HomeMy WebLinkAbout0121 RUDDER ROAD - Health 121 Rudder Rd
247-180 Hyannis
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
't 121 Rudder Road 2l I 1 I 5D
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is Wesel Lyannis pert:ONO ho Is MA 02672 12/07/10
required for every
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Michael Kellett
use the return Name of Inspector
key.
Aardvark Environmental Inspections
a" Company Name
P.O. Box 896
Company Address
East Dennis MA 02641
Citylrown State Zip Code
508-385-7608 SI 3742
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 by the Local Approving Authority
12/07/10
Inspect is Signature Date W i r?
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.
C
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hyannisport MA 02672 12/07/10
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.
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.
0 Y ❑ N ❑ ND(Explain below):
Commonwealth of Massachusetts
IVTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hyannisport MA 02672 12/07/10
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
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 FIND (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
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is P
West Hyannis port MA 02672 12/07/10
required for every
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 system passes if the well water analysis, performed at a DEP 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
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West HY P annis ort MA 02672 12/07/10
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.
An portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Y P P P Y P t PP Y
❑ ® 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 CM 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.
-Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is West H annis ort MA 02672 12/07/10
required for every y p
page. Citylrown 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?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hy p annis ort MA 02672 12/07/10
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes ❑ No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ® Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 08/10Date
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:
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is p
required for every y West H annis ort MA 02672 12/07/10
page. Citylrown 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:
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)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):
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Commonwealth of Massachusetts
W-112,N Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hyannisport MA 02672 12/07/10
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:
09/22/95 per BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.5
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.):
Septic Tank(locate on site plan):
Depth below grade: 0.7
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: 1500 gal
Sludge depth:
3"
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is p
required for every y West H annis ort MA 02672 12/07/10
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
Scum thickness
2"
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
16"
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was sound and tight with tees in place and liquid at outlet invert.
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hyannisport MA 02672 12/07/10
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hyannisport MA 02672 12/07/10
page. Cityrrown 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 even
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.):
The box was level and tight with no sign of carryover.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is p
required for every West Hyannis port MA 02672 12/07/10
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 6
❑ 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.):
This system has six infiltrators surrounded three feet of stone. There was no sign of ponding or failure
in the stones.
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hy annisport MA 02672 12/07/10
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
P
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West Hy p annis ort MA 02672 12/07/10
page. Citylrown 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
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is p required for every West Hyannis port MA 02672 12/07/10
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: 20.0
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: 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:
USGS maps show an elevation of over 20.0 feet
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
•Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
121 Rudder Road
Property Address
Acrivi Vlahakis
Owner Owner's Name
information is required for every West HY annisport MA 02672 12/07/10
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
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V :
TOWN OF BARNSTABLE
LOCATION /o2I U SEWAGE
VILLAGE _ ASSESSOR'S MAP & LOT �(
INSTALLER'S NAME & PHONE.NO. ��
/� MAtu C�2 ber Soh c
SEPTIC TANK CAPACITY
LEACHING FACILITY:(tyge)
NO. OF BEDROOMS' �,g PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PER ISSUBO:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No..--- ............ 0L t FEs.J....3
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Ditjipwi al lVildw Tonlitrurtion Permit
Application is hereby made for a Permit to Construct ( ) or Repaif�Vt ) an Individual Sewage Disposal
System at:
........................................--....................u................................ •------------•-----••-•--•-•----------------.....................................................
Location-Address or Lot No.
rt=.---------••-------------------------------------------------•--- ------...--------••---------------------------•-------.......--•-----------------....------...._.
owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
U
.-� Dwelling--X No. of Bedrooms.__-_-3....................................Expansion Attic ,(/U ) Garbage Grinder /K0 )
Other—Type of Building v'J"Y'`----------------- No. of persons----------3_-_----------- Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow--_3=�_-.r� ....................gallons per person per day. Total daily flow-----3.3,0--------------------_...........gallons.
WSeptic Tank—Liquid capacity.Z 5 Dgallons Length_1.L_'_6__"_ Width5._:-8-a------ Diameter---------------- Depti?'. '_ ...-.
x Disposal Trench—No. __...2------------- Width.._�.4�_._�_�� Total Length��.9_�_8 7-_----_ Total leaching area-4.fi-5.-.Z.Q-•-sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (I ) Dosing tank ( )
Percolation Test Results Performed by_----------------- ........-............................................ Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.__---_---_-__._-..- Depth to ground water........................
--------------------------------------------------------------------------------------------•------•-----•----•----......................................
0 Description of Soil.----- _ctt1 .---loa2Z---t.0....r/=sd-iL..m ,7._a i coa,7.-s_ '6anc!
x ---------------------------------------------------------- ......................................
U ..................................................----------------------•-•---------••----------------------•------------•-----•----------•---------------------------------•------...-----------------
W _
f ----------------------------------------------------------•------.- ----
U Nature of Repairs or Alterations—Answer when applicable.-.__�`:1_'_U�l _y,:_2�or. .tank_. ;, cl,6a-tict�!tf ron.
-------------------•---------....
;L?`=o?= _._?x:'_ --- s....i��----------5 ' .
- / �Agreement: V S c d," r{ 04ez.4 O- J-(O"I U"
The undersigned agrees to instafl the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian e has be is ued by the board o ealth.
Signed .. 8/3 /9 5
A
Application.Approved BY ��:?1-...../..-vl. t--..- .... - ._-.-.f
Dace
Application Disapproved for the following reasons: ............................................
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- --------
Permit No. ----------1.. .�1..�� Issued .. ...- - e......
Uare
THE COMMONWEALTH OF MASSACH4J'SETTS
BOARD OF H BALTH
TOWN OF BARNS ABLE
Appltratton for t#bipi?al Workii mitrortton remit
6 ;
Application is hereby made for a Permit to Con,t-,•uct)( ) or Repaiv� X9an Individual -Sewage Disposal'
System at: f # r '7
..,.`
1 /2udden Road lJe s t K ann-L-6 on
`.'/
............ --------------�?...
Location_Address or Lot No.
. .i:..-. .2uan ----------------------`-----------------------------------.------••---------------.--..._.----•---
Owner Address
W ,./?�-l7acomen fin.
Installer .
Address
Type of Building Size.Lot... ......... .........Sq. feet -
a dwelling-Z No. of Bedrooms...... __________________--___Expansion Attic #0 Garbage Grinder�0 )
aOther—Type of Building W---------------- No. of persons----------3........_:_____ Showers ( ) — Cafeteria
Otherfixtures .------------------------------------------------------------------------- ....
Design d Design Flow_e.. 9.... .......... ..........__gallons per person per day. Total daily flow_- 3.3.0_______.:-------__._.c--------gallons.
W_.�.
WSeptic Tank—Liquid f apacity_7.5O0galIons L ength__1.0__'_h" Widths.►8-A_-_._'Diameter----------.----- Dept la5 ..............
x
Disposal Trench—No. ____.�............. Width_..�4._____q_.. Total Length4...._$_........ Total leaching area. &5_°5n...sq. ft.
Seepage Pit No--------------------- Diameter._-._____--_-_..r_ Depth below inlet..................... Total leaching area_`:-.".....sq: ft,
Z Other Distribution box Dosing tank ( )
Percolation Test Results Performed by-------------------- ----------------------------------------------------- Date._:_................................... `
W
Test Pit No. I_______________minutes per inch Depth of Test Pit-------------------- Depth to.ground water...................:L:,
44 Test Pit No. 2................minutes per inch Depth of Test Pit__ __--*..______.... Depth to ground water_ ._.F___..
a, t �
Description of Soil ---•----•• -- -•-- --------•- ------------------------•. . ------......... ---•--- ----......_..--•---•----------- ` `
Sa,4du .foam Y-o medium and coan�e sand �
• I1 .................................................................................... ___ ...._..............t_........ ... .
v/ ..................................................... t
•-------------- ------------------------------------- -----•------------•-------------------------- --•--------- --- --- ------------- ... + *t' `
1-1500 a--2on Zank. i ... n� r�icon
U Nature of Repairs or Alterations—Answer when applicable_ ___________ _____-.-✓.-___. _--------_ _...... •k* ..
&jei_ &zaY_olt.s.. 0M t..9-XiJi n,7 C"hpOO.&J. 14 ---1 i�
Agreement: Vw ✓ ! D^t S+b►^t 0 " SCd4f �C P-v "
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System'n{�ccardance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned furthera-g ees not to place the
s system in operation until a Certificate of Compliance has been is hued by the board of"'ealth�.
' Signed ... .. .�.. ... ... .. . ...... -..:... . , 8/3a6/9
5 ,
e
Application Approved BY .... . . ��.?1. . -/.. !. - _ - '"�`.•--1'�! _.... � �. .
Application Disapproved for the following reasons: --......... _...................................... - .....--.............
_..�` ... �.
.
pp •Dace t
Permit No. ...........7. .--'" -- 2------------- Issued - .:. - ...::.-4....
'Daze
9'
• W
-.r�.�....�-�.r.�. •�t�..�- -,�.. t.b¢rpglwi,..��w•oatt a.�e..a®at=rnw tsar.a c.lu�Dt••r®,o9t•.>®ar.)'tt-—'c.Y tan ari.—..------s 'ere-- r. • .r--
THE COMMONWEALTH OF MASSACHUSETTS •.
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance �
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repa': ed� XXX
by h�-1'i'ac..o.m.�en` fin• ------ ------ ---- `----- -..--..--- -.----- �
Ifltifa��e� 4
at ...1 Z1 .Rudde2...Ro-ad_.Wezt NuanaiiPo i,Nazz, r- n
...- -
has been installed in accordance with the-,provisions of TITLE 5 of The'�State Environmertal Cod as�escribed in
the application for Disposal Works Construction Permit No. .. •S -.._-...-.- dated7./,P .
THE ISSUANCE'OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE r
SYSTEM Wt L UNCTION SATISFACTORY. , , r �'
DATE �.`.... �1 . .... ----.... Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD `"OF HEALTH , ` s
qg TOWN OF BARNSTABLE
No.... FEE ....30..
�iool orko �ua� trrtion remit . 0
Permission is hereby -'----------------------------------- ---------z ----•
to Construct ( ) or Re air ( Xx an Individual Sewage Disposal System
at No...._......_1Z� iZudc en Road 0es Kyann.Zipon�.,8a!3.6. ^ �.
--------------------------------- �`
Street �.
as shown on4 the,application for Disposal Works Construction Permit No:i`� /�/ 9 /q �
/ Z
Board of Health
DATE................. be ................................... -
FORM 3880E HOBBS 6 WARREN;INC..PUBLISHERS �.;\ t • ,' ,;n.
3' i'
Town of Barnstable
• Department of Health, Safety, and Environmental Services
a►RNIMAsu, t
6;� � Health Division
367 Main Street, Hyannis MA 02601
office: 508-790-6265 "n►omas A.McKean
FAX: 508-775-3344 Director of Public Health
May 30, 1995
Phyllis Ryan
4 Lawrence Road
Wayland, MA 01778
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
The septic system owned by you located, at 121 Rudder Road, W. Hyannisport was
inspected on April 26, 1995 by Joseph Macomber/Ronald Cadillac a Massachusetts
licensed septic inspector.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Liquid level full to the bottom of the cover(hydraulic failure). _
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OA�HE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health (_
ASSESSORS MAP NO:
PARCEL NO: e 4
t T'
,P 411 221 229
RECEIPT FQR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
N
v
Sent to
N
Street and No. JIM SATKO
a P.O.,State and ZIP Code
N 145 BUCKWOOD DR. , HYANNIS
Postage S
2.32
Certified Fee 1. 10
Special Delivery Fee
Restricted Delivery Fee
Return Receipt showing
to whom and Date Delivered 07
rn
Return Receipt showing to whom,
Date,and Address of Delivery P
m
j TOTAL Postage and Fees U' �/5 '97
2.o Postmark or Date / boo
E
0
LL
N
a
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front)
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving
the receipt attached and present the article at a post office service window or hand it to your rural carrier.
(no extra charge) !
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of
the article,date,detach and retain the receipt,and mail the article.
3. If you want a return receipt,write the certified mail number and your name and address on a return
receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per-
mits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse
RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return
receipt is requested,check the applicable blocks in item 1 of Form 3811.
IP 6. Save this receipt and present it if you make inquiry. *U.s.G.P.o.19e9-234-555
I
l
--7z
Town of Barnstable
_ BARNgI'ABf$ 1 Department of Health, Safety, and Environmental Services
6"9 �� Health Division
� 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A McKean
FAX: 509-775-3344 Director of Public Heahh
May 30, 1995
TO: Jim Satko
145 Buckwood Drive
Hyannis, MA 02601
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE,TITLE 5.
The septic system owned by you located at 121 Rudder Road, W. Hyannisport was
inspected on April 26, 1995 by Joseph Macomber/Ronald Cadillac a Massachusetts
licensed septic inspector.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Liquid level full to the bottom of the cover(hydraulic failure).
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any, order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER RDER THE BOARD OF HEALTH
homas A. McKean, R.S., C.H.O.
Agent of the Board of Health
'.ASSESSORS MAP NO:� "2
PARCEL NO: C�
Z 548'6.41 �1,59
Receipt for
Certified Mail
o No Insurance Coverage Provided
s s Do not use for International Mail
(See Reverse)
V) Sent to
O)
T
t Street and No
epr
l0
P.O.,State and ZIP Code
O
p Postage 1
0 _
E Certified Fee
O
LL Special Delivery Fee
FRestfictedLDeliveyyFFee ly
cReturn Receipt Showing ]
to Whom&Date Delivered
Return Receipt Showing to Whom,
Date,and Addressee's Address
TOTAL Postage 1
&Fees
Postmark or Date
�y� 9S
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
uZi
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and present the article at a post office service window or hand it to
your rural carrier(no extra charge).
IC
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Cl)
address of the article,date,detach and retain the receipt,and mail the article. .0
r
3. If you want a return receipt,write the certified mail number and your name and address on a 12
return receipt card,Form 3811,and attach it to the front of the article by means of the gummed cd
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT (
REQUESTED adjacent to the number. C7
O
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M
endorse RESTRICTED DELIVERY on the front of the article.
0
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL
return receipt is requested,check the applicable blocks in item 1 of Form 3811. to
a
6. Save this receipt and present it if you make inquiry. 105603-93-13-0218
Town of Barnstable
= Department of Health, Safety,and Environmental Services
RAMSTA 3M
6'0: ��� Health Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
May 30, 1995
TO: Phyllis Ryan
121 Rudder Road
W. Hyannisport, MA
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
I
The septic system owned by you located at 121 Rudder Road, W. Hyannisport was
inspected on April 26, 1995 by Joseph Macomber/Ronald Cadillac a Massachusetts_
licensed septic inspector.
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Liquid level full to the bottom of the cover(hydraulic failure).
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance
with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of
receipt of this.notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
P E HE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
` . 'Agent of the Board of Health
i
r
[Installer letter]
TO: 'P �ls (Date)
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL
CODE, TITLE 5.
bl ,
The septic system owned by you located at 12 was
inspected on �l z 1ss by�-Q�sv- ,k M4co—b-c,/ a Massachusetts licensed septic
inspector. -. n
Y�ano(c� �Jrl'�C
The inspection of your septic system showed that your system has failed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: ��
(e� - G
You are directed to hire a licensed Town of Barnstable septic system installer to submit a
sketch diagram of a proposed system to the Town of Barnstable Health Division Office
(Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance
with 3l0 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of
receipt of this notice.
You are also directed to bring the septic system into compliance within thirty (30) days of
receipt of this order letter.
You are further directed to maintain the system by hiring a licensed septage hauler to
pump the septic system to prevent discharge of sewage or effluent into the buildings, onto
the surface of the ground, or in to surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to
any court of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
i
ii
L
)dA lw S
ASSESSORS Ma i�0•
PARCEL NO:
DATE: 4411
TL
PROPERTY ADDRESS:_ 121_g_u,ddez_&oad-_-_____ OVED
west Hyannis�ort ______ 1995
DEFT.Mass. 02672------------------------
On the above date, 1 inspected the septic system at the above address.
This system consists of the following:
A. 2-6 'x8 ' block cesspools.
Based on my inspection, 1 certify the following conditions:
A. This is not a title five septic system.
B. Both block cesspools filled to capacity.
C: The system is' in failure.
D. System should be upgraded to a title five...sepkxc,=system.
SIGNATURE:
Name: J_P_.Macomber Jr..
CompaW__Macomber & Son-Inc:.
Address: Box 66
_Centerville,Mass,_Q�E32
Phone:__508_775_3338-__---__-
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBEDield
Tanks-Cesspools-L
Pumped & In
Town Sewer Co
P.O. Box 66 Centerville775.3338 77
draft 1113195
SUBSURFACE SEWAGE DISPOSAL SYSTEM DgSPECTION FORM
Address of property 2 I c.4C4d
Owner's name (and/or resident) P//YI-LI C YRnJ
Date of Inspection 411 Li/9,5
PART A .
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least 30 days and the
system has been receiving normal flow rates during that period. Large volumes
of water have not been introduced into the system recently or as part of this
inspection.
As built plans have been obtained. trl.7-cv rnli.,� his bv,J_
C4 a
The facility or dwelling was inspected for signs of sewage back-up.
The.site was inspected for signs of breakout.
All system components, excluding the SAS, have been located on the site.
�T�m 6u1� The septic tank manholes were uncovered, opened, and the interior of the septic
U —1,0 f r tank was inspe ted for condition of baffles or tees, material of construction,
7— y dimensions, depth,of liquid, depth of sludge, depth of scum.
The size and location of the SAS on the site has been determined based on
existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were provided with
information on the proper maintenance of SSDS.
l
draft 1113195 9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INTORMATION
FLOW CONDITIONS
If residential
number of bedrooms
number of current residents
garbage grinder, yes or no
laundry connected to system, yes or no
seasonal use, yes or no h jc'u - �-t G¢ "2 foul
If nonresidential, calculated flow:
Water meter readings, if available: 64 Tb p
_ Last date of occupancy
GENERAL INFORMATION
. -,nping records and source of information: L
1 l U`C /�O 2wwLP y .0 �J*I -T
Ab System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
12
016 �41 t
Type of system
Septic tank/distribution box/soil absorption system
Single cesspool
V Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Other (explain)
Approximate age of all components. Date installed, if known. Source of information:
Po Sewage odors detected when arriving at the site, yes or no
r
. z i
draft 1/13195 1C
SUBSURFACE SE«•AGE DISPOSAL SYSTEM INSPECTION FO%NI
PART B
SYSTEM INFORMATION continued
SEPTIC TANK: 00 �S� C�•y���c,���z„� CO-, P/000
(locate on site plan)
depth below grade: l— 7 7z�
material of construction: concrete _metal _FRP _other(explain)
dimensions:
rkt-F-
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
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, recommendations for repairs, etc.)
DISTRIBUTION BOX:
(locate on site plan)
depth of liquid leve above outlet invert
Comments:
(note if level and distribu ion is equal, evidence of solids carryover, evidence of leakage into or out of box,
recommendation for repai s, etc.)
1
draft 1113195 11
PUMP CHAMBER:
ate on site plan)
pumps in working order, es or no
Comments:
(note condition of pump ch er, condition of pumps and appurtenances, recommendations for maintenance or
repairs,etc.)
SOIL ABSORPTION /YSTEM (SAS):
(locate on site'plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type
leaching pits and number
leaching chambers and number
leaching galleries and number leaching trenches,
number, length
leaching fields, number, dimensions
overflow cesspool, number .
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for
maintenance or repairs,etc.)
s714
draft .1113195
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
CESSPOOLS:
(locate on site plan)
number, and configuration
depth-top of liquid to inlet invert nef kiK"- -y
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool must be pumped as part of
inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for
maintenance or repairs,etc.)
-sty f•FG,�, �11� � l�n _ `
AJ 4u.JtiJ 6Z ��r•��s�T
PRIVY:
(locate on site plan)
materials of constructio
dimensions
depth of solids
Comments:
(note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, recommendations
maintenance or repai ,etc.) i.
draft 1/13/95 13
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOK- I
PART B
SYSTJ:M INFORrZATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
tv
� ,tt
i
37 � US
C-,S
DEPTH TO GROUNDWATER
�►v,-mot !a��hy�r � Sy��m 6 ' t '�`
15 4-depth to groundwater Dr �� ,�,�
�v °�
method of determination or approximation:
1
1
i
draft 1113195 `v 1
� 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM I1\'SPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or N'D). Describe basis of determination in all instances. If "not
determined", explain why not)
Backup of sewage into facility? R"/'vim7 - !?o:---- -
D Discharge or ponding of effluent to the surface of the ground or surface waters?
GV Static liquid level in the distribution box above:outlet invert?
K5Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow?
IUD Pumped 4 times or more in the last year? number of times pumped —
Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank
failure imminent?
Is any portion of the SAS, cesspool or privy:
00 below the high groundwater elevation?
00 within 50 feet of a surface water?
k)v within 100 feet of a surface water supply or tributary to a surface water supply?
N� within a Zone I of a public well?
NO within 50 feet of a bordering vegetated wetland or salt marsh?
V17 within 50 feet of a private water supply well?
IUb less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform
bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
v.f
draft 1113195 15
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector
N p C �
Inspector Number
Company Name
Company Address �o� ZrS� GtJ Y�y rir� �-
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address and that.the information
reported is true, accurate and complete as of the time of inspection.
Check one:
1 I have not found any information which indicates that the system fails to
adequately protect public health or the environment as defined in 310 CMR .
15.303. Any failure criteria not evaluated are as stated in the FAILURE
CRITERIA section of this form.
I have determined that the system fails to protect public health and the
environment as defined in 310 CMR 15.303. The basis for this determination is
Gprovided in the FAILURE CRITERIA section of this form.
Ins ector's Signature P g
Date14�5
Original to system owner
Copies to:
Buyer (if applicable)
proving authority
' 04/19/95 09:25 BARNSTABLE WATER COMPANY 001
5087901578
pa/19/1995 13:01 9.067901578 J o MACOMBER 3 '3ON PAGE ti3:
J09EPH P. MACOMBER & SON, INC.
004.•ox w
rr�u>. rrsa.�z
Hyannis Water,
April 18,95
To; 'Rena* Fax # 790-1313
From; sklp Macomber Fax N 794 570
Need. water readings for vent ``two Years.
Addresses.
1 . Jim Satko
145 Suckwood Drive
Hyannis,Mass.
2 Phyllis Ryan
121 Rudder Road
Wgat "yannisportjMass.
YLrASB f:U'fL: SATKO AT 145 RUCKWOQD DRIVE Ht1S ONLY BEEN ON A KLTLK
FOK ABOUT A YEAR- average gtrly tire 2,000 cubic :r.r.t
C
IS RYAN HAS ONL: B:;LN ON A METER APPROXIMATELYTHS - a eraRe qtrly use 1 ,jUO cubic feat
�I yuu have Jtly further gtire.:tluns, please do nc>t licc.itatc
to contact me.
ZP7g4`�
i
• TOWN OF BARNSTABLE
LOCATION 411 '"-A, SEWAGE #
VILLAGE�� ���A ,�y�� ; ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANKtAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
mop
DATE COM LANCE IS UED:`
VARIAN E GRANTED: Yes No
A. `b
ov f
o
�E
SYSTEM PROFILE
W
NOT To SCALE
N . DIMENSIONS HOLD
o :
top 1500 GALLON H-10 SEPTIC TANK
foundation
= 22.1
NO PROPOSED GRADE CHANGES `
existing TIE INTO EXISTING LINE USE 2" MIN. OF DOUBLE WASHED 1/8" USE CLEAN DOUBLE WASHED
foundation 4" sch 40 pvc TO 1/2" PEASTONE ON TOP. 3/4" TO 1 1/2" STONE.
PROVIDE 6" MIN. COVER 4" sch 40 pvc TOPSOIL
4" sch 40 pvc TOP OF PEASTONE = 17.0
__>L 3 S�1"/fit. 2,> S= 1"/ft. 9„ OF COVER
,> 1 f
S=5/8" ft. 1Q" 14"
INVERT 17.21 :«:.;L�«7,:�; v+. ..: EFFECTIVE DEPTH
41 Q„ ..••. ... .
native soil , :.• ;`,�,t., 4" .;,; .: , .•r.,
INVERT 18.95 INVERT 18.05 INVERT 17.38 INVERT 16.50 Y 7,3' 14.5 bottom
EXISTING INVERT 17.80 USE 1' OF STONE ON SIDES & 3' OF STONE
x�':^.., ;�� _ } , .Y, *• - ,,. �,, .,} yo` g.� ON ENDS & 14 UNDER FOR A 5 X 24 —9 bottom TH 1=7.2'
native soil -6" Stone [310CMR 15.221(2)] X 2' DEEP LEACHING AREA. -
1$'
10' 6" 5' 2'
8'& 9' 18'-9" LEVEL
LEVEL
3 INFILTRATORS PER ROW
TANK ELEVATION MAY BE LOWERED IF — X
PITCH OF EXISTING BURRIED LINE IS GREATER.
CONSTRUCTION NOTES
SOIL EVALUATION LOG PER 310 CMR 15.021 (3) R.J. CADILLAC
MUST INSPECT SYSTEM PRIOR TO BACKFILL.
TEST DATE: May 23,
1995 ALL CONSTRUCTION TO MEET STATE
SANITARY CODE AND TOWN OF BARNS—
PERFORMED BY: Ron Cadillac, Soil Evaluator TABLE BOARD OF HEALTH REGULATIONS.
WITNESSED BY: Edward F. Barry, inspector
IF UNSUITABLE SOILS, OR SOILS DIF— THIS PLAN IS VALID ONLY IF IT BEARS AN
PERC RATE: < 2 min./in. (Cl & C2 layers) FERING FROM THE SOIL LOG ARE FOUND, ORIGINAL RED STAMP AND SIGNATURE.
SOIL SURVEY: 1993, Scale-1: 25,000 CONTACT THE BOARD OF HEALTH AND
CdA—Carver coarse sand R. J. CADILLAC. �L-,�AeF, � �
Excessively drained, poor filter RONALD
BUILD UP COVERS TO WITHIN �
GEOLOGIC MAP: 1986, Scale-1: 100,000
ONE FOOT OF FINAL GRADE, D-'
Obn—Barnstable plain deposit
AND MORTOR IN PLACE.
FIRM: Flood Zone C
WATER LEVEL (USGS): May, Below normal
HIGH WATER TABLE: No water encountered, no mottles, 7 z lq�
No adjustment
PERVIOUS MATERIAL: 10'—naturally occurring
TEST HOLE I DETAIL SHEET
DEPTH (inches) ELEV.(feet)
SOIL VALUATOR DATE 0 19.5 FOR
2" 0 layer
DESIGN DATA
4., E layer PHYLLIS H . RYAN
B layer 1 Oyr 5/6 AT
BEDROOMS: 3 sandy loam
GARBAGE GRINDER: No 24" 17.5 LOT 171 121 RUDDER ROAD, W. HYANNISPORT, MA
REQUIRED CAPACITY: 330 GPD C1 layer 2.5y 6/6
SEPTIC TANK SIZE: 1500 med. sand JULY 289 1995 SCALE: AS SHOWN
BOTTOM LEACHING AREA: 247.5 SF
50"
[2(24.75 X 5')] Q 68,> C2 layer 2.5y 6/6
SIDE LEACHING AREA: 238 SF coarse sand
[2(59.5' perimeter) x 2' deep] RONALD J. CADILLAC, PLS, RS
DESIGN CAPACITY: 359 GPD PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
[(247.5 SF + 238 SF) X .74 GPD/SF] 148" no water-dry 7.2 P.O. BOX 258, WEST YARMOUTH, MA 02673
(508) 775--9700
SHEET 2 OF 2 j
ALL LOTS WITHIN 100 FEET OF PROPOSED SEPTIC SYSTEM ARE ON TOWN WATER.
NOT TO
s r SCALE
wE
N
MAIN
sTREET
N r
N BENCH MARK -TOP OF CONC.
m BOUND= 19.98 ASSIGNED
INSTALL 1500 GALLON SEPTIC TANK
x 19.7 x 20.1 INSTALL D-BOX 121 RUDDER ROAD '...,
C.B./dh fnd, INSTALL 2-24#-9" X 5' X 2' DEEP LOCATION MAP
LEACH AREAS USING 6 INFILTATORS
MAP 5 x 19.6 �908 PARCEL 179 W/14" STONE UNDERNEATH TO PROVIDE
ASSESSORS A 2' EFFECTIVE DEPTH NOTES
x 21.5
PARCEL 3 �+ 20.4 PUMP & FILL OLD CESSPOOLS AND 1. LOCUS IS A.M. R247, PARCEL 180,
REMOVE ANY CLOGGED SOIL FROM 2. ELEVATIONS SHOWN ARE
F p E I�j�'R C T x 1 8 /s?��9 L UNDER PROPOSED LEACH AREA, ASSIGNED.
f� TH 1 �� ti r' c• �� - � � 1 3. LOCUS IS IN FLOOD ZONE C ON
O
Q6 FLOOD INSURANCE RATE MAP
1 3 DATED JULY 2, 1992.
ya9. ,
20.2 x 20.5
x 21.8
x 18.9�j� O na4 /
20.6 21.4
x .9
18.4 .2 70. -- :_ 2�Z
---_ ,01 21.0 B.21dh fnd 21.1
17.6 1.4 / Q
21.4
E 720.E
20.8
0.8
- -
1
�`
21.0
.0/ [
" 2 ,�o� ti - ��6 20.0 x 0.8 / THIS PLAN IS A VALID COPY ONLY IF IT BEARS
ry '� -
�L ---- /
,�O � �'� __ � • �i �� _.-= 3 / AN ORIGINAL RED STAMP AND SIGNATURE.
x 1 7.9 s�%�j 1 .0 -_ }��QQ� �� / x 1 2r.7 (,,20.0
OQ \moo 19.4 / 20.3 tNpgss
clo
21.4 2
y� �yOC' l a �F =. -
1 / / q• �ja/ 6
BENCH MARK--TOP CONC. WEST 2t ^pry 18.2
CORNER BULKHEAD 21,17 CEL
tix . OO ryq x 2�/ 2
x 19.7 / 7
8
,� 16.9 � 1 T PLAN
PARCEL 181 ,� 17.6 S E L N
x 1 ,\(b/� FOR
x 15.\ /
x 15.7 ,/ PHYLLIS H . RYAN
15.5 LOT 179 121 RUDDER ROAD, W. HYANNISPORT, MA
JULY 28, 1995 SCALE: 1 "= 20$
LEGEND
TH 1 TEST HOLE LOCATION NUMBER RONALD J. CADILLAC PLS RS
w WATER LINE MARKINGS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
E OVERHEAD ELECTRIC WIRES P.O. BOX 258
x 15.7 EXISTING ELEVATIONS ('X' MARKS POINT)
YAR
18 - EXISTING CONTOUR WEST MOUTH MA 02673 i
UTILITY POLE HEALTH AGENT APPROVAL DATE (508) 775-9700
PAGE 1 OF 2 (OVER) j
I
i
ALL` LOTS WITHIN 100 FEET OF PROPOSED SEPTIC SYSTEM ARE ON TOWN WATER,
ROE 2$ NOT TO
WEST SCALE
Lo MAIN
-- SHEET
CIA
N BENCH MARK--TOP OF CONC.
m
BOUND= 19'98 ASSIGNED
y <o G �-
a INSTALL 1500 GALLON SEPTIC TANK
x 19.7 x 20.1 INSTALL D-BOX 121 RUDDER ROAD
C.B./dh fnd. INSTALL 2-24"-9" X 5' X 2' DEEP LOCATION MAP
LEACH AREAS USING 6 INFILTATORS
908 PARCEL 179 W/14" STONE UNDERNEATH TO PROVIDE
ASSESSORS MAP 115 x 19.6 A 2' EFFECTIVE DEPTH
NOTES
x 21.5
PARCEL 3 20 4 PUMP & FILL OLD CESSPOOLS AND 1. LOCUS IS A.M. R247, PARCEL 180.
+, REMOVE ANY CLOGGED SOIL FROM 2. ELEVATIONS SHOWN ARE
FIRE DISTRICT
x 1 .8 59 UNDER PROPOSED LEACH AREA. ASSIGNED.
f� 3. LOCUS IS IN FLOOD ZONE C ON
TH 1 ���� '�'� a FLOOD INSURANCE RATE MAP
s 3 DATED JULY 2, 1992.
y> 19. 20.2 x 20.5 ,p
x 19.4 x 21.8
�-
X 18.ry UO aas 21.4
20.6 20.9
'f 9.2 n
oo��
x 18.4 ,2U.5p•== 21.3- 21.9
� = `a, >20.8 C.B./dh fnd 21.1
°�
19.10.7 �Q / 21 /
:_: / 21.0 x /
17
g � ��� __ q E 21.4 0.6
_
20.8
0.8
20.o x THIS PLAN IS A VALID COPY ONLY IF IT BEARS
Bpi x �+. ��' Irv
AN ORIGINAL RED STAMP AND SIGNATURE.
(,2 0.07.9
OQ '.-: e a /
19.4 / 20.3
19�74z
21.4 11
2 .�, .e
q0 .h / Q
XS1� �p� 2 0.6 �'� .��0/
BENCH MARK--TOP CONC. WEST sS >>• x 2 Airy'/ 18.2 / C, su
1.
CORNER BULKHEAD - 21.17 9ti x 19. AR1...\C /
ryp 2�/ 2 / 71z,(619-
X 19.7
16.9 /
PARCEL 181 // 17.6 SITE PLAN
// FOR
x 15.4�
x 15.7 ,/ PHYLLIS H . RYAN
15.5 LOT 179 121 RUDDER ROAD, W. HYANNISPORT, MA
JULY 28, 1995 SCALE: 1 " = 20'
LEGEND
lb TH 1 TEST HOLE LOCATION, NUMBER RONALD J. CADILLAC, PLS, RS
w WATER LINE MARKINGS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
E OVERHEAD ELECTRIC WIRES P.O. BOX 258
x 15.7 EXISTING ELEVATIONS ('X' MARKS POINT)
18 -.- EXISTING CONTOUR WEST YARMOUTH, MA 02673
1 UTILITY POLE HEALTH AGENT APPROVAL' DATE (508) 775-9700
PAGE 1 OF 2 (OVER)
w
SYSTEM PROFILE NOT TO SCALE
o DIMENSIONS HOLD
top 1500 GALLON H-10 SEPTIC TANK
foundation I
= 22.1
NO PROPOSED GRADE CHANGES
existing TIE INTO EXISTING LINE USE 2" MIN. OF DOUBLE WASHED 1/8" USE CLEAN DOUBLE WASHED
foundation 4" sch 40 pvc TO 1/2" PEASTONE ON TOP. 3/4" TO 1 1/2" STONE.
PROVIDE 6" MIN. COVER 4" sch 40 pvc
4" sch 40 pvc TOPSOIL TOP OF PEASTONE = 17.0
rx 3>, >, S�1"/ft. 12„ S= 1"jft. 9" OF COVER ■■
S=5/8" ft. 10" 14"
177
INVERT 17.21 • ;,,. ..,
4, 0„ _.. ..... :..,-..,,. ,K. , E VE DEPTH ' ., ,., .; •, .. , '.r
��,t L:•�t.•i �.i ,f�. FF t.'r 1.F. r� , yY� . •l y '.. � .�R'•.
native soil W y.. . . :�. L
INVERT 18.95 INVERT 18.05 INVERT 17.38 INVERT 16.50 7 3' 14.5 bottom
EXISTING t INVERT 17.80 USE 1' OF STONE ON SIDES & 3' OF STONE
1ti� �:i..p�ta t':t.s."i•:,,'J.. #.'.: ,_N.a,.v- .:«'�ti. 4,+ t ON ENDS & 14" UNDER FOR A 5' X 24'-9" bottom TH 1=7.2' -
.native soil
" "�40_6" Stone [310CMR 15.221(2)] X 2' DEEP LEACHING AREA.
..r
18'
10' 6" 5' 2' 8'& 9' 18'-9" LEVEL
LEVEL
TANK ELEVATION MAY BE LOWERED IF -- 3 INFILTRATORS ROW
X
PITCH OF EXISTING BURRIED LINE IS GREATER.
CONSTRUCTION NOTES
SOIL EVALUATION LOG PER .310 CMR 15.021 (3) R.J. CADILLAC
MUST INSPECT SYSTEM PRIOR TO BACKFILL
TEST DATE: May 23, 1995 ALL CONSTRUCTION TO MEET STATE
PERFORMED BY: Ron Cadillac, Soil Evaluator SANITARY CODE AND TOWN OF BARNS—
TABLE BOARD OF HEALTH REGULATIONS.
WITNESSED BY: Edward F. Barry, inspector -_--
IF UNSUITABLE SOILS, OR SOILS DIF— THIS PLAN IS VALID ONLY IF IT BEARS AN
PERC RATE: < 2 min./in. (Cl & C2 layers) FERING FROM THE SOIL LOG ARE. FOUND, ORIGINAL RED STAMP AND SIGNATURE.
SOIL SURVEY: 1993, Scale-1: 25,000 CONTACT THE BOARD OF HEALTH AND
CdA-Carver coarse sand R. J. CADILLAC. 0NOf
Excessively drained, poor filter BUILD UP COVERS TO WITHIN �� JRONALD
AH
GEOLOGIC MAP: 1986, Scale-1: 100,000 ONE FOOT OF FINAL GRADE, AD}4�
Qbn--Barnstable plain deposit AND MORTOR IN PLACE.
FIRM: Flood Zone C A 1`1'
WATER LEVEL (USGS): May, Below normal
HIGH WATER TABLE: No water encountered, no mottles, 7 he
No adjustment J lrr��
PERVIOUS MATERIAL: 10'—naturally occurring u y
a,,V2 TEST HOLE .1 DETAIL SHEET
DEPTH (inches) ELEV.(feet) C
SOIL EVA ATOR DATE 0 19.5 FOR
2" 0 layer
DESIGND ATA 4„ E layer PHYLLIS H . RYAN
B layer 10yr 5/6 AT
BEDROOMS: 3 sandy loom
GARBAGE GRINDER: No 24" 17.5 LOT 179 121 RUDDER ROAD, W. H YAN N I SPOR T, MA
REQUIRED CAPACITY: 330 GPD C1 layer 2.5y 6/6
SEPTIC TANK SIZE: 1500 med. sand JULY 281 1995 SCALE: AS SHOWN
BOTTOM LEACHING AREA: 247.5 SF
50"
[2(24.75 X 5')] Q >, C2 layer 2.5y 6/6
SIDE LEACHING AREA: 238 SF 68 coarse sand
[2(59.5' perimeter) x 2' deep] RONALD J. CADILLAC, PLS, RS
DESIGN CAPACITY: 359 GPD PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN
[(247.5 SF + 238 SF) X .74 GPD/SF] 148" no water—dry 7.2 P.O. BOX 258, WEST YARMOUTH, MA 02673
(508) 775-9700
SHEET 2 OF 2