HomeMy WebLinkAbout0128 RUDDER ROAD - Health 52 RUDDER RD.
HYANNIS
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TOWN OF PARNSTABLE S/
,I.00A"r1ON ` \\�d� SEWAGE #
Vr,jLAGE ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) . (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet.of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
3
O 46
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PI 31 L
66
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I O CAT ION SEWAGE PERMIT NO.
VILLAGE
INSTA LLPRIC NAME & ADDRESS
I
Ow ER
7=
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED - /�- �4-
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No........................ Fmc..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�T?..--........0F... ......................................................
Appliratiou for Uiipngal Worse Tomitrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (4-1—lin Individual Sewage`Disposal
System at
.�S..._ r � rano r tNo.
..:._..._..........
...� -- � _-------•--------------------- -'
ocationddress4 .................. .--.----
.^. .........
Owner Address
AddressIle ---•-- ---••-------------------------------------
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................. _Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4 Other fixtures ---------------------------•--•. .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft.
3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
0 Description of Soil.-:�� ' ; •------------------ ---------------- ---- --------------------------•---•------
V .-----------------------------------------•---------•-----•-----•--------- -------.-----•--••----------------------------------------------------------------------------------------------------------
W --------------------- -----------------------------------------------------------------•----------- -------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when applicable.-_-.__/G'''_�_[2_______ ___ _________�_------______._........ .,_...._.........__.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Li
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued the board of health.
Signed - . ........... .................... ------
ate -
ApplicationApproved By.........................................,......................................................... ........................................
Date
Application Disapproved for the following reasons----------------•-----------------------------------------...--•----------------•-----------••---------------•---
-•--------------•---••--......---------•...--•--...-----•------•---•----------•---------•---------•---•-------------------------•--••-------•----•--------••---• -•-•--------------•--•-•----------
Date
PermitNo......................................................... Issued.... .......--.•- ------
Date
a
No................ ....... FRIC..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............OFJ&et,
.........................
Appliration for Bhipoiial Workii tomitrurtion ratuff
Application is.hereby made for a Permit to Construct or Repair (4-T-an Individual Sewage Disposal
System at 4r�/ -
................................... ............
..........*------*------------------
i42Location OL%ddress
or
t No.
.................. .................................................................................................
Owner ............................................Address
. .......................................... ......................................................
In alfr Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons.....__..................... Showers Cafeteria
PL4Other fixtures ......................................................................................................................................................
Design Flow...........................................gallons per person per day. Total daily flow---- .......................................gallons.
9 Septic Tank—Liquid capacity............gallons Length______________ Width___............_ Diameter_____-_-_______- Depth....
Disposal Trench—No..................... Width_...__.............. Total Length......___........... Total leaching area------------------:--sq'fe '
Seepage Pit No...................... Diameter.._..:_..___.__...._ Depth-below inlet.................... Total leaching area.................sq. ft.
Other Distribution box ( ) -Dosing tank ( . ).
Percolation Test Results Performed by............................................................................ Date_.__............._..._.._.___........__.
Test Pit No. I................minutes per inch Depth of Test Pit..........._.._____. Depth to ground water...t--------------------
Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water..____.............._._.
--------------------------*------ ---- ---------------------------"...........*----------------------------- ----------------
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0 Description of Soil`-S 0-2.,z�...:2�........ ...........................................................................................................
........................................................................a.........:..
U ................................................................................................................
............... ...... ...
------------------------------ e.. 41
- !--------!--------- -- .........................
- -------------------------------------------------------------------------------------- --------- -------------
........... 5,- .,i
U Nature of Repairs or Alterations—Answer when applicable_-___ ------- _7�
-----------------------------------------------*-----------------------------"..............---------------------------- ............. ......
Agreement:
........The undersigned agrees to install the aforedescribed Individual Sewage Disposal'-System"i'n"acco,rdance,with
.... -------- ------------ -- ----------------------
the provisions of T 1 TLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system.in"
operation until a Certificate of Compliance has beyn issued X the board of health.
Sign
Application Approved By .................................. . ... .... .... .................
Date
Application Disapproved for the following reasons----------------•-•-•---•----------------------------..........................................................
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued...........................................I------------
Date
THE COMMONWEALTH OF MASSACHUSETTS qr
BOARD OF HEALTH
......................OR. . .....................
4-4-.1.11,................... ...
Trrfifiratr of Tompliatta
T��-,,j I� TOkERTIFY, That the Individual Sewage Disposal System constructed o'r Repaired
k--a-if.
..................... .. ............................ ...........................
R.. -----------......
ry.. ...... ... ------ -------------
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.... ...... Install
at._11.., ... ................ .... .......................Z ......... ........................... ...............................................................
has been instilled in accordance with the provisions of T 5 of The Kt'ate Sanitary C.Ae xs deictibed in the
applicationPermit No. ...........4_0................ dat,-
for Disposal Works Construction __/ /- ------- .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN TION SATISFACTORY.
DATE................. . . ............... Inspector......... ,"Oe
...............................
---------------- ------ --- -- ---- ---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,,HEALTH
toe) ...... ........... .OF...
.44�..................................e........................
........
N ...... ............... FEE........................
Disposa rhi Toni-Itration op"amit
Permission is hereby granted.-------- - .
....................... ..................................................................................
s 0 ,
to Construct Repair an In 1ew al Sage I)ispoy
Vstem
at No...-!�_Z............... .
Stree
.............. .......................................�O--- !d.... Z.<a.9................ ............
as shown on the application for Disposal Works Construction e it ........ Dated.._.. . ...................
. . . . ............................................
Board of altt
DATE...... I. .................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LOT NO. 'L ADDRESS:_ Gc�/f�se�
F^ n
OWNERS NAME:'
SEWAGE PERM No- K L--C a NEW: REPAIR:'-
DATE ISSUED:_ S�- DATE INSTALLED:
INSTALLERS NAME:
M•
INSTALLATION OF:
WATER TABLE : FINAL INSPECTION B L �`
DRAWING OF .INSTALLATION ON REVERSE SIDE :
`75
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTIONjk `
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM "A
PART A
CERTIFICATION
.,
Property Address: 52 RUDDER RD HYANNIS,MA 02601 `�
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Owners Name: JIM MACLAGHLAN :y
Owner's Address: 52 RUDDER RD HYANNIS,MA 02601 fi'-A.
Date of Inspection: 1 I/1/01
4 Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
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Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 1QQ1 ��
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Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and x °tt
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: '
X Passes,'0
Conditional y, asses
. �,
Needs Fu Evaluation by the Local Approving Authority ,;
Fails
K ,4,
Inspectors Signature:
*, Date: 11/1/01 � <i
The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or DEP)within.
30 days of completing this insp tion. If the system is a shared system or has a design flow of 10,000 gpd or greater,the nk
t inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be �
' sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. �.
Notes and Comments "3
THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO :
' PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND RAISING COVERS TO SYSTEM
****This report only describes°conditions at the time of inspection and under the conditions of use at that time.This GL ��
inspection does not address how the system will perform in the future under the same or different conditions of use.` � ;
it * sT .
Page 2 of 11 3fi jtr
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM }
zc{
PART A
CERTIFICATION(continued)
Property Address: 52 RUDDER RD HYANNIS,MA 02601
Owner: JIM MACLAGHLAN ``
a, �eilr�4tf
Date of Inspection: 11/1/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X 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.
a :
Comments: g
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO.
PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND RAISING COVERS TO SYSTEM ,z
B. System Conditionally Passes:
_ One or more system components as'describe p P d in the"Conditional Pass".section need to be replaced or repaired.The s stem
Y ,gs
upon completion of the replacement onrepair,as approved by the Board of Health,will pass.
Answer yes,no or not determined�(V,N,ND)in the for the following statements.If"not determined"please explain 5-
n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound exhibits l
substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced,, r:
with a complying septic tank as approved by the Board of Health. '` t y
*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. h
k
ND explain: n/a
n/a 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 off;
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced ,
ND explain: n/a f.
n/a 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): J `..
a _broken,pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page 3 of i l
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OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS '
l`y }
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _
PART A t
CERTIFICATION(continued) a T.
Property Address: 52 RUDDER RD HYANNIS,MA 02601 y
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01 �
C. Further Evaluation is Required by the Board of Health: f
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:
"A'
_ Cesspool or privy is within 50 feet of a surface water k
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment: g: .3
_ The system has a septic tank and soil absorption system SAS and the SAS is within 100 feet of a surface water
Y P rP Y (SAS)
supply or tributary to a surface water supply. Y � '
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. `b s
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
Y P
_ 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 ' 4
supply well". Method used to determine distance n/a
"This system passes if the.�vell water analysis,performed at a DEP certified laboratory,for coliform bacteria and A,
volatile organic compounas'Nridicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy '
of the analysis must be attached to this form. Y
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3. Other: F :
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n/a
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Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS € F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION continued
Property Address: 52 RUDDER RD HYANNIS MA 02601
P Y
Owner: JIM MACLAGHLANYn, $
Date of Inspection: 11/1/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no'to each of the following for all-inspections:
Yes No
_ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' s
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged ry
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
- X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/Z day flow ` _
X Required pumping more than 4 times in the last year NU due to clogged or obstructed pipe(s).Number of times
pumped nla.
X Any portion of the SAS,cesspool or privy is below high ground water elevation. k,A,
X An portion of cesspool o`r ri ° is within 100 feet of a surface water supply or tributary to a surface water supply.
Y P P P �'Y PP Y rY
_ X Any portion of a cesspool or;priry is within a Zone 1 of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
- X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water uali analysis. This system asses if the well water analysis,performed at a DEP
P q h' Y l Y P Y +P
certified laboratory?,:for coliform bacteria and volatile organic compounds indicates that the well is free;
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to ory �R
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be ;w41y.
attached to this form.] ,
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 �
CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be
necessary to correct the failure. r'b .
YsA, ;
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet,of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply ;
X the system is located mi a nitro en sensitive area Interim Wellhead Protection Area—IWPA or a mapped
r°'
- Y g ( ) PP fit
Zone II of a public water supply well 9`"
by
If you have answered"yes"tto any question in Section E the system is considered a significant threat,or answered, uz'� K
"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.
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS "
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ryz ,i,
PART B x'
CHECKLIST Property Address: 52 RUDDER RD HYANNIS,MA 02601
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01
Check if the following have been done.You must indicate"yes"or"no"as to each of the following: 2s:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system.components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection? sr
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) r�
X _ Was the facility or dwelling inspected for signs of sewage back up? }H
X _ Was the site inspected for signs of break out? r SW
X _ Were all system components,excluding the SAS,located on site?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ;
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenancey,E.�°
of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on: r �
7y,
Yes no
X _ Existing information. dr'�6xample,a plan at the Board of Health. ,' r
C''.,
X _ Determined in the field(if any'of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3)(b)] r:
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Page 6 of 11 F
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
24,
54F
SYSTEM INFORMATION
Property Address: 52 RUDDER RD HYANNIS,MA 02601 *
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.2;03 (for_example: 110 gpd x#of bedrooms):330
Number of current residents:2
mow. ..
Does residence have a garbage grinder(yes or no):NO
Is laundry Yon a separate sewage system{Yes or no):NO [if yes separate,inspection required]]
Laundry system inspected(yes or no): NO � .
Seasonal use:(yes or no):NONr ;
Water meter readings,if available last 2 ears usage d n/a _
g { Y g {gP )): �
Sump pump(yes or no): NO
Last date of occupancy: n/a
a±f l
COMMERCIALANDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203 : n/a d
) gP
Basis of design flow(seats/persons/sgft,etc.): n/a `
Grease trapes or no : NO
resent(yes )
Industrial waste holding tank present(yes or no):NO
Non-sanitary waste dischargeXtoathe Title 5 system(yes or no): NO *G.� `.
Water meter readings,if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
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GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no):YES �rflh
If yes,volume pumped: 1500gallons--How was quantity pumped determined?n/a .
Reason for pumping: MAINTANENCE' "k
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TYPE OF SYSTEM ,v
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
Shared system{Yes or no)Cif yes,attach previous inspection records,if any)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from,.;
system owner)
_Tight tank Attach a copy of the DEP approval r
Other(describe): n/a €
Approximate age of all components,date installed(if known)and source of information:
1980 «
n
Were sewage odors detected when arriving at the site(yes or no):NO �_
Page 7 of 11 '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS x.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 5 �
PART C
SYSTEM INFORMATION(continued)
Property Address: 52 RUDDER RD HYANNIS,MA 02601
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01 p'
;* T
BUILDING SEWER(locate on site plan) �
Depth below grade:30" b'.
Materials of construction:_cast iron X40 PVC_other(explain): n/a s � N=
Distance from private water supply well or suction line: n/a4�.
Comments(on condition of joints,venting,evidence of leakage,etc.): ` '
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade:24" �
Material of construction:Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)-: r
Dimensions:6'X 6' BLOCK CESSPOOL" �[
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle:33"
Scum thickness:4
Distance from top of scum to top of outlet tee or baffle:4" :'
Distance from bottom of scum to bottonfof outlet tee or baffle: n/a
' How were dimensions determined: MEASURED
i
I Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related '
to outlet invert,evidence of leakage,etc.):
t MAIN CESSPOOL AND ALL COMPONENTS APPEAR TO BE!STRUCTURALLY SOUND. RECOMMENDM
PUMPING EVERYONE TO TWO YEARS TO MAINTAIN USEFULL LIFE. `
GREASE TRAP:_(locate on site plan). ''° }
Depth below grade: n/a
Material of construction: concrete metal fiberglass_polyethylene other(explain): n/a `
Dimensions: n/a ' ��
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a ��
Distance from bottom of scum to bottom of outlet tee or baffle: n/a "
UZ,`
Date of last pumping: n/a h
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related r
to outlet invert,evidence of leakage,etc)-,
NS Y'
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Page 8 of 11
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �. x
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Ew°
PART C
SYSTEM INFORMATION(continued)
Property Address: 52 RUDDER RD HYANNIS,MA 02601
Owner: JIM MACLAGHLAN i
Date of Inspection: 11/1/01
x �y
TIGHT or HOLDING TANK:. (tank must be pumped at time of inspection)(locate on site plan) � .
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a `b
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A `}'
Alarm level: N/A Alarm in working order(yes or no): NO
t Date of last pumping: n/a
! Comments(condition of alarm and float switches,etc.):
n/a ;4
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Yrt ,
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into 3
or out of box,etc.): ;
BOX IS STRUCTURALLY SOUND.
r�
PUMP CHAMBER:_(locate on site plan) �q't.
Pumps in working order(yes or no):NO
Alarms in working order(yes or no):NO sal
l" 0
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a a .
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Page 9 of I 1 ri
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS `_
12�j
E SEWAGE DISPOSAL SYSTEM INSPECTION FORM
SUBSURFACE
PART C
.yr
SYSTEM INFORMATION(continued)
� yY
Property Address: 52 RUDDER RD HYANNIS,MA 02601 `
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01 ;.
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
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If SAS not located explain why:
n/a f a Y
Type
1000 GAL V X 6' leaching pits, number: 2
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a �
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a ' '
n/a overflow cesspool, number: p .
n/a innovative/alternative system
L
,Type/name of technology: n/a ' y
4 %
0
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT-PIPE COMES '''
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IN 1 LOWER THAN NORMAL-THIS PIT HAD 6 OF LEACHING LEFT AT THE TIME OF INSPECTION. Y ��f
BOTTOM AT 9' -2' OF STONE AROUND PIT.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
U.
Number and configuration: n/a w
Depth—top of liquid to inlet invert: n/a s
Depth of solids layer: n/a =
Depth of scum layer: n/a
t Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no):NO r �y'
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): :fi ,
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a 4 �
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): L'
n/a z:.
Page 10 of 11
-i.r.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMS
PART C F
SYSTEM INFORMATION(continued)
'A"
Property Address: 52 RUDDER RD HYANMS,MA 02601 ;
Owner: JIM MACLAGHLAN
Date of Inspection: 11/1/01
SKETCH OF SEWAGE DISPOSAL'SYSTEM
Provide a sketch of the sewage disposal system including ties to at least,two permanent reference landmarks or benchmarks. F ;
Locate all wells within 100 feet.Locate where public water supply enters the building.Mi
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. Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C --
r
SYSTEM INFORMATION(continued) ,_
Property Address: 52 RUDDER RD HYANNIS,MA 02601
Owner: JIM MACLAGHLAN 4
Date of Inspection: 11/1/01 .
3
SITE EXAM
Slope
_Surface water
Check cellar
Shallow wells
Estimated depth to ground water 12+feetY
�ry
Please indicate(check)all methods used to determine the high ground water elevation: f
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a � .
NO Observed site(abutting property/observation hole within 150.feet of SAS) t
NO Checked with local Board of Health-explain: n/a T:
NO Checked with local excavatdrs, installers-(attach documentation) z k
YES Accessed USGS database-explain: n/a fit:
You must describe how you established`the high ground water elevation: h' °g
GROUNDWATER DETERMINED BY AUGER NO WATER AT'-12 FEET.
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