HomeMy WebLinkAbout0421 SCUDDER AVENUE - Health u
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Commonwealth of Massachusetts '
e
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rz.
�M 421 Scudder Ave 0
Property Address
Suzanne Finney !
Owner Owner's Name /
information is required for every Hy p annis ort V Ma 02646 6/5/17 '
page. City/Town State Zip Code Date of Inspectro%
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 DiBuono
use the return Name of Inspector
key.
DiBuono Sewer and Drain
r� Company Name
8 Johns path
Company Address
S Yarmouth MA 02664
City/Town State Zip Code
508-364-9587 S113522
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,
6/5/17
Ins rector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
/'O�jd vs
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is H annis ort
required for every Y P Ma 02646 6/5/17
page. CityrFown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System Contains a 1,000 gallon septic tank as well as a 1,000 gallon pump chamber, a concrete
distribution box as well as 2 500 gallon leaching chambers in stone.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pag'e 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is H is ort Ma 02646 6/5/17
ann
required for every y p
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is
required for every Hyannisport Ma 02646 6/5/17
page. Citylrown 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
.W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is H annis ort Ma 02646 6/5/17
required for every y p
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
I
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is
required for every Hyannisport Ma 02646 6/5/17
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ 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
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•-Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is required for every HY p annis ort Ma 02646 6/5/17
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: Vacant
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ® Yes ❑ No
Water meter readings, if available last 2 ears usage d 198 GPD
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is p required for every y H annis ort Ma 02646 6/5/17
page. City/Town 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: Not provided
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):
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
i
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is H annis ort Ma 02646 6/5/17
required for every y �p
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
7/12/02
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: 1.5
p g 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.):
System is vented at the roof line
Septic Tank(locate on site plan):
Depth below grade: 1feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1000
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is Hyannis port Ma 02646 6/5/17
required for every p
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
24"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
42"
Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is required for every Hy P annis ort Ma 02646 6/5/17
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is required for every Hy p annis ort Ma 02646 6/5/17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level and at normal level
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ® Yes ❑ No*
Alarms in working order: ® Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump and float switches are working. Alarm is also working
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is required for every Hy p annis ort Ma 02646 6/5/17
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ 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.):
No ponding no breakout
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5, Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is required for every Hy p annis ort Ma 02646 6/5/17
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
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17
l
Commonwealth of Massachusetts
W - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is p
required for every y H annis ort Ma 02646 6/5/17
page. Cityfrown 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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is
required for every Hyannisport Ma 02646 6/5/17
page. Cityrrown 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: NGE at 120"
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: 7/12/02
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Test hole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
6/5/2017 Assessing As-Built Cards
^� TOWN OF BAARNSTABLE �-
LOCATION a/ Sc pyl Ele /"'J6rc. SEWAGE a �-33:�)_
VILLAGE N�S /00 it i ASSESSOR'S MAP&LOT_2Zd'-l38
INSTALLER'S NAME&PHONE NO. "H 6,vs7- SoF_77J-(3 6
SEPTIC TANK CAPACITY .9X-ST /ooy// s000 lu.�p C�.g��it2
LEACHING FACILITY:(type)C�).570,o rDA-�Sties
(size) A �
NO.OF BEDROOMS =
BUILDER OR OWNER_ '2 F� TT
PERMITDATE: !Y / dot COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom ol'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_9=-�/ _ a
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http://www.townof)arnstable.us/AssessingtHMdisplay.asp?mappar=288138&seq=1 1/2
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for VoluntaryAs
sessments
;M 421 Scudder Ave
Property Address
Suzanne Finney
Owner Owner's Name
information is
required for every Hyannisport Ma 02646 6/5/17
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
❑ System Information—Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
11
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- TOWN OF BARNSTABLE ��--
. LOCATION ��1 SG ve—a rQ SEWAGE #�Z
VILLAGE PG d2% ASSESSOR'S MAP & LOT 231-138
INSTALLER'S NAME&PHONE NO.49-c/f C O"iST
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SEPTIC TANK CAPACITY I-SX4T JOOd ldoo ?enp Gis9"ig2
LEACHING FACILITY: (type) —5700C1,4,'649,Z5 (size) o2s x 13 , -Z—
NO. OF BEDROOMS-3
BUILDER OR OWNER_ �� � U,✓,01,eT7-
PERMITDATE: Oo2 COMPLIANCE DATE: 2
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
e
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
g.
3j =
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17 = 35
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TOWN OF BARNSTABLEC
LiCATION � S��iGC� cQ �� SEWAGE #ZoeZ-33.a-
ViILAGE_ C�'Yiliyni�.5 /`'c d2 i ASSESSOR'S MAP & LOT 2x8--- /38
INSTALLER'S NAME&PHONE NO. /5` L o,vs% C
SEPTIC TANK CAPACITY _fx4g l®ay 20o0 ?&1^,e CW 4- 1;e
LEACHING FACILITY: (type)Q)S40o C14.1 S SCS (size) ,2-5-x 13 x
NO. OF BEDROOMS n n
BUILDER OR OWNER_ -k OC Un/! /� TT—
PERMITDATE: / dv2 COMPLIANCE DATE: Y 1,F10 2
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
tj
(I �) I)
r1 .�
1 �
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O
Doto T o
No. Vmml r� �} I e2
� ` 7
THE COMMONWEALTH OF MASSACHUSETTS Enteeedincomputer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippliCation for ]Disposal 6pStrm Construction 3pPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 'Z 1-5(_t2dde4, Av P Owner's Name,Address,and Tel.No.
«-M,n Susa In e 509 -53
Al7-1
s is Map�arcel I'�J y
Install s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Ei GaVCL+I0n _6D9-4j7-D66_-6 A i A
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 0
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued b this Boar Health.
Signe Date
Application Approved by Date 1-b Ll DL-
Application Disapproved by Date
for the following reasons
Permit No. C9_0 Date Issued 51,161
No. �� C7` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
e a
01pplicatlon for Misppl4aY 6pStrlM /CortstrUction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.J4 21 5 L f ddN Av�1 Owner's Name,Address,and Tel.No.
A�r�s Map/Parcel �' �1`. `� 5USQll i n V Sri� - 5 3 y -� �y
Instal le's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Cy-CDV0J10n 6D9- 41TD663 A] iA a
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons t Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets ,,,_ Revision Date
Title i a a "% ,.
Size of Septic Tank ` �'f ( L = Type of�.A.S. w
Description of Soil !
C
Nature of Repairs or Alterations(Answer when applicable)
wf V IiJ'
Date last inspected:
Agreement: ¢ f ,✓
r
The undersigned'agrees to ensure the construction and m imenance of the afore'described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental fCodef and not to place the system in operation until a`Certificate of
Compliance has been issued b this Boar Health.
/ I
Signe Date-6 ` C�
ApplicationApprove&by A Date` b
Application Disapproved by {' Date
for the following reasons i M1
Permit No. (9-01/ - Date Issued x
--------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS"
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ^) Upgraded( )
Abandoned( )by y_n yo an
``
at '"192S 1 �0 P-1 A\j P has been constructed in accordance
with the prw' ions of Title 5 and the for Disposal System Construction Permit No-3b),9-/J� ( dated 5 h
Installer �d & Designer —
#bedrooms Approved design flow _. gpd
The issuance of thi pentit shall not be construed as a guarantee that the system 'll futi n as desi ed. nnC
Date f{ 2- Inspector ��', r I�d
- •-- - -- -_ -- r --,.----�- ----��---- --------------------------------- -,-_ -----•--------------
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposat 6pstem (Construction J)ermit
Permission is hereby granted to Construct( ) Repair(✓) Upgrade( . ) Abandon( )
System located at `4 21 St irl!L�V��n I D�ar4-
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. 5
Provided:Constru/tion mus4 be completed within three years of the date of this Cb
Date�// �� Approved ---
of'"E'�ti
Town of Barnstable
U.S.POSTAGE>>PiTNEYBOWES
Public Health Division / 37.
BARNSfABLE.
ASS � 200 Main Street M 1 gFOM ZIP 02601
o+°0 Hyannis,MA 02601 ` Y ? ZIP
l $ 005.50
9
i •. 0001361475SEP. 20, 2011. I
�7011 ,0470 _0.00*17 4525�5266
�''! i I ���` U.S.POSTAGE>>PITNEY BOWES
4;'
nv
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11 r_ ZIP 02601 $ 000.000
ex-
CDA -�• 02 1VV
Lei Pti"1 -1 Mr Joseph Bo�bara 0001361475 SEP. 21. 2011.
421 Scudder Avenue 7
p = "' Hyanis, MA 02601
RETURN 70 'SENDER
NO SUCH STREET
UNABLE TO rORWARD
OC:: tt 02601400200 *2094-jj0
jj12:3t1-ii29 26
. 028010-4002. - _ � 1�T71'7:17J7'�D��7.i��J-77/JDi�7�7?�.��;117ri-JD;iDiiT�)-111.7)l1/F1/�ii
•MiPLE:TE T'HIS SEC'Tl6N COMPLETE • ON •
E Complete items 1,2,and 3.Also complete A. Signature I /
item 4 if Restricted Delivery is desired. ❑Agent
i ■ Print your name and address on the reverse X ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
I ■ Attach this card to the back of the mailpiece,
I or on the front if space permits. �
I D. Is delivery address different from item 1? ❑Yes I
1. Article Addressed to: If YES,enter delivery address below: ❑ No I
l I
Mr. Joseph Bonbara
421 Scudder Avenue i.
Hyannis, MA 02601 a. Service Type
❑Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number I� 7011 0470 0001 4525 5266
(transfer from service label)
I
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
0p SHF Town of Barnstable
Barnstable TOIY
P Regulatory Services Department ed`aC j
+ BARNSTABLE,
"A . D
ss 039. Public Health Division
�0 m
ArFD MAC a' 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7011 0470 0001 4525 5266
September 20, 2011
Mr. Joseph Bonbara
421 Scudder Avenue
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 421 Scudder Ave., Hyannis,MA was last inspected on
8/11/2011, by Ricky L. Wright, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• At time of inspection H-10 d-box is cracked and leaking due to being under
driveway. Recommend replacing with H-20 rated d-box.
• At time of inspection pump chamber appears to be structurally sound and in good
working order, however the high water alarm needs to be reattached.
You are ordered to repair or replace the septic system within two (2) years) from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
E:m'as McKean, R.S., CHO
Agent of the Board of Health
Document in Scrap(2)
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Town of Barnstable Barnstable
1. Regulatory Services Department AN-Amn;cac j
.
+ BARNS'TABLE,
639. Public Health Division
ArFb MAC A, 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7011 0470 0001 4525 5266
September 20, 2011
Mr. Joseph Bonbara
421 Scudder Avenue
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 421 Scudder Ave., Hyannis,MA was last inspected on
8/11/ 2011,by Ricky L. Wright, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• At time of inspection H-10 d-box is cracked and leaking due to being,under
driveway. Recommend replacing with H-20 rated d-box.
• At time of um inspection chamber appears to be structurally sound and in good
p pump
working order, however the high water alarm needs to be reattached.
You are ordered to repair or replace the septic system within two (2) years) from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
mas McKean, R.S., CHO
Agent of the Board of Health
Document in Scrap(2)
�- - -
� 6� °U
q I«�n
� .
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
I
on the computer,
use only the tab 1. Inspector: 1,
key to move your
cursor-do not Ricky L. Wright
use the return Name of Inspector
key.
B & B Excavation, Inc.
ry Company Name
14 Teaberry Lane
Company Address
Sandwich MA 02563
City/Town State Zip Code
508-477-0653, S14595
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
8/11/11
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the appig ro-Vi 'aathority.
****This report only describes conditions at the time of inspection and under the conditions of use
i at that time.This inspection does not add r;_ss:bo#jjhe,lyste�m w ll perform in the future under
the same or different conditions of use.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. Cityrrown 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.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
'wM 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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 ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
421 Scudder Ave
M
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. Cityrrown 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:
At time of inspection H-10 d-box is cracked and leaking because of its location under the drive way
.Recomend replacing d-box with H-20 .Also the high water alarm float needs to be repaired to
engineer specs.
t
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
❑f ® 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 '/z day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. City(rown 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.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
J
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
°M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hy annis Port Ma 02601 8/11/11
page. Cityrrown 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?
❑ Z 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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
ImEft, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GSM 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d n/a
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ . No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 7 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information
required for every Hyannis Port Ma 02601 8/11/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2002
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >20feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage.
Septic Tank(locate on site plan):
Depth below grade: 2
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:
5.2x5.2x8.6
6"
Sludge depth:
t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official n Insp ecti0 Form
rm
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
421 Scudder Ave
M
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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
32"
Scum thickness
6"
Distance from top of scum to top of outlet tee or baffle
10"
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? scour stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection tank appeared to be in good tees present no sign of back up. Recommend
pumping tank.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
4 W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11 page. Citylrown 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
-1"
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.):
At time of inspection H-10 d-box is cracked and leaking due to being under drive way.Recomend
replacing with H-20 rated d-box.
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.):
At time of inspection Pump chamber appears to be structuraly sound and in good working
oder,however the high water alarm needs to be reatached .
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ 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.):
At time of inspection leaching appeared to be in good shape no sign of staining or hydraulic
failure.Water level was 1.6 feet below invert at time of inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments
421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every yH annis Port Ma 02601 8/11/11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
1
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form =Not for Voluntary Assessments
wM 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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
r A
&Aek- 2
3
fi 20�C 1'
IJ
} 3 . 30' G
AEI = 27
-ty z. g '
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 421 Scudder Ave
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
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: >12feet
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:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
• W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
421 Scudder Ave
�M
Property Address
Joseph Bonbara
Owner Owner's Name
information is required for every Hyannis Port Ma 02601 8/11/11
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓�
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprication for igogal *pgtem �Congtruction Vermit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. P, Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and T No. _
l34a-
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/41
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �Cu-_S-s Qx gn Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer hen applicable) loepd 6�1
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issuedby this Boaz ealth. p
Signed Date 0 ��
Application Approved by S Date
Application Disapproved for the following reasons
Permit No. �('i��— '�`�� Date Issued
4,7
`. No. �J�A cam J . --i /; Fee
s 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Rpprication for igpool *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 'El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. r
4 Assessors Map/Parcel --� ). /
G /T7 r
Installer's Name,Address,and Tel.No. Designer's Name,Address and T� No. e
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garba'ge.Gnnder�(/��
Other Type of Building No.of Persons Showers( y) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) AePAI ey !J C "",6�c
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue(jby this Bo d<f'Health. 01
Signed Date
Application Approved by Date O C�
Application Disapproved for the following reasons
r
--PermitNo��—---"�`� —— —— =— ———
DateIssued---- ------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Dis sal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by Aa ST a
at has been constructed 'n Iccordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.2CX-S2 33Z dated C)'
Installer Designer
The issuancd of this permit shall not be construed as a guarantee that the syst will function a_ designed.
Date U•z k Inspector_ ...
1 �
No.��� � � , --------------------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
lwigpogar *pgtem Cr Mruc ion Perm, %t
r S' o t
Permission is hereby granted to Construct ),Re r Up, jrade,( Abandons}�
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction mu t be completed within three years of the date of this pe it. n C l
Date: Approved by S
f '
LOCATION SEWAGE PE MIT MQ.
94
VILLAGE
.. IN NAME A ADDRESS
y
e UILDER. OR WISER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
-V �
r
O C
N �
fA
Y
LAJ
7
g
C
. c.
i
riJ
I+
u�
No........................ Fimim j...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................. ...........OF......
Appliration for Dwpoiial Works Toutitrurtion "pamit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.....klz o........... ..................................................................................................
•Location-Address or Lot No.
4.......T ------------------------------- ------------------------------------------------------------------------------------------------ -
, 'i(idn Address
...................... ..................... ...............# .... ..17�.. i�;a r -------------------------------
Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms-............................................Expansion Attic Garbage Grinder
aOther—Type of Building7---------_------------_- No. of persons____________________________ Showers — Cafeteria
Other fixtures
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width..............._ Diameter...__.__........ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................._. Total leaching area....................sq. f t.
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. 1................minutes per inch Depth of Test Pit.__........__....... Depth to ground water......___...............
44 Test Pit No. 2................minutes per inch Depth of Test Pit..._..........__._.. Depth to ground water.._......_..........__..
9 ..............................................................................................................................................................
0 Description of Soil.................... -
MW------------ ------------------------------------------------------------------------------------------------*----------------------
.........................................................................................................................................................................................................
........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable Tvq.<........:3.....
I ---------- ------
.................................................................................................................................................... ...................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in 1!
operation until a Certificate of Compliance has been issued by the' board of health.
SignedA"
. ............ �i -
---------------
Application Approved By.............................................................. .... ............ 7 �eeg
........................................
Date
Application Disapproved for the following reasons:................... .. ............. ...................................................................
................................................................................................................................. .......................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tntifiratr of Tontpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by---------------------------------,-�..............................................................................................................................................
lagaller
at.............................. ...................r�
has been installed in accordance with the provisions of TITLE 5 of The t Sanitary Code as described in the
;"a
application for Disposal Works Construction Permit No_____________ -.. .._ '
dated.....___......__.__......___.___....._.__...__..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....
Inspector...... ........................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF................ 1-5
No.... FEE.......I�...........
Disposal Vorks T'Wanstrudion "Prrmit
Permission is hereby gie`anted.......................all-�Cll—--------------------------------------------------------------------------------------------------
to Construct ( C) orlRepair an Individual Sewage Disposal System
at No................../- '�7'
. :;?=z............... e;p 1/__4. ................. 'g
Street
as shown on the application for Disposal Works Construction Permit No...................... Dated..........................................
.............................. .................. ----------------------------
Boa d of Health
DATE
FORM 1255 A. M. SULKIN, INC., BOSTON
i' SYSTEM PROFILE TEST HOLE LOGS
T-EF--FNDN. AT EL 21.2' (NOT T❑ SCALE>
I ACCESS COVER TO WITHIN 6 OF FIN. GRADE
/ ACCESS COVER (WATERTIGHT) TO ENGINEER: A.H. OJALA, PE
MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' [IF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 21.5' WITNESS: DAVID STANTON
19.1$' RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE 0,75' MIN DATE: 7/12/02
FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH
EXISTING1000 4,
r "''°Rsron,
GALLON SEPTIC 17.78' °' "TEE 20.0 CLASS I SOILS P# 10282
TANK CH- 10 ) GAS m
-: RE-US BAFFL 19.45' Dodo 19.28 a C7 E7 m Cl m m 0 CWI-
m ����`
19.17 Q Q Q Cj [] [] [� Q [ AROUND
o00 0 0QEOCO boa LOCUS
6' CRUSHED STONE OR MECHANICAL g�
COMPACTION. (15.221 C27) $ 2' Q Q Q 0 Q Q Q Q ] 0 17.17' �j ELEV,
DEPTH OF FLOW = 4' r M ON 21.5'
< % SLOPE) ( Y. SLOPE) 3/4 TO 1 1/2 DOUBLE WASHED STONE A
TEE SIZES:
- - INLET DEPTH = 10,. LS
- �� 16" 10YR 6/2
OUTLET DEPTH = 14 ---
g LOCATION MAP NITS
PUMP LEACHING LS
FOUNDATION
- EXIST SEPTIC TANK 1' CHAMBER _-105' D" BOX 13' FACILITY _ _ 5.67' 24" 7.5YR 5/6 19 5. ASSESSORS MAP 288 PARCEL 138
VARIANCE REQUESTED UNDER MAX. FEASIBLE
COMPLIANCE 15.405 la: REDUCTION IN SETBACK, SAS
TO LOT LINE (10' TO 5')
C 1b: REDUCTION IN SETBACK, PC TO GARAGE (10' TO
Ji 20.6 5')
11.5' MED/COS
V 20.9 ALARM AND CONTROL PANEL ,
TO BE INSTALLED INSIDE
BUILDING. ALARM TO BE ON INV. IN 17.6' ` ` _
/ SEPARATE CIRCUIT FROM PUMP 2.5Y 6 6
2 1000 GAL. H-10 S/ 2' PRESSI��E PIPE TO D'BOX ;
p q�. ALARM BN-- 700 GAL.+
SLOPE 'TO DRAIN BACK TO PC
h�1 21.1 1p/ 10 FLAT SWITCH RESERVE WEEP HOLE
y S. SETTINGS; PUMP ON CHECK VALVE
0.6 4' WORKING RANGE 8 ZOELLER 'btASTEMATE'
RRY 4' SUBMERSIBLE MODEL M282 1/2 HP PUMP
/ + PUMP CUFF 8' SYSTEM (OR EQUAL)
0.2
+ O OV4� 4 20.4 120"
/ yY + y ,2 ,SO 6' CRUSHED STONE DR o�oao "0 0000
/ 2 W KS, o p0, C❑MPACTI❑N NO WATER ENCOUNTERED NOTES:
I121.1 PUMP CHAMBER
E C. IN
HIS 20.i 90 - CNDT TO SCALE> APPROXIMATED FROM QUAD
21.4o AREA. SEPTIC DESIGN: (GARBAGE DISPOSER IS Nnj ALI oMr) _ ) 1. DATUM IS
EXIST. DWELL. /} �,-, _
tig11 E ��.�. >?c nannM r 110r; n -` 330 r,Pa;' __..a _ 2. MUNICIPAL WATER IS_ ,EXISTING
DECK U 3E A 330 GPD DESIGN 5 q� __
114..J 1 V.� � ,.a .r ...._-._ ,,.__..�_-...
�Fq TF = 21.2' � N FLO`�/ 3. �1IhIMUM PIPE PITCH TL] BE li8•: MEf� r• r;J_I_..':_
D LOT AREA SEPTIC TANK: 330 GPD ( 2 > = 660 4. jE:>IGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 .
20.6 9,000t SQ. FT. _ -`- 5. 'IPE JOINTS TO BE MADE WATERTIGHT.
1.0 �+ 1/ US A 1000 GALLON SEPTIC TANK (RE-USE EXISTING) 6. CO`JSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
21. $'4 LEACHING: ENVIRONMENTAL CODE TITLE V.
+ 2(25 + 12.83) 2 (.74) 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ORII..Y AND IS NOT
BENCH MARK -- HYDRANT ON TAG >ts SIDES: _ �-- TO BE USED FOR ANY OTHER PURPOSE.
BOLT. ELEV = 23.4' EXIST SEPTIC rn BOTTOM: 25 x 12.$3 (.74) = 237
TANK 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' ,'PVC
(RE-USE) 70TALt 472 S.F. 349 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
S4 1 18.5 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
Op. GARAGE USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH,
1c 19.1 18 EWAL) WITH 4' STONE ALL AROUND 10, PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACHING
0 -i AREA
19 .
PROP. PUMP CHAMBER + 18.8 � 00 17
18. ,moo L E.aE N TITLE 5 SITE PLAN
PROPOSED SPOT ELEVATION OF
1�
100x0 EXISTING SPOT ELEVATION 421 SCUDDER AVENUE
IN THE VILLAGE OF:
I
15 - � - 10 PROPOSED CONTOUR H YA N N I S P Q R T
1
14 4 100 EXISTING CONTOUR PREPARED FOR: WILFRED RUNDLETT
1
1
20 0 20 4.0 60
HIGH WATER M �=+ 12.9 BOARD OF HEALTH
13.1
- APPROVED DATE MA SCALE. 1" = 20' DATE: JULY 12, 2002
12.8
off 508-362-4541
12.8 SCHOOL HOUSE POND fax Sob 362-9880
`AN OF M
dOWn L Upe engineering, Inc, o��t� ARNE �tN OF
t H. ARNE H.
CIVIL ENGINEERS 3 OJALA
0.26348 oQ
LAND SURVEYORS `'�� fcrsTER awy o. 2
s oQ o /STt
939 moin st. yormouth, mo. 02675 Nal
02-- 187 ARNE 0JALA, DATE