HomeMy WebLinkAbout0008 ORR'S AVENUE - Health 8 Orr.'s Avenue
t . . I , -A:
Hyannis CP/R
'290 067. ,..
J
N
TOWN OF BARNSTABLE
LOCATION For r 5 h Jam. SEWAGE# •2oo
VILLAGE ASSESSOR`S MAP&PARCEL �9U /&7
INSTALLERS NAME&PHONE NO. pl�
SEPTIC TANK CAPACITY s CCU f f /v
LEACHING FACILITY:(type) 09 16() L C A/Z 0 (size) /Z X 2 S
-NO.OF BEDROOMS
OWNER L`l, 2 e&H, yJ i
PERMIT DATE: 3!2 8 - Zoo's COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .v /0 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) I Feet
FURNISHED BY �4 p i C9.2 C2�.�w,o n 3�� ux.
�S h-C
f'1
'v
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
i� Application for Mtgpoot *p5tent Cort.5tructtou Verrtttt
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components
Location Address or Lot No. d D 912 s A ve- Ny"nn,3 Owner's NamF,Address; d Tel.No.
£ lez�A/,Je M . bwaraC I Q&arer-, 4-e%
Assessor's Map/Parcel '090 Cv(0 $ a r r s Ave. Srt A 0 3(00 1
Y�
Installer's Names Address,and Tel.No., 5C)Ss q2 28 Designer's Name,Address and Tel.No. 506 a-73 o3 77
Cape were. Fn•k,-prI54, .sc C tn;erI'-ts inc
PO 7(o 3 Cent l-e r ut f iV\A aol(o 3Z fa Wo ce1,.CV% tMA OaS is
Type of Building:
Dwelling No.of Bedrooms 3 5 Lot Size Jtf, 200 sq.ft. Garbage Grinder ( )
Other Type of Building 5tvt9(c Ccrv.,T No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) `3 30 gpd Design flow provided 3 .S a. gpd
Plan Date :3 /U �u8 Number of sheets / Revision Date
Title
Size of Septic Tank /5'00 1410 Type of S.A.S.
Description of Soil See A f't e-ck4e d Jon e 0 = Z c
Nature of Repairs or Alterations(Answer when applicable) 1 Ve V S e ti call ctnar)-2
Date last inspected: ,206&
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe �' >>o Date
Application Approved by ® t� Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
No. ••. Fee
s
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
ff PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
1
Yication for i� o�aY otenY
. . � �� � � �p Congtruction Permit
Application fora Permit to Construct( )" Repair OO-Upgrade O Abandon,( ❑.Complete System Individual Components
p.
SLotNo.Location Address or Owner's Nam ,Address;and Tel.No.
} i C/,zA�r�h M g baarac,
Assessor's , � ar rS Ave \1 tianY\, MA OaL(00 i
LOG
5u5 4 7 yu 28 sob
Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. 9
C'c�pe wrc�. £h heip.i54. �C �c.,S �rt.ar�nS t'nc.
Po 3ov 7(o 3 emn e r vd WA O)(o 3Z fatJ MA 005-31
Type of Building:
Dwelling No.of Bedrooms _3 Lot Size JY, ZOCU sq.ft. Garbage Grinder ( )
` Other Type of Building 5%A9(t Cat.t l..r No.of Persons Showers( ) Cafeteria( _ )
` Other Fixtures
i
Design Flow(min.required) 3o gpd Design flow provided gpd
Plan Date l U 106 6 Number of sheets / Revision Date
Title a
t Size of Septic Tank /3"00 /'/ /a Type offSSwA�
Description of Soil See A 4 Fa ckJ e
Al
IVC_ 1
,-Nature of Repairs or Alterations(Answer when applicable) To V SP 0 4,A a c n�.,cjl)2
v
Jt-0 U ko,AV
i
Date last inspected: wCt£c
Agreement:
i
-The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
` .accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of �
Compliance has been issued by this Board of Health.
Signed „ e Date
Application Approved by D Date /
.. Application Disapproved by: Date
for the following reasons
i
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 (yC ) Upgraded ( )
Abandoned( )by Ot s',�)6?
at �' {Z( (`S ;n;y has been constructed in ccordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. `-' dated
Installer On pe„ise L �4 4 t A��4 Designer , f7r%o tn vie�%V%o
#bedrooms Approved design flow
PP g d
gP
The issuance of this permit shall of be onstrued as a guarantee that the system
(eGill' n a designed.
Date �Q Inspector` ._....fe�
———— —————————.——————————————--=—-—
No. .��I Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1wigpogal 6pgtem Cott5tructtompermit
Permission is hereby granted to Construct ( ) Repair ( � grade ( ) eAbandon ( )
System located at A
r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and//the following local provisions or special conditions.
Provided: Construction iytst be ompl`eted within three years of the date of thi
Y p ermit,
Date �L Approved b ��
Town of narnstable
OFf.E
Regulatory Services
Thomas F. Geiler, Director 8ARN9CABLE, a ector
MASS. Public Health Division
Thomas McKean Dir
ector
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644
Fax: 508-790-6304
Installer & DesiQne'r Certification Form
Date: 2`/.-06
a.,
Designer: 5G cnq.- .neert y
: �, G= Installer: �cafduidc,
Address: 2fi,154 Gccxnberry wy Address: 3Dx 7U3
�a3t W ar'cii►G�►'1 � 9�t4 b 2�3 fi' �-���-f.t/�:�l� 2 l/Y1 t�'
d2w31
Y
G n,2e" <'-%eS was issued a permit to install a
(date) (installer)
septic system at. 0 fr s V c- based on a design drawn by
(address) ,
ng:nezein �. T�nG. dated rfcrcin io, L008
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow:
� Cy
��o JOHN L. �m
o CHURCHILL
( taller's Si ture) JR. w
CIVIL
° 41807 fi
. S ,
(Designer's S' ature) (Af Desi s Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q: Health/Septic/Designer Certification Form
a
TOWN OF BARNSTABLE
LOCATION $ or r 5 d•t SEWAGE# 2oo 8 11
VILLAGE ASSESSORS MAP&PARCEL ,290,A17
INSTALLERS NAME&PHONE NO. `IA�ay[aG ►. e r df K Sufs Y 2 S/O�R'
SEPTIC TANK CAPACITY /s-00 H /o
i
LEACHING FACILITY:(type)U)S{O CC /'20 (size)
NO.OF BEDROOMS
OWNER z e - C u.aKc vi Q
PERMIT DATE: 3'18 ' Zoos COMPLIANCE DATE: w' 2 3 i
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N /0 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) ' - I Feet
FURNISHED BY LLC-
-T
C
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m ZP
Z .
f11 iQ3 �3 q0-o
R2 -70.5. c 44.5'
Dt '21 'S Cf
BZ s.S
33 3S-0 C(Q y(,t,
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3S �f3 �
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pFSHE Tp�
Town_ of Barnstable Barnstable
A&AmMcaCity
Regulatory Services Department 1
BARNSTABLE,
"A55. Public Health Division
200 MainStreet, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
January 16, 2008
Elizabeth & Guaraci Quarentei
8 Orr's AvenueQ— bo
2�
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 8 Orr's Avenue Hyannis, MA was inspected on January 9,
2008, by Robert Pablini, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system FAILED under the
guidelines of 1995 TITLE V (310 CMR 15.00) due to the following:
Backup of sewage into facility or system component due to overloaded or clogged SAS
or cesspool.
F You are ordered to repair or'replace the septic system within Sixty (60) days from the
date of this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE OARD OF HEALTH
omas McKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\8 Orr's Avenue,Hyannis.doc
I
Commonwealth of Massachusetts
W Title '5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr s Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 .1/09/2008
every page. City/Town 'State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Importantg
When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of,Inspector
use the return
key. Capewide Enterprises,LLC ,
Company Name
� ( ❑
P.O.Box 763
Company.Address -
Centerville Ma S-02632
rerun' City/Town State iP Code
(508)428-4028 S 14454 uz i
Telephone Number License Number ry
C 3
01 t
B. Certification
I certify.that l have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1.5.340 of
Title 5 (310 CMR 15.000). The system:
❑ Passes-'.l ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
1/09/2008.
Inspector's Signa Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design.flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
W Title '5 Official Inspection Form •
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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.any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist..Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no.or not determined (Y, N, ND) in the ❑for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
8 Orr,s ave.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
W Title *5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 8 Orr's Ave.
Property Address
Elizabeth &Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
P
l The system required pumping more than 4 times a year due to broken°or obstructed i e s The
❑ Y q P P� 9 Y P�P O•
system will pass inspection if(with approval of the Board of Health): .
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health;
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
8 Orr,s ave.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
i
1 Commonwealth of Massachusetts
W Title '5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth &Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
�
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.): l
❑ 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 D'EP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each.of the following for all inspections:
Yes No
® ElBackup'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
El ® 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.
8 Orr,s ave.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
i
Commonwealth of Massachusetts
W Title *5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpa-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ T 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
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
i
Commonwealth of Massachusetts
W Title *5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� M 8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection .
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® 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?
Z. ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Z ❑ 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)]
8 Orr,s ave.•12/07 Title 5 Official Inspection Forrr:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
W Title *5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: unknown
Does residence.have a garbage grinder? ❑, Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2006:41,000
g ( y g (gpd)): 2006:46,000
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
I
Commonwealth of Massachusetts
W Title '5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No.
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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)
❑ Tight tank. Attach a copy of the DEP approval.
I
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
30+-years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
f •
Commonwealth of Massachusetts
W Title *5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 2 feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
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:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
I
1 Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of,leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, l
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
i
Commonwealth of Massachusetts
T'itle '5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
' 8 Orr's Ave.
Proper
ty Ad
dress
p Y Add
Elizabeth &Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy-attached? ❑ Yes .❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ .Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
8 Orr,s ave.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
I
Commonwealth of Massachusetts
W Title'5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
^M Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ 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.):
8 Orr,s ave.•12/0.7 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
W Title 5 Official .Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for Hyannis Ma. 02601 1/09/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1-main 1-overflow
Depth—top of liquid to inlet invert cesspool dry
Depth of solids layer
Depth of scum layer 0
Dimensions of cesspool main and overflow 6'x8'
Materials of construction Concrete Block
Indication of groundwater inflow ❑ Yes ® No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Cesspools were dry at time of inspection.Stain line show that system is in hydraulic failure.4"of solids
observed on top of inlet pipe.Stain lines were up in riser build up.
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments.(note condition of soil, signs of hydraulic.failure, level of ponding, condition of vegetation,
etc.):
8 Orr,s ave.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Map Page 1 of 2
Town of Barnstable Geographic Information System
Parcel Viewer custom Map Abutters Map Size Zoom Out
I�
`------- ----- ILI
t
Mill
,. 0 20 Feet
1
I --• s �r � i
Set Scale 1" =.20 I Aerial Photos
(`nnvrinht 9rlr)r-9(V17 Trv..n of Rnrne+,hlo RAA All rinhfc roconn
http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=290067&map... 1/10/2008
f
�^ Commonwealth of Massachusetts
W Title' 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
8 Orr's Ave.
Property Address
Elizabeth & Guaraci Quarentei
Owner Owner's Name
information is required for y H annis Ma. 02601 1/09/2008
'
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of CP 20'
'feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
As-Built Card
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:Gaherty& Miller Model 12/16/94 groundwater elevations.USED:USGS Observation Well
Data.USED:Tevhnical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations.
8 Orr,s ave.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
OF 1HE tp�
ti�p� ti� Regulatory Services
BnRxszns Thomas F. Geiler,Director
`0�
9
639• .Public Health .Division
ArFD MA'S A
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts Department of Environ
mental Protection
.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition,by receiving this report the Town of Barnstable Health Division does not
automatically approve the number,of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
.�`'"E'° Town of Barnstable y�Ptes POSrq�F
Public Health Division A ® �
200 Main lbl5
��FD +D10 PITNFY BOWF_5•
�Hy 0i 2601 0004606238 � N 1 7 20 8
�F. 7��5 1160 00�0 0191 . 0249 MAILED FROM ZIP CODE 02601
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TDEU RNA \r ,. 5
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pN T��p�UfIESgEU � '
DN SgU -
/hS 029 40 1 02 02J 12it79
RETURN TO SENDER
UNDLA2MErD
UNABLE TO FORWARD
MC: 02SOA 400.200 *2084-00600-14-37
0286104002 III,,,,,t,)�LI„11,,,,,,11►!„ill,�,Il,,,,,l,lil„�ll,,,;l�i,l
i
FEW—
■ Complete items 1,2,and 3.Also complete COMPLETE'THIS SECTION ON DELIVERY:
SENDER: COMPLETE THIS SECTION
A Signature
I ❑Agent
item 4 if Restricted Delivery is desired. X 0 Addressee
■ Print your name and address on the reverse
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I
I E Attach this card to the back of the mailpiece,
I or on the front if space permits.
I D. Is delivery address different from item 1? ❑Yes I
1. Article Addressed to: If YES,enter delivery address below: No. I
I 3. Service Type �
0 Certified Mail ❑Express Mail \
G—4\. `� S I b Z L.>y 0 Registered 8 Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
i
I 4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number 7005 1160 0000 0191 0249 i \
I (Pransfer from service labeq
}p r r; 102595-02-M-1W
+1 r Domestic Return Receipt I
PS Form 3811,February 2004� _ __
�OF THE Tp�
Town of Barnstable Barnstable
AMmRegulatory Services Department I�`ca��.F
ffy
aaeus-raaLe,
"ass. Ok i679• Public Health Division
O ��
AIFb0 M a 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO.
January 16, 2008
Elizabeth & Guaraci Quarentei
8 Orr's Avenue
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located"at 8 Orr's Avenue Hyannis, MA was inspected on January 9,
2008, by Robert Paolini, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic stem showed that the system FAILED under the
p p Y Y
guidelines of 1995 TITLE V (310 CMR 15.00) due to the following:
Backup of sewage into facility or system component due to overloaded or clogged SAS
or cesspool.
You are ordered to repair or replace the septic system within Sixty (60) days from the
date of this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER-ORDER.OF THE OARD OF HEALTH
omas McKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\8 Orr's Avenue,Hyannis.doc
a
Town of Barnstable P#
Department of Regulatory Services
: .0 ABM : Public Health Division Date
KAM Sol �� 200 Main Street,Hyannis MA 02601
Fp t,Ntl�
Date Scheduled L-aT
ime Fee Pd.
:....:.,�, s..
Soil Suitability. Assessment for Sewage Disposal
Performed By: �1(C.\0,eA eCMe,1nW 1 e 1 t, CSC Witnessed By: t bACACk Oe S M ora(S
LOCATION& GENERAL INFORMATION
Location Address �( r ,'� Owner's Name
LJ &2�f 1
Address O'IXL-)
Assessor's Map/Parcel: ct D 18(a 7 / Engineer's Name e q
NEW CONSTRUCTION REPAIR V Telephone#. SV %4'2Z q G Z t
Land Usef UMoE��u�T-P#m r r iJe i� Slopes(%) 0 ySurface Stones
Distances from: .Open Water Body 5-too ft Possible Wet Area >WO ft Drinking Water Well >IGt) ft
Drainage Way ft Property lane >10 ft Other /A ft
SKETCH:(Street name,dimensions of tot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
vaw� f
• 1�10ft
IDaieE
Hutrx�Eu-S wcrc '
Parent material(geologic) OLA100 SK Depth to Bedrock 120�
Depth to Groundwater. Standing Water in Hole: �IZO` C.5_ Weeping from Pit Face - >IZO`%•C..S,
Estimated Seasonal High Groundwater >%W 'g.`.S.
DETERARNATION FOR SEASONAL HIGH WATER TABLE
Method Used: +�c�c On gneN
Depth Observed standing in obs.hole: >Up B G•5. in. Depth to soil mottles: �ZO~_S};G; ^ in,
Depth to weeping from side of obs.hole: 321I20" Q+,,,•G,• , ._in, Groundwater Adjustment N f& ft.
Index Well# Reading Date: Index Well level „ Adj.factor Adj.Oroundwater level
PERCOLATION TEST bete 3-5-db Thne u AM
Observation t
Hole# Time at 9"
Depth of Perc =8M'`w Time at 6" r'
N
Start Pre-soak Time @ 1ti: fir^ Time(9"-6") _-
End Pre-soak M.1lS Puh
Rate MinJlnch Z ,F�. o
Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) ~ r
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:\SEPTICIPERCFORM.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,% vel) .
0-A �Iw
-2$ 13 t6jo- S le
Z$- 124> C, MW. cowl S406 �ooSE• v M ce�.oP,s
1%04gS". 10b"
DEEP OBSERVATION HOLE LOG Hole# 1
Depth from Soil Horizon Soil Texture -Soil Color r Soils + t � Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.% 1
o_ty
Iz6 L $' Y b !R4 Loo**,kV-%2*GgW COLO"
- (W
DEEP OBSERVATION HOLELOG Hole#
Depth from Soil Horizon Soil Texture Soil Color 'Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
` Consistency.%Orave
Al
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color 'soil : Other
Surface(in.) (USDA)' (Munseli) Mottling (Structure,Stones;Boulders.
ons' en
'
Flood Insurance Rate May:
Above 500 year flood boundary No— Yes'._:_____
Within 500 year boundary No Yes '
Within 100 year flood boundary No •� Yes
Depth of Naturally Oceurrina Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption syatem? YES
If not,what is the depth of naturally occurring pervious material?
t
Certification
I certify that on /a-17—?9 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise a d experience described in 10 CMR 15.017.
Signature
Date
Q WEPTIC�PERCFORM.DOC
X�v
U
No. 2�b�f 3 / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migpool bpgtem Congtruction Permit
Application for a Permit to Construct( : )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ® s Owner's Name,Address and Tel.No.
1 , '7
Assessor's Map/Parcel � _ '�'�a►'+^�S ,, A� '���� ����/�e�
Installer's N e,Address,and Tel.No. b�h✓✓p,� S Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
0
Nature of Repairs or Alterations(Answer when applicable) 4&W 6 S
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental.Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Boar f ealth. ,
Signed ��`/ Date 0
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
--- — ---- —————————
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS "Entered in computer: l/
r f Yes Q
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
w
Zfpprication for Miopooal 6potem Con6truction Vermit
Application for a Pen-nit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. �'/ o S � Owneros Naame,Address and Tel.No.
Assessor's Map/Pazcel 2^�J a T 5 � ' (I ��J( .4
Installer's Name,Address,and Tel.No. a r1 N S eQ, Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
s..
1 Other Type of Building No. of Persons Showers( ) Cafeteria( )
'Other Fixtures
Design Flow t gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets w Revision Date
Title `
Size of Septic Tank Type of S.A.S.
Description of Soil r
i
Nature of Repairs or Alterations(Answer when applicable) �il�✓
Date last inspected:
Agreement: -
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal-system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Boar ff ealth. /A
Signed �//I�/ " ���1 e� Date
Application,Approved by Date � 3d
Application Disapproved 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 SewagF Disposal System Constructed( Repaired Upgraded( )
Abandoned( )b5y ( >N s2 ^r+
�'A �����p,-, ^ iSI�Cr has been const ct d in accordance
with the provisions o Title 5 ari the for Disposal System Construction Permit No.? 32 7 dated 5
Installer V 0 /1 .�1 ' ��� Designer
The issuance ofethis pet°mi shall not be construed as a guarantee that the syste _will function as designed.
Date f�� _ Inspectorb
—2��-327 -----------------————————
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Xh5pogat *potem Construction 3permit
Permission is hereby gzar►ted,tq Construe,( Q)RePPT( ~�p rade ( )Abandon( )
System located at _ �r� / QAA, a
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons ction must be completed within three years of the hate of this permit.
Date: C �� Approved by c � _�
rS
"� mo
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. 'A Business Certificate ONLY REGISTERS YOUR NAME in
town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town
Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall).
DATE: W-- o7—a5
Fill in please:
APPLICANTS YOUR NAME: fi•R D, p4 A
BUSINESS YOUR HOME ADDRESS: o y e- _ i s _ mom- 6o /
TELEPHONE # Home Telephone Number: 5-0 ® .
NAME OF NEW BUSINESS ; +N '� e v' - TYPE OF BUSINESS i(('
1S THIS A HOME OCCUPATIONS YES t0 f� tV Ck �t^1a�Y►
(� �
Have you beers given a ppr4val from #I1a bulld�rtg clrvrs�or�? YES NO Q lr S L{ ce'
ADDRESS OF BUSINESS a. Y �. rvr m MAP/PARCEL' NUMBER
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business
in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
2. BOARD OF HEALTH
This individual s een info Z
f tMperitsequirements that pertain to this type of business.
Authorized Si a ure"
COMMENTS: 9 w
,v e'Aia
3. CONSUMER AFFAIRS (LICENSING AUTHOR
This individual h en Tnfo d of t " i '' s' reggir,errjents that pertain to this type of business.
Authorized Signature] rt.i`-, qt
COMMENTS:
Date: i 0 0`1—
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: �N N ��'
BUSINESS LOCATION: 3 oYIKL A- y(f, -
MAILING ADDRESS: 4 rl G Mail To:
TELEPHONE NUMBER: 'W F- -1 cl 0- 5 4 o Board of Health
Town of Barnstable
CONTACT PERSON: _ y r'j C� n`I .� P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: `1 1 LI D,C _ "7 r a . Hyannis, MA 02601
TYPEOFBUSINESS: C- O nn gvTP ✓
i
Does your firm store any of the toxic or hazardous materials listed below, either for sale,or for you own
use? YES (N0) �J-y
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing
address:
ADDRESS:
TELEPHONE: A
LIST OF TOXIC AND HAZARDOUS MATERIALS f 'The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite) .
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
I Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine.
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED ( nc._carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor& furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers � Other products not listed which you feel
(including bleach) / /may be toxic or hazardous (please list):
Spot removers & cleaning fluids / A
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
-aa (0
COMMONWEALTH OF MASSACHUSETIS '"` .
EXECUTIVE OFFICE OF ENVIRON�itN, PL AFFA�F,�B�
d DEPARTMENT OF ENVIRONMENTAL P640CsTION�
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 8 Orr's Avenue PARCEL ASSESSORS MAPNO'
Hyannis MA 02601 NO;
Owner's Name: Paulette Theresa
Owner's Address: Same
Date of Inspection: May 24,2004
.Name of Inspector: PATRICK M. O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailing Address: 189 CAM METT ROAD
MARSTONS MILLS MA 02648
Telephone Number: 508-428-1779
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of oil site sewage disposal systems. l am a %V11111no,/
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �aox�.�H OE
_ Passes
_X_ Conditionally Passes PAT m
Needs Further Evaluation by the Local Approving Authority
Fails = ELL :rn
Inspectors Signature: w Date: 5/24/2004
�1/1,11,
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments: Single cesspool needs to be abandoned per town laws excluding single cesspools from
title 5 compliant. Pipe leading to cesspool must be connected to cesspool with overflow. This process is
required to be permitted and inspected by the health dept.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of l I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 8 Orr's Ave, Hyannis
z
Owner: Paulette Theresa
Date of Inspection: May 24,2004
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 any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes: XX
Single cesspool must be abandoned.
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
f
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: S Orr's Ave,Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I 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 coliform
bacteria and volatile organic compounds indicates that the well is free fi-om pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 1 i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 8 Orr's Ave,Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_X_ Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_X Liquid depth in cesspool is less than 6"below invert or available volume is less than !h day flow
_X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
_X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (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.)
_No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
— _ 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 It of a public water supply we]I
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
A
r
Page 5 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 8 Orr's Ave, Hyannis
Owner: Paulette Theresa
(Date of Inspection: May 224,2004
Check if the following have been done. You must indicate :" es"or"no" as to each of the following:
g
Yes No
Pumping information was provided by the owner,occupant,or Board of Health
_X_ Were any of the system components pumped out in the previous two weeks?
_X_ _ Has the system received normal flows in the previous two week period
— _X_ Have large volumes of water been introduced to the system recently or as part of this inspection?
_X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_X_ _ Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out'?
X_ _ Were all system components,excluding the SAS, located on site'?
_X_ _ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum :'
_X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
_X_ Existing information. For example,a plan at the Board of Health.
_X_ _ Determined in the field(if any of the failure criteria related to Pail C is at issue approximation of
distance is unacceptable)[310 CMR 15.302(3)(b)]
Ph
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
t
Property Address:8 Orr's Ave,Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
Number of current residents: l
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Two years consumption: 51,000 gal.=70 gpd.
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIALANDUSTRIAL
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 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records: Pumped two years ago. Pumped June 25,2004
Source of information: Owner
Was system pumped as part of the inspection(yes or no): Yes
If yes, volume pumped: _1000_gallons-- How was quantity pumped determined? Cesspool Size
Reason for pumping: Cesspool inspection( Right Main Cesspool)
TYPE OF SYSTEM
__Septic tank,distribution box,soil absorption system
_X_Single cesspool
_X_Overflow cesspool
_Privy
Shared system(yes or no)(if yes, attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank —Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1964+/-
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address: 8 Orr's Ave, Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
BUILDING SEWER: X (locate on site plan)
Depth below grade: V
Materials of construction:_X_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line: 30'
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: No (locate on site plan)
Depth below grade: -
Material of construction: concrete_metal_fiberglass__polyethylene
—other(explain) _
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: -
Sludge depth: -
Distance from top of sludge to bottom of outlet tee or baffle: -
Scum thickness: -
Distance from top of scum to top of outlet tee or baffle: -
Distance from bottom of scum to bottom of outlet tee or baffle: -
How were dimensions determined: STICK WITH HINGE FLAP.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
GREASE TRAP: No (locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal__fiberglass__polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping: _
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Page 8 of I 1
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Orr's Ave,Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan)
Depth below grade:
Material of construction: concrete metal __fiberglass polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: No (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
PUMP CHAMBER: No (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
• n
Page 9 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Orr's Ave, Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_ leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
_leaching fields,number, dimensions:
_X_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.): Observed approximately 3"standing water in overflow pit
CESSPOOLS: X (cesspool must be pumped as part of inspection) (locate on site plan)
Number and configuration: One single and one with overflow
Depth—top of liquid to inlet invert: 8"
Depth of solids layer: 3"
Depth of scum layer: 0"
Dimensions of cesspool: 6'dia. x 6' deep
Materials of construction: Block
Indication of groundwater inflow(yes or no): No
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Single cesspool empty,other cesspool liquid level at bottom of outlet pipe
PRIVY: No (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
r
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Orr's Ave, Hyannis
Owner: Paulette Theresa
®ate of Inspection: May 24,2004
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.
Orr's Avenue
Js
21 �
32.
12 l3
Single cesspool to be abandoned
Cesspool w/overflow
Page I 1 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 8 Orr's Ave,Hyannis
Owner: Paulette Theresa
Date of Inspection: May 24,2004
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water: More than 12 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
_X_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:
Augured hole 12' deep no water observed.
COMMONWEALTH OF MASSACHUSETTS
ExECUTIVE,,.OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT.OF ENVIRONMENTAL PROTECTION
r '
TITLE,.5_
OFFICIAL INSPECTION:FORM-NOT FOR YOLUNTARY AS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:. RECEIVED
Owner's Name:
Owner's.Address:
MAR 2 6 2002
Date of Inspection: A�ofj TOWN OF BARNSTABLE
HEALTH DEPT.
Name of Inspector: please rint).
Company Name MAP
Mailing Address: .p ! " PARC�
A cQe
Telephone Number:� _�'7/ LOT
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal.system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my.
training and experience in the proper function and maintenance of on site sewage disposal systems.I.am a DEP
approved system inspector pursuant to Section 15.340 of.Title 5,(310 CMR 15.000). The system:
y Passes
Conditionally'Passes
eeds.F rther Evaluation by the Local Approving Authority.
' ails
Inspector's.Signature: / Date: fear
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared.system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the.
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and.Comments 4/0.. /471ero,r re- eSS��'l
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will.perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/1.5/2000 page 1
J , P
Page 2 of I i
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: V
OAP�,,O_
Owne
Date of Inspection:
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 any of the failure criteria described in 310 CMR
15303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or morst niponents as described in the"Conditional Pass"section need to be replaced or
repai !TreAe system,upon ccfayletion of the replacement or repair,as approved by the Board of Health,will pass.
s
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is-structurally
unsound,exhibits substantial infi`Itration or exfiltrati'on or tank failure is imminent. System will pass inspection if the
existing`tank is replaced with a complying septic tank'as'approved by the Board of Health.
*A metal septic tank will pass inspection.if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due.to broken or
obstructed.p ipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection if(with_
approval of Board of.Health):
broken'pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system.required putnping more than 4 times ayear due to broken or obstructed pipe(s).'The system will
pass inspection if(with approval of the Board of Health):.
broken pipe(s)are replaced
obstruction-is removed
ND explain:
2
r
Page 3 of 1'1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
0
Owner,•
Date of 5spection:
C. Further Evaluation is Required by the Board of Health:
Conditions.exist which require further evaluation by the:Board of Health in order to determine if the.system'
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health.determines in accordance with,310 CMR 15.30.3(1)(b)that the
system is not functioning in manner,which.will,protect public health,safety and the environment:"
Cesspool or privy is.within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland.or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier, if any).determines that the
system is functioning in a.manner that protects the public health,safety and environment:,.
The system has a septic tank.and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water su 1 pp y or tributary to a surface water supply,
_ The system has a septic.'tank and SAS and the SAS is within.a.Zone I 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 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 tothis form.
3. Other:
3
Page 4 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLi1NTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Q,-
Owne '
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 N
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or pon'd.ing 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 '
oftimes.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 I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private,water supply well.
Anyportion 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 D.EP certified laboratory,for coliform.bacteria and volatile organi.c.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.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct_the failure.
E. Large Systems:
To be considered a.large.*system the system must serve a facility with a-design ilow 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 above)
yes no
the system js 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
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
f "
Page 5 of 1.1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owne
Date of ainspeycti�on:
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
_ Pumping.information was provided by the owner;occupant;or Board of Health
Were.any of the system components pumped out in the previous two weeks
_ Has the system received normal flows in the previous two week period?
JZHave 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)
V _ 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?
i� 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 beendetermined based on:
Yes no
_ �xisting 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 1 l
OFFICIAL-INSPECTION-FORM=NOT FOR VOLUNTARY ASSESSMENTS
. .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI.ON-FORM
PART C
SYSTEM INFORMATION
Property Address:
OwnekD
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(:design): : Number of.bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (fo example. 11.0 gpd x#of bedrooms):��
Number of current residents•
ee
Does residence have.a garbage grinder(yes.-or no}�- 'r
Is laundry on a separate sewage system (yes or no --[if yes separate inspection required)
Laundry system inspected(yes or n
Seasonal use:(yes or no):
Water meterreadings;i ale(last 2.years usage.(gpd)):
Sump pump(yes or n -
Last date of occupancy:
COMMERCIAVINDUSTRIAI,,,& --
Type of establishment:.
Design flow(based on 3I0 CMR:15.203): or
Basis of design flow(seats/persons/sgft;etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):.._
Non-sanitary waste discharged to the Title 5 system'(yes or no):
Water meter readings, if available: _
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source<of information:
Was system.pumped as part of theiinspection.(yes or no): ,�-
If yes,volume pumped: gallons—How was quantity pumped determined?.
Reason'for.pumping: . .
TYPE OF SYSTEM
_Septic tank,distribution box,soil absorption system
Single cesspool,
_Overflow cesspool
_:Privy
_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
Z0tbe?-(describe): p ,0_U
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving.at the site(yes or no): L(,
6
Page 7of11
OFFICIAL.INSPECTION FORM.-NOTFOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
.SYSTEM INFORMATION,(continued)
Property Address:
Owner
Date of Inspection: V 11,4 /a--)QOa
BUILDING SEWER(locate:onsite plan)
Depth below grade:
Materials of construction: cast iron 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence ofleakage,etc.):'
SEPTIC TANK-,&&(locate on site plan)
Depth below grade:
Material of construction:_concrete—metal—fiberglass—polyethylene
—other(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a.copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee.or baffle:
Scum thickness:.
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle'.
How were dimensions'determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAlocate on.site.plan)
Depth below grade:_
Material of construction:_concrete—metal_fiberglass—polyethylene—other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM NOT"FOR VOLUNTARY ASSESSMENTS >
SUBSURFACUSEWAGE-DISPOSAL SYSTEM INSPECTION FORM
PART:
SYSTEM`INFORMATION(continued).
Property Address: �If NFL
Owner-. l
Date of Inspection: .41�2
TIGHT or HOLDING TANK. bank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass Polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION`BOX/'"" (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUMP CHAMBER (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note concsrt�onof pump chamber;condition of pumps and appurtenances;etc:):
8
Page 9 of 11
,
OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY,ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM IN.F.ORMATION(continued)
Property Address:
Owner
Date of Inspection: C�rJc�
SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required)
If SAS not located.explain why:,
Y.
Type
leaching..pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
le hing 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,
\ '
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: ZO-00 RTC
Depth—top of liquid to inlet invert:
Depth of solids layer: 0//—gl'
Depth of scum layer: e)'�- A
Dimensions of cesspool:_ .1)( g '
Materials of construction: (v'`X 9"'
Indication of groundwater inflow(yes or no
Comments(note condition of soil,.signs of by raulic failure,) el of ponding,condition of vegetation,etc.):
//042VA, 1,id' p"n
ape
PRIVY-(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
k
Page 10 of 11
OFFICIAL,INSPECTION FORM-.-;NOT FOR,VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION`FORM
PART.0
SYSTEM INFORMATION(continued)
Property Address:
Owner•. �
Date of Inspection: LP /0�
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.
'd
10
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address:
Owner
Date of Inspection: V
SITE EXAM.
Slope
Surface water
Check.cellar
Shallow wells
Estimated depth to ground water /6 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from.system design plans on record-if checked,date of design plan reviewed:
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)
Vy Accessed USGS database=explain:
You must describe how you established the high ground water elevation:
11
Permit.Number: Dater
Completed by:
HIGH GROUND-WATER LEVEL.COMPUTATION. !/
Site Location: b (�' �� /f" C��i � Lot No.
Owner: ®Q �p�l�l�/f Address: Af
Contractor: Address: C7H ��S�`l1/� ✓�P/�S�DS�"
Notes
STEP 1 Measure depth towater table
to nearest 1/10 ft. ............ .................................... .......; . :.... .....,....:.. .Date.:
month/day year.
STEP 2 Using Water-Level Range Zone
and;Indez WelI Map locate._
site and determine:
OAppropriate.index well..................
OB Water level range zone ..... .........
STEP 3 Using monthly report"Current Water Resources Conditions
deterrine current depth to �y
water level for index'well ...........................
month/year
STEP 4 Usi.ng Table of Water-level Adjustments.
for index well (STEP 2A)., current depth
to water level for index well (STEP 3),
and.water-level zone (STEP 26) !
determine water level adjustment ....._:............:............................:.........................................
STEP 5 Estimate depth to high water
by:subtracting the water
level adjustment (STEP 4)
from.measured depth to water
levelat site (STEP 1) ..............................................................................................................
Figure. 11--Reproducible computation form;
1
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` __.__-.._ _. _ _ W
r
TOP OF FOUNDATION - 35.0'± PROVIDE PRECAST CONCRETE EXTENSION RISER FINISH GRADE OVER D-BOX= 33.4r± FINISH GRADE OVER CHAMBERS= 33.2 - 33.5'
PROPOSED VENT WITH CHARCOAL
- WITH CONCRETE COVER TO WITHIN 6 OF FINISH FILTER TO ABOVE GRADE GENERAL NOTES
GRADE OVER INLET AND OUTLET COVERS. PLACE CAST IRON FRAME&COVER 3/4"TO 1-1/2"DOUBLE WASHED
FINISHED GRADE OVER H-20 CONCRETE RISER 4"SCHEDULE 40 PVC MIN SLOPE 1% PLACE CAST IRON FRAME& STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
@ FOUNDATION = 34.0'± INSPECTION PORT w/ H-20 ACCESS COVER OVER ALL CHAMBERS
FINISH GRADE OVER TANK EL.= 33.9± 5" DIA. OUTLETS) 2"OF 1/8"TO 1/2"
o COVER TO F.G. (SEE NOTE#21) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
SLOPE @ 2/o MIN. OVER SYSTEM DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL
<;XISTING 20"MIN. ACCESS COVER 12" MIN.
ADJUST TO REQUIRED 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
SFWFP PIPE TOP OF SAS = 31 .50' GRADEW/MIN.20RMAx.4 OF HEALTH AND THE DESIGN ENGINEER.
(TYPICAL FOR 3) 36"MAX. 9"MIN. BRICK COURSES OR
i _ PROVIDE H-20 36 MAX. 30.50' 36"MAX. EQUIVALENT DIMENSION 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
PROPOSED 4" 9 MIN. BREAKOUT EL = 31 .00' WITH REINFORCED
SCHEDULE 40 PVC CONCRETE RISER CONCRETE COLLARS. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
=- 2" DROP MIN. __ 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
- MIN.SLOPE 0 t% 6" 3" 3" DROP MAX. 3 9" o ELEVATION = 31.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
-.
� _ UPROVIDE WATERTIGHT o 0 0
1 O" JOINTS (TYP.) O 0 A 40 MIL GEOMEMBRANE LINER IS PLACED AT LEAST FIVE FEET FROM S.A.S.AND THE TOP
14" ' 4" PVC IN FROM o o OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
s2.0'_+. 31.50
SEPTIC TANK O 4 PVC OUT TO o o C: 00 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
LEACHING FACILITY o
31 .75' �0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
12" 2� 0 D O D O 0 0 °O o 0 0 0 0 0 00
OUTLET TEE r , 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO
48" 30.85 MIN. 30.6$ 00 0 o BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR
10.0' FROM FND. 22"ZABEL FILTER 6"CRUSHED STONE ! o0 0 0 0 0 0 00 CD 0 0 0 0 0 o INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING
(PROP. PIPE LENGTH =9±) MODEL#A1801-4x22 OVER MECHANICALLY - APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER.
(GAS BAFFLE ON BOTTOM) 5 TYP.)COMPACTED BASE 4.0 8.5'(TYP.) 4 0 3.55' 4 9' 3.55' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L DATUM OF 35.00'
6" CRUSHED STONE
TO BE INSTALLED ON A LEVEL STABLE < 23.20' 12.0'
ESTABLISHED ON A NAIL SET IN A TREE AS SHOWN ON PLAN.
OUTLET DISTRIBUTION BOX 25.0' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
* (
OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET 28.50' GROUND WATER ELEv.= THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
COMPACTED BASE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 2 - 500 GAL. H-20 CHAMBERS CHAMBER END VIEW DISCREPANCIES TO THE DESIGN ENGINEER.
LENGTH 10.50' WIDTH 5.67' DEPTH 5.67' CROSS SECTION VIEW 5 MIN.
�+ f �^y BOX
TYPICAL PROFILE p C E 10- ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
SEPTIC TANK PROFILE DIMENSIONS PER WIGGINS H-20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS *G.W. EL.=17'± PER TOWN OFBARNSTABLE STRUCTURES SHALL BE MADE WATERTIGHT.
*CONTRACTOR TO VERIFY NOT TO SCALE PRECAST CORP., POCASSET, MA NOT TO SCALE NOT TO SCALE 1992 GROUNDWATER CONTOURS MAP 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
NOTE: T ST PIT DATA DETERMINATION FROM APPROPRIATE AUTHORITY.
1.) MAGNETIC MARKING TAPE SHALL BE °
PERC#: 12137 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
PLACED ALONG THE TOP EDGE OF EACH LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
SEPTIC SYSTEM COMPONENT. " M ® INSPECTOR: Donald DesMarais THEY SHALL WITHSTAND H-20 LOADING.
SOIL EVALUATOR: Michael Pimentel, E.I.T. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
-F a DATE: March 5, 2008
FINES.
��;• TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
•w ELEV TOP= 33.40' LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
• i ELEV WATER- <23.40' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
ACCORDANCE WITH 310 CMR 15.255(3).
MAP 290 PERC RATE _ <2 MIN/IN 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
W LOT 66 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
DEPTH OF PERC= 28"-46"
a j-
16. PROPOSED PROJECT IS LOCATED WITHIN:
TEXTURAL CLASS: 1
S82°56'00 ASSESSORS MAP 290 PARCEL 67
39 w "E --- --
m o 0 174.22' 0" 33.40' OWNER OF RECORD: ELIZABETH M &GUARACI QUARENTEI
I o o Benchmark
MAP 290
o^ °) Nail in Tree LOT 171 Fill ADDRESS: 8 ORRS AVENUE
�Z Elev.=35.00' _ ' 14" 32.23' HYANNIS, MCA 02601
Approx.M.S.L. B Loamy Sand FEMA FLOOD ZONE
10Yr 5/6 AS SHOWN ON COMMUNITY PANEL# 2500001 0006 D
3 28" 31.07'
PROPOSED PVC VENT PIPE; LOCATION o �,� 17. DEED REFERENCE:
TO BE DETERMINED BY OWNER MAP 290 o N " Perc BOOK 19605, PAGE 186
LOT 67 M MAP 290 46" _ram 29.57'
f N �� 18. PLAN REFERENCE:
PROPOSED 2-500 GALLON 24,200 S.F. ± LOT 170 PL. BK. 130, PAGE 43
TREELtNE LEACHING CHAMBERS (H-20) 0 � • � Medium-Coarse Sand
11 2.5Y 6/6 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
33. _ • C (Loose;Variegated 20. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. THIS PLAN IS TO BE USED ONLY
DIRT DRIVE x33. 33.5 100.89. • I colors start at 85"and FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
5 _ 25.41' G� N end at 108") FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
°
27.0' ( 25.0' (4) Sg1 p410 W �p I 21. A 4" PERFORATED SCH.40 PVC PIPE SHALL BE PLACED N'N A VERTICAL POSITION TO A
33.1 x _ 75 48 • G DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
TP 2 O O '- TP 1 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
33.2' 33.4' PROPOSED DISTRIBUTION BOX (H-20)
(6 (3) 120" 23.40'
U.P.#666/1 LOCUS PLAN
C� l 33.6 No Standing, Weeping, or Mottling Observed
3x 33.6x rn SCALE: 1" = 1000'
LP 33.7x EXISTING CESSPOOL & OVERFLOW
LEACHING PIT TO BE PUMPED AND TEST PIT DATA
FILLED WITH CLEAN COARSE SAND
PERC#: 12137 LEGEND
CP
EXISTING SHED j DESIGN DATA INSPECTOR: Donald DesMarais
SOIL EVALUATOR: Michael Pimentel EIT
34 , E.I.T.1 � X100 EXISTING SPOT GRADE
�)C HC-3 HC-2 { DATE: March 5, 2008, 100 EXISTING CONTOURS
TEST PIT#: 2
c
MAP 290 102 PROPOSED CONTOURS
G W t �0.0' 12.2' PROPOSED 1500 GALLON NUMBER OF BEDROOMS 3
z (2) LOT 68 DESIGN FLOW 110 GAUDAY/BEDROOM ELEV TOP= 33.20'
` ' O SEPTIC TANK
102 PROPOSED SPOT GRADE
W co ` TOTAL DESIGN FLOW 330 GAUDAY ELEV WATER= <23.20'
#$ �' (1) = W ---- -W EXISTING WATER LINE
Z -- EXISTING CLEANOUT DESIGN FLOW X 200 % = 660 GAUDAY PERC RATE
p
Q } EXISTING N (n
C) USE PROPOSED 1500 GALLON SEPTIC TANK DEPTH OF PERC = ❑/H/W - EXISTING OVER-HEAD UTILITIES
Q WO wv 1 3-BEDROOM _ N
U) "�a DWELLING o o _ TEST PIT LOCATION
l V ) - o TEXTURAL CLASS: 1
v TOF = 35.0'±
D m INSTALL 2 - 500 GALLON H-20 CHAMBERS 0" 33.20' O O O PROPOSED 1500 GALLON SEPTIC TANK
y. PATIO Fill
< "�'\ SIDEWALL CAPACITY 14 32.03
B PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
" Loamy Sand 0 PROPOSED H-20 DISTRIBUTION BOX
-'f zz BIT DRIVE (LENGTH +WIDTH)(2)(2' HIGH) (0.74 GPD/S.F.) = GAUDAY 10Yr 5/6 0 PROPOSED 500 GALLON H-20 LEACHING CHAMBER
> �
� w (25.0'+12.0') (2)(2') (0.74 GPD/S.F.)= 109.5 GAUDAY 28" 30.87'
co
E w EXISTING CESSPOOL
LL O `° "-' HC-1 (ABANDONED PER TITLE V BOTTOM CAPACITY
Ili INSPECTION DATED 5-24-04)
of �33'� Medium-Coarse Sand
I ( LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY
2.5Y 6/6
(25.0'x 12.0') (.74 GPD/S.F.) = 222.0 GAUDAY REV. DATE BY APP'D. DESCRIPTION
C
(Loose;Variegated -- __ __ __ . _ __ __._
1 BIT DRIVE colors start at 85"and PROPOSED SEPTIC SYSTEM UPGRADE
end at 108")TOTALS: PREPARED FOR:
�
<� CAPEWIDE ENTERPRISES
� TOTAL NUMBER OF CHAMBERS: 2
"'
°
S873300W
TOTAL LEACHING AREA: 448.0 SQ.FT. LOCATED AT
65.00' TOTAL LEACHING CAPACITY: 331.5 GAL./DAY 120" 23 20 8 ORRS AVENUE
SWING TIES ; \ No Standing, Weeping, or Mottling Observed HYANNIS, MA
DESCRIPTION HCA HC-2 HC-3 V-EDGE OF PAVEMENT
SEPTIC COVER IN (1) 59.6' 23.9' - MITCHELL'S WAY
RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: MARCH 10, 2008
0 10 20 40 80 FEET
SEPTIC COVER OUT(2) 67.3' 17.2' - (40'WIDE LAYOUT)
fy-jH OF 4ta_
LEACHING CORNER 3 - 36.7' 44.3' ?� L
a� JOHN L. o� PREPARED BY.
( ) CH JRRCHILL JC ENGINEERING, INC.
LEACHING CORNER(4) - 48.7' 54.8' No a 807 2854 CRANBERRY HIGHWAY
LEACHING CORNER(5) - 55.7' 49.2' EAST WAREHAM, MA 02538
LEACHING CORNER(6) - 45.6' 37.2' SITE PLAN 508.273.0377
SCALE: 1"=20' Drawn By: BSM j Designed By:MCP I Checked By: JLC i JOB No.1385
ii�''