTOM EL 1,6DO Tank h� �l �- S 0.48 � S = 0.15 S = O O Total of Ten Units 16 B Trench Formation 31.25' � EL 30.2 Bot Test No Aggregate (Stoneless) Pit 1 CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTAfENT OF ENVIRO"ZWTAL PROTECTION PURSUANT TO 310 CAM 16 017 TO CONDUCT (No Bnd Aster) SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFVEJfE'D BY AfE CONSISTENT WI'M THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE Cross Section tion DESCRIBED-IN 310 CMR 15.017 1 FURTHER CERTIFY THAT THE RESULTS OF AfY N.T.S. SOIL EVALUATION AS'INDICATED ON THE ATTACHED SOIL EVALUATION FORA4 ARE ACCURATE AND IN ACCO ANCE WITH Mig CJ67 15100 THROLCH 15.107 F.C. 43.0 • Min 8" Sand Min 6" Sam! Over Units Over Units Top 39.33 1 Inv se.9z 2 =0.Ae Hot 38.0 96t 38.0 EDA'ARD A. STONE, CERTIFIED SOIL EVALUATOR 34" se" 34" DEEP OBSERVATION DEEP OBSERVATION (16" x 34," x 75" 1I20) High Cap &hhtrators HOLE LOG ! Septic Upgrade Repair Plan L G HOLE LOG 1n Test Hole #1 Test Hole #2 DESIGN DATA Barnstable, MA (EL = 43.2t) (EL = 43.1 f) Dg h lev soil soil Soil �h v Soil Soil Sail Numiher of Bedrooms: 2 a l � �it) Horiiaa Texture Color �n) ) Horiaon Texture Color �(N OF Mq3 Loco t�U At (USDA) (Munsell) (USDA) (Muasell) Garbage Grinder: NO ya`� sqo ,2`� a. la n d er Drive 0 - 10" 42.4 A LOAMY SAND 10YR4/3 0 - 6" 42.6 A LOAMY SAND YOYR413 Desi Flow ,j�j0 �o�' DAVID �, (110(W/HR/Day x Number of BR) D. a to,, - 28" 40.9 B LOAMY SAND 10YR516 6" - 2x' 41.3 B LOAMY SAND 10YR5/6 Septic Tank 4500 FLAHE J . N Hyannis, MA 02601 28" - 48" $9.2 C1 SANDY LOAM 10YR6/6 2x' - 42" 39.6 Ct SANDY LOAM f0YR6/6 (xio4mnm @ Design Flow x zoos) Gal. Applicant 48" - 156" 30.2 C2 COARSE SAND 1OYR7/6 4x' - 120" 33.1 C,2 COARSE SAND 10YR716 Leaching Area: Phillip L Spencer f0% Gravel to% Gravel 10 Units x 6.26 x 7.9 SF = 494 Sq. Ft. t � • & Cobble & Cobble. A TW 495 23 a lander Drive Long Term Acceptance Rate (LTAR):x 0.74 1 Hyannis, a,f A 26 1 Deep Obs Hole Date: 3/3/10 Deep Obs Hole Date: 3/3/10 1 l,}' 1V1 tY L! i! Soil Evaluator. BD STONE Soil Evaluator: ED STONE {Sideaan Area + Bottom Area) x LTAR Witnessed By: D. STANTON Witnessed By: D. STANTON Leaching Area Design Capacity: 365 GPD Pere Rate: Pero Rate: < 2 MIN/IN 0 54" SCALE N. T.S. DATE.- March 16, 2010 Soil Survey Description: CARVER Soil Survey Description: CARVER Geologic Material: ctAclu ourirASH MRWNS Geologic Material OLWIAL OMAss AfORRAW Depth to Standing Water. NA Depth to Standing Water. NA '365 GPD Provided - 330 GPD Required 35 Reserve PREPARED BY Depth to Weeping Water NA Depth to Weeping Water. NA Inc.Depth to Mottiing(Color): NA Depth to Mottling(Color): NA - EAS' Survey, Eel Seasonal High GW: NA Est Seasonal High G* NA USGS Observation Well: NA USGS Observation Well NA 141 Rte 6A P.0. Box 1729 Date of last Measurement: NA • Date of last Measurement: NA Comments: Rodney Fisher Excavator Comments: Rodney Fisher Excavator Sa'2ndWlch, MA 02563 (508) 888-3619 Sht2of2 Dwg: ,or 1022.d wg