The URL can be used to link to this page

Home My WebLink About0026 PRAM ROAD - Health 26 PRAM ROAD HYANNIS z A = 268 046 iF TAD W1 d7]F A.BLNS' %.0 SEW 'GE 1-OCA VON SSESS®It S MA1' i.lLC1T SEPT T t".AIP�CIfiY . I C%%tNG'K�I�C%�LIT Y hype) �-e .: (sxxe) r-�� j NO,,CDF Dr kGQmS --» PERMIT e,.r . _,. :�.�.w.::CC�11 �C YA1�J 1��T •.�,„ ,�.._ ._....,�= S��rarataog►I��aeruanr�cstvre�cr tie ,. tvtnxljx►uru/.d' d' sect %'alv 8c��JJt►e��Su�(y!J �,(c�l`:a�tic3%:caGS�iug�?acility �qy ivf+89s�xisz due � u sst�oc ev�thsn;�0p feet uf�t�ach.�ea%;far'al�t},) ._._... i clj i^cy Vrl t�az�r9 and lL6�cOjljj Facill¢y GL;awry wc(paaid�, Al 1C urdl3ktrd by I O _-7 v � J TOWN OF BARNSTABLE .LOCATION I'M AM R V SEWAGE # Zovi 3 VILLAGE T/LL 1)/AA4&YS D o Rf , ASSESSOR'S MAP & LOT Z INSTALLER'S NAME&PHONE NO._✓, A1 A C B A if elf' S CAI SEPTIC TANK CAPACITY �m ® LEACHING FACILITY: (type)AZ d WC11Az1&f 1V (size) SB, GAl NO. OF BEDROOMS 3 D BUILDER OR OWNER PERMITDATE: y /S—- Zoo/ COMPLIANCE DATE: ZZA>I Separation Distance`Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility .(If any wells exist li on site or within 200 feet of leaching facility) Feet of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� o �` �`b,` 1$, ._ � ► \ G � . \, , �� \ e ' - �,\ - - � \ �� 9h ati � � . _ _, - � . � � i � �� + ; .� TOWN OF BARNSTABLE . LOCATION Pro-'ln AA SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ac e--S I .� 1 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished b< InJ ]l:u..�`- % ��-Z 0, t� `p J J b i C� 3 - \ y ^j V a � it 7c) Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_ M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis . MA 02601 3-18-14 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. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 CitytTown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ®, Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation y the Local Approving Authority 3-18-14 Inspector's Signature Date The system inspector shall submit a copy of this•inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5ins-3/13 Title 5 Official Insp 'on VForm:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 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: System is in good working order with no sign of failure. 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. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. CitylTown , State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑' ND (Explain below): ❑ obstruction is removed ❑ Y : ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts " Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *. This asses analysis,system if the well water anal performed at a D P y p y , p E certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or ® clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below_ invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. I ❑ "® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑' ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence _of,ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. . E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 26 Pram Rd M Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection C. Checklist i Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No N.: ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ - Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ElY Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information . Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN.flow based on 310 CMR=15.203 (for example:-110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 26 Pram Rd b Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. Cityrrown State Zip Code Date of inspection D. System Information Description: Number of current residents: 1 Does residence have a,garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) ' Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow_(based on 310 CMR 15.203): Gallons per day(gpd) r Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Pram Rd Property Address Linda Ryan ` Owner Owner's Name information is required for every Hyannis f ' f MA 02601 3-18-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2008 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: , gallons How was quantity pumped determined? Reason for pumping: Msaintenance 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/Altemative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments qM 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" at tank inlet feet Material of construction: ❑ cast iron _ ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 14"_ feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness R . 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top"of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection: Form Subsurface Sewage Disposal System Form,.-Not for Voluntary Assessments 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 .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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts .j Title 5 Official Inspection Form Subsurface Sewage Disposal System'Form --Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) .: Distribution Box (if present must be opened) (locate on site plan): , Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes' ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ 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.): Leach chambers in good condition and holding 6"of water with no visible stain lines. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments wM 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _ Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately v d ron f p Do A-c- i,; i3 ,c- I-ld rt 446 s i t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts .' Title 5 Official Inspection form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Pram Rd Property Address Linda Ryan Owner Owner's Name information is required for every Hyannis MA 02601 3-18-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 4v, em T0VW0FB: "y LOCATION, 001 , SEWAGE # --ZCT'D[ VILLAGE#AIA"IS y,O OX 1- ASSESSOR'S MAP & LOT INSTALLER'S NANM.&PHONE NO. T1*O- A4,4 C 0 if eX- S 77 SEPTIC TANK CAPACITY -LEACH1246 VACIL (size) J-00 6.4,e- : NO. OF BEDROOMS UIL WNE B DER MO R 77 COMPLIANCEt:-`bkM--': :p D � eparaton Distance Betweefiffie-. mum' Adjusted": ter e &Bottom oft Mai'iGrbundwA Tabl' i o,t Facility % Private W ater Supply NcIAnd Leach,ifig Facility (If any w. eL ils,exis on tr within 200leet of Ieadlung aciIity. , Feet ....... E4e6f Wetland and ac ingac6. nyw�tl wetlands.t �witWn 300-feet:o'f le ac t hingfkili.y) F ' ee ,,:��., t f. 4711 F sh-d'b is b J., oe 777777= 0 NoA ,01'- F7� Fee$ 50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migpooal 6pe;tem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 26 Pram Road Owner's Name,Address and Tel.No. Linda Ryan West Hyannisport,Mass. 26 Pram Road Assessor'sMap/Parcel 71 6, Q lif West Hyannisport,Mass.02672 Installer's Name,Address,and Tel. 5 0 8—77 7G50—3 3 3 H Designer's Name,Address and Tel.No. 5 0 H—7 7 5—3 3 3 H J.P.Macomber & Son Inc J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XX)Io.of Bedrooms 3 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 Loamy sand to medium fine sand Na ogRep or Alterations(Answer when applicable) Omitting cesspools. Installing 1-1 ga lon septic tank; 1-Distribution box and 2-500 gallon leaching chambers packed in 4 ' of 1l " stone_ 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 Envi onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this o 4d o e Signed - Date 6/1 3/01 Application Approved b Date f, d � Application Disapproved he following reasons Permit No Date Issued $a b 1 yR i No. '�'LJ�r / Fee 5 0.0 . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ��•r ZippYication for Mi5paal *pgtem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XIComplete System El Individual Components Location Address or Lot No. 2 6 Pram Road Owner's Name,Address and Tel.No. Linda Ryan y West Hyannisport,Mass. 26 Pram Road I Assessor's Map/Parcel West Hyannisport,Mass.02672 �`. r s ame,Ad ss,and Tel.No. 5 0 8-7 7 5-.3;3 3 8 Desi ner's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8 . t: .MNacoer & Son Inc J.gP.Macomber & Son Inc. Box 66 Centerville,Mass.02632'" c' Box 66 Centerville,Mass.02632 4 r' Type of Building: ' Dwelling XXXNo.of Bedrooms 3 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 V" Revision Date Title Size of Septic Tank Type of S.A.S. r-- Description of Soil Loamy sand to medium fine sand. hh f-ff� Omitting cesspools. Installing iat d Rgepalrfor t ea%1 C( an whe a c ble) s ri u ion box an — 00 gallon leaching chambers packed in 4 ' of 1�" stone. ;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 issu by this d of44' Signe Date 6/1 3/01 Application Approved b Date Application Disapprove r the following reasons Permit No. '045� :-- Date Issued /37 .� --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS CCrtificate of Compliance` THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repairb ( )UpgradeAXX� :- Abandoned( )by J.P.Maeomber & Son Inc. at 26 Pram Road West Hyannis Ort Mass. has been constru ted in a-ccordance with the provisions of Title 5 and the for Disposal System Construction Pe I '' -.7 ZJ dated '" At- Installer J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Designer The issuance of this oernlit sh 1 not be construed as a guarantee that the syste ill f a designe Date Z/G Inspector - t y ------------------------------------- $ 50. - 00 1 /� - No �¢ � �/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwi5pooar bpotem Con0truction Permit Permission is hereby granted to Construct( )Repair( )UpgradAXX)Abandon( ) System located at26 Pram Road West Hyannisport,Mass. his/her duty to or Disposal System Construction Permit.The applicant recognizes and as described in the above Application f s ppy P Y ' comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date oft. ., )Sate: 4��' � Approved y 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) Joseph P.Macomber Jr. hereby certify that the application for disposal works construction permit.signed by me dated 6/1 3/01 concerning the property located at 26 Pram Road West Hyanni sport,Mass. meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. •I The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. +� There are.no wetlands within 100 feet of the proposed septic system v There are no private wells within 150 feet of the proposed septic system There,is no increase in flow and/or change in use proposed JThere are no variances requested or needed. 11 The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A_.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(cuing GIS information) y off' B) G.W. Elevation �� +the MAX. High G.W. Adjustment. f 9, DIFFERENCE BETWEEN A and B 3 3 L SIGNED : d/Xo�ee .'X DATE:6/1 3/01 ' (Sketch 441sed plan of system on back). Q:health folder,em w Yowl ' f 1 � - 96 TROY WILLIAMS f' t p SEPTIC INSPECTIONS I 001- so Certified *MA Department of Environmental Protection ,a To11,�,t 9gcf Z; (508) 385-1300 A., 19 Hummel Drive , South Dennis, MA 02660 �n `Ft COMMONWEALTH OF MASSACHUSETTrS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS COPY r DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET, BOSTON, MA 02108 617-292.5500 WILLIAM F.WELD TRUDY COaE Govemor Secrctan• ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION e+r6 P,,,iat Rd. LJ. 1-Iynr,n y ��+'t Property Address: Address of Owner: Date of Inspection: 1042,2 /98 Of different) Name of Inspector: Troy Williams h,S L J, f k d s Rct 1 am a DEP approved sjem inspector pursuant to Section 15.340 of Title 5(310 CMR 1S.000) Company Name: Troy Wi I I lams Septic Inspections /Vo/Ai ,j fp,,,.( '44 MailingAddress: _19 HUMMpl Drive , South Dennis , MA 02660 Telephone Number: 15-0-8T3.8.5-1.3-0.0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: '(/✓ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: AJ SYSTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If'not determined% explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector w$h a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (—i—d 04/25/97) Paq• 1 of 10 A ` Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 26 Pram Road, West Hyannisport,MA Property Address: Thomas Nolan Owner: October 22, 1998 Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) /V/,9 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Pram Road,West Hyannisport, MA Owner: Thomas Nolan Date of Inspection: October 22, 1998 D) SYSTEM FAILS: /v/9 You must indicate ewer "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure.criteria as defined in 310 CHAR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within too feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet front a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 2.00 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 If of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further.information. (r—ised 04/25/97) _ _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 26 Pram Road,West Hyannisport,MA Property Address: Thomas Nolan Owner: October 22, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yeses No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal A flow rates during that period. Large volumes of water have not been introduced into.the system recently or as part of this inspection. _/ As built plans have been obtained and examined. Note if they are not available with N/A. .Y _ The facility or dwelling was inspected for signs of sewage back-up. V1/. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _ )jZ1*9 The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material•o(construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. A/l9 Existing information. Ex. Plan at B.O.H. JE _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J (-i-d 04/2%/91, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 26 Pram Road,West Hyannisport,MA Owner: Thomas Nolan Date of Inspection: October 22, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: O Garbage grinder(yes or no):.ZV0 Laundry connected to system (yes or no): VC S Seasonal use (yes or no): YGS Water meter readings, if available (last two (1)year usage (gpd): Sump Pump (yes or no): A/0 Last date of occupancy: Q Gc C. ; ;o w 1 �y .� COMMERCIAUINDUSTRIAL• A///g Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no) Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: O y tti. ,v. 4 i H .J tt . I�.b / t -16- b w.i./ System pumped as part of inspection. (yes or no) A/o � �"� If yes, volume pumped: gallons 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) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) /V G "- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Pram Road,West Hyannisport,MA Owner: Thomas Nolan Date of Inspection: October 22, 1998 BUILDING SEWER: 'V/A (Locate on site plan) Depth below grade: Material of construction: _cast iron _ 40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: /j9 (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 Certificate of Compliance _(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 dimensions were determined: ). Comments: ! (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: /V�,9 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (rwiud 04/25/911 _ _ _ r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 26 Pram Road, West Hyannisport,MA Property Address: Thomas Nolan Owner: October 22, 1998 Date of Inspection: TIGHT OR HOLDING TANK: N/°9(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:&�j, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:�/�j9 (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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Pram Road,West Hyannisport,MA Owner: Thomas Nolan Date of Inspection:October 22, 1998 SOIL ABSORPTION SYSTEM (SAS):z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:_ 31004 . Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ^ w�. 61 w i, D 1C w.F-t —'r- AL ,L. ,.rh.t O I h 3 .S (� i.J u S ✓� s 1� �y C U Ue,r �• c, e *-L tr S dl H ,� a t ► s c n >� a v 1 c. -�. /u r w r c ✓. 1 S ft 4- CESSPOOLS: h (locate on site plan) Number and configuration: 6;n t, 1+nw h C is s/-2oa Depth-top of liquid to inlet invert: 1 . 5 1 Depth of solids layer: 3�' Depth of scum layer: 3 " Dimensions of cesspool: Materials of construction: Indication of groundwater: AID VC inflow(cesspool mustj)e pumped as part of inspection) ��h R ✓ cv �+� �� S �6 tN t iJl !�►J W m c� . /3 '1�ro✓S�, St.r. �Ly v�.ci >�e.• Comments: (not condition of soil, sips of hydraulic failure, level of ponding, condition of vegetation, etc.) S {i.✓u v/. .t c ah �Lt✓ �/a .,� n, �e �+-► I c,�- t �D Gc.f/,dov 1 a./ ►, ✓ Jf�. c_� d.: a/ Gr. �t o✓u O. ti� IJf4c w: a2 j i�v .� o.i. ++.. u W G 1, �:�..,.1� u... � � Syr�u c�( �w � O .r ✓'� PRIVY:�[�� C /1'1 t s / ti '�.� � �-S5 ,, 1 w jf rvtS, o. �-, (locate on site plan) ,o-y �,c�1t f�Uss;llp G"� w�4fr � lfl„✓' [r �o �o w /a Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (rwis.d 04/25/97) P&q• a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Pram Road,West Hyanni sport,MA Owner: Thomas Nolan Date of Inspection: October 22, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) r`Jt /g q�! .c/aw V _ w1tJ� V1 GrsSp°` I• cL�sp�� i '�-Ado-�c ��'�'h o v �,,�, Cllc S SPo o �3 1�� L. � M..:r. , ..... w. s�^c�c.r•J� S S c-; �� Sflc+ P4SS sTr�.�a itif�orL_� l7Gh! !+•,ul �+i 1 t 0.•, �c�.�r�.}-� c l I L ✓�L 1 'Tyia— /O Ctt J 'P.c' 1 3 c'�- j9 yr, a O h S/�'� C -�i..+►/�� ITh. S S !nO T v vL C.6•a-.S 7� C GA G� 1 0. VArC.t L G TZ/'�'V✓L C.o o ', . tti S � o r w o✓k.: �..� 0 X't U JC_4 df Ctss �oo .v f S Ho P✓oi6 J6 4— < 7D C.G) a2 a�..t� 0.%Itrw'ZS . (r•vi••d 04/25/97) ,tl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Pram Road, West HyannispoM MA Owner: Thomas Nolan Date of Inspection: October 22, 1998 Depth to Groundwater_ Feet adjusted high groundwatcr level Please indicate all the methods used to determine High Groundwater Elevation: / Obtained from Design Plans on record V Observation of Site(Abutting property, observation hole, basement sump etc.) -A/— Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) 14"4Id 9 . 5` � �cto �- G 5 le tJ&l,