HomeMy WebLinkAbout0629 SCUDDER AVENUE - Health 629 SCUDDER A17E.
HYANNIS
A = 287 046
- e
�I
I
'1
I
I
o e
Commonwealth of Massachusetts
a4(p
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port {� _ Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page. Cityrrown
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. Inspector Information
filling out forms
on the computer, Sean M. Jones
use only the tab
key to move your Name of Inspector
cursor-do not S.M.Jones Title V Septic Inspection
use the return Company Name
key. 74 Beldan Lane
Company Address
Centerville Ma 02632
Cityrrown State Zip Code
774-248-4850 smjonestitle5@gmail.com, S14522
sean@smjonestitle5.com License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
10/28/2020
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
Tdle 5 oRiciai inspection Form:Subsurface Sewage Disposal System•Page 1 or 18
t5insp.doe•rev,7/28l2018
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
629 Scudder Ave(main house)
U )
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page. City/Town
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3,or 5 and ail of 4 and 6.
1) 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:
The property located at 629 Scudder Ave Hyannis Port(main house)is served by a Title V septic
system consisting of a 1500 gallon septic tank, distribution box and 6 500 gallon leaching chambers.
Although the system was found to be in proper working condition at the time of inspection this report
does not guarantee future performance under similar or increased usage.
2) 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):
Tate 5 Official inspection Form:subsurface Sewage Disposal System•Page 2 of 18
t5insp.doc•rev.7/26=18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every State Zip code Date of Inspection
page. city/Town
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
3) 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.
a. System will pass unless Board of Health determines in accordance with 310 CMR
16.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
t5lnsp.doc-rev.7I2612018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (main house) --
Property Address
Fitz erald
Owner Owner's Name
information is H annis Port Ma 02647 10/28/2020
required for every --paw Cityfrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
facility or stem component due to overloaded or
Backup of sewage into ty y P
❑ ® P 9
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
t54nsp.doc•rev.MIMI 78 Title 5 Official Inspection Form:Subsiaface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
629 Scudder Ave main house
Property Address
Fitzgerald
Owner Owner's Name
information is Ma 02647 10/28/2020
required for every Hyannis Port
City/Town State Zip Code Date of Inspection
page-
C. Inspection Summary (coot.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1h day flow
El ® 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 water supply
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 2000 gpd-
10,000 gpd.
El ® 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.
5) 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 CA.
Yes No
El ❑ 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
t51nsp.doc•rev.7/26f4018 Title 5 Official Inspection Form:Subsiuface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave main house
Property Address
Fitzgerald
Owner Owner's Name
information is Ma 02647 10/28/2020
required for every Hyannis Port
page.
City(fown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
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)]
Title 5 officiai Inspection Form:Subsurface Sewage Disposal System-page 6 of 18
t5insp.doc•rev.7126=18
Commonwealth of Massachusetts
F Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
nis
required for every Hyan State Zip Code Date of Inspection
page.
D. System Information
1. Residential Flow Conditions:
6
Number of bedrooms(design): 6 Number of bedrooms(actual):
660 gpd
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to--
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? El Yes No
®
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ® Yes [❑ No
seasonal usage
Last date of occupancy: Date -
Title 5 ofri mi Inspection Form:subsurface Sewage Disposal System-Page 7 of 18
tsinsp.doc-rev.7f28P B
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurrace Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house
Property Address
Fitzgerald
Owner Owners Name
information is Hyannis Port Ma 02647 10/28/2020
required for every Zlry/ own State Zip Code Date of Inspection
page.
D. System Information (cont.)
2. 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Tank pumped for inspection
Source of information:
Was system pumped as part of the inspection? ® Yes ❑ No
1500
if yes,volume pumped: gallons
How was quantity pumped determined?
size of tank
routine maintenance
Reason for pumping:
Tale 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
t5insp.doc.rev.7/26/2018
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
629 Scudder Ave (main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page. CitylTown
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed(if known)and source of information:
system installed 2001 per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
2.5
Depth below grade: 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.):
Joints in good condition, no leakage,vented through roof.
Title 5 official Inspection Fonn:subsurface Sewage Disposal System Page 9 of 18
t5insp.doc•rev.712612DIS
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page. City/Town
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1.5
Depth below grade: feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1500 gallons
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle r
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
Tank pumped for inspection
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was pumped for inspection and should be done again every 3 years for proper maintenance. h-
20 tank was structurally sound and not leaking.
Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
l5inap.doc•rev.7@62018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (main house
Property Address
Fitzgerald
Owner Owner's Name
information is ann Hy is Port Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page Citylrown
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. 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
t5insp doe•rev 7rA=i 8 Idle 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house) _
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port _ Ma 02647 10/28/2020
required for every Cityrrown State Zip Code Date of Inspection
page.
D. System Information (cunt.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened)(locate on site plan):
0"
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,any
evidence of leakage into or out of box, etc.):
Distribution box was video inspected and found level and in good condition with no rot. Water level
was even with outlet invert with no signs of past backup.
Title 5 Ofrrial inspection Form:Subsurface Sewage Disposal System Page 12 of 18
t5lnsp.doc•rev.7262018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.629 Scudder Ave (main house
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
page. Cityfrown
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order. ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
6x500 gals.
® leaching chambers number:
❑ leaching galleries number
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number.
❑ innovative/alternative system
Type/name of technology:
rdie s official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
tsinsp.doc•rev.7262018
Commonwealth of Massachusetts
.
Title 5 .Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every City/Town State Zip Code Date of Inspection
page.
D. System Information (cont.)
11. Soil Absorption System(SAS)(cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
s.a.s. consists of 6 h-20 precast leaching chambers in a 53'xl2'trench. No signs of past overloading
12. 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
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 18
t5ir sp.doc-rev.M60018
Commonwealth of Massachusetts
6 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave main house
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Ma 02647 10/28/2020
nnis Port
required for every Hy State Zip Code Date of Inspection
page. Citylrown
D. System Information (cont.)
13. 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.):
t5insp.doc-rev.7126=8 Tale 5 official Inspection Form:subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every City� -Zip Code Date of Inspection
page.
D. System information (cont.)
14. 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
At tiL VI
AZ 7,7
i3
13'L 31 L �S
C3
T)3
I
I
I.
t5ensp.doc•rev.7/2612DI6 Title s official inspection Form:Subsurface Sewage Disposal System•Page 16 Or'a
i
c� Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port _ Ma 02647 10/28/2020
required for every State Zip Code Date of Inspection
pag® Cityrrown
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
12'+
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
El 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:
Groundwater was established by accessing town of Barnstable groundwater contour maps.
Before fling this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7R612018 Title 5 official inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(main house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every
page Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
I
t5fnsp.doc•rev.7rd5=1 8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 18 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port ✓ Ma 02647 10/28/2020
required for every y
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 A. Inspector Information
filling out forms
on the computer,
use only the tab Sean M. Jones
key to move your Name of Inspector
cursor-do not S.M.Jones Title V Septic Inspection
use the return Company Name
key. 74
Company
A Lane
Co
r� Company Address
Centerville Ma 02632
Cityrrown _ State Zip Code
774-248-4850 smjonestitle5@gmail.com, SI4522
sean@smjonestitle5.com License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
10/28/2020
Inspector's Signatur 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
t5insp.doo-rev.7126M8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Pape 1 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald --
Owner owner's Name
information is H annis Port Ma 02647 10/28/2020
required for every y
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
The property located at 629 Scudder Ave Hyannis Port(cottage house) is served by a Title V septic
system consisting of a 1500 gallon septic tank, distribution box and 2 500 gallon leaching chambers.
Although the system was found to be in proper working condition at the time of inspection this report
does not guarantee future performance under similar or increased usage.
2) 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):
t5insp.doe•rev.7126/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
IrTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
v 629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner owner's Name
information.is required for every H annis Port Ma 02647 10/28/2020
.�
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
J
❑ 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):
3) 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.
'a. System will pass unless Board of Health determines in accordance with 310 CMR
1S.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
lug
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Citylrown state Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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.
c. Other:
4) 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
t56isp.doc•rev.M26 018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
lv
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is H
required for every y annis Port Ma 02647 10/28/2020
page. Cityrrown state Zip Code Date of Inspection
C. Inspection Summary/ (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number 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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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 CA.
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
t5insp.doc-rev.7126=18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. cityrrown State Zip Code Date of Inspection
C. Inspection Summary (coot.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
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)]
t5msp.doc.rev.7/26P2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
f
Commonwealth of Massachusetts
Tithe 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 629 Scudder Ave (cottage house)
Property Address
Fitzgerald _
Owner Owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. 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 gpd
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
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 0 No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ® Yes ❑ No
Last date of occupancy: seasonal usage
Date
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is required for every H annis Port Ma 02647 10/28/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Tank pumped for inspection
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? size of tank
Reason for pumping: routine maintenance
t5insp.doc.rev.728/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every y
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
4. 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):
Approximate age of all components,date installed (if known)and source of information:
astem installed 2001 per town records
Were sewage odors detected when arriving at the site? ❑ Yes 0 No
5. Building Sewer(locate on site plan):
2.5
Depth below grade: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.):
Joints in good condition, no leakage,vented through roof.
i
t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner Owners Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Citydrown State Zip Code Date of Inspection
D. System Information (cont.)
6. 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
1500 gallons
Dimensions: j
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle s
How were dimensions determined? Tank pumped for inspection
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was pumped for inspection and should be done again every 3 years for proper maintenance. h-
20 tank was structurally sound and not leaking.
t5insp.doc•rev.7128/2018 Title 5 Official inspection Form:Subsurrace Sewage Disposal System•Page 10 or 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port Ma 02647 10/28/2020
required for every y
page. Cityrrown State Zip Code Date of Inspection
D. System Information (coot.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
B. 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
t5insp.doc-rev.7r2fiW18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
v
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property address
Fitzgerald
Owner owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Cltylrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, eta):
Distribution box was video inspected and found level and in good condition with no rot. Water level
was even with outlet invert with no signs of past backup.
t5msp.doc•rev.7262018 Tine 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house_)
Property Address
Fitzgerald
Owner Owner's Name
information is H annis Port
required for every Y Ma_ 02647 10/28/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
'Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number:
2x500 gals.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5usp.doc-rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (coat.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
s.a.s. consists of 2 h-20 precast leaching chambers in a 23'x12'trench. No signs of past overloading
12. 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
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
tRW.doc•rev.7/262018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
j� 629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner Owner's Name
information is Hyannis Port
required for every Y Ma 02647 10/28/2020
page. ddylrown State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
l
t5lnsp.doc•rev.7282018 Title 5 Official Inspection Forth:Subsurface Sewage P g Disposal System•Page 15 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(cottage house)
tiv.I I
Property Address
Fitzgerald
Owner owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
i 17
.AZ_ 3'
3 336
T r
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Forth_SubsuRace Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection- Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave (cottage house)
Property Address
Fitzgerald
Owner owner's Name
information is required for every Hyannis Port Ma 02647 10/28/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (coat.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12'+feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed:. Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater was established by accessing town of Barnstable groundwater contour maps.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5utsp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
t
Commonwealth of Massachusetts
1, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
629 Scudder Ave(cottage house)
Property Address
Fitzgerald
Owner Owners Name
information is required for every Hyannis annis Port Ma 02647 10/28/2020
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
I
t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
F}s'iin,
d d5s E ,,,,F'yji1'T{�.r;3jt;if, nE6'ih, d'F ."rh" `�r ..Zf.Et.�.-'a. ,�S4 :a rs a} Kl !'•,{ k:- 1�J.:[;-�'-
V.
_ r -
-
TOWN-OFBARNSTABLE
LOCATION _���. �c e� ✓+; SEWAGE # 200/ — 026
j VILLAGE. ACahtr.c o 1 � ASSESSOR'S MAP & LOT o�rT
ell
INSTALLER'S NAME&PHONE NO. Ae-Ly 06 �—
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) . 00 cwy,1 /_t //)
j s ' `�"``� 1 �1 (size) �21 5_7
NO. OF BEDROOMS
BQLDE OWNER e:hc�
i PERMITDATE 'Y-/Z-O / COMPLIANCE DATE:
j Separation.Distance Between the:
MazimumAdjusted Groundwater Table to tti.e Bottom of Leaching Facility
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;Leachng Facility(If any wetlands ezis.t
within.300.feet of e hin' facli
r��F 8 tY) Feet
Furnished by.
�cN
'
I,
F .
F is
t1 1.,3e� L
/ nf,
�)Qy
_0.
V
C
TOWN OF BARNSTABLE
-`LOCATION .' SEWAGE.#..
VILLAGE ASSESSOR'S MAP & LOT R J_
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY X 0 w 1 fi<2 c'
LEACHING FACILITY: (type (size) �� �;►� .f��
NO.OF BEDROOMS `3
BUILDER OR OWNER
PERMIT DATE:T COMPLIANCE DATE: Z "
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
i 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
O
TOWN OF BARNST.ABLE
wLOCATION vr� SEWAGE #
VILLAGE ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /��� f�•- �1 f{'2ae
LEACHING FACILITY: (type zo (size) 1. ' Y,:2 S—�ck-
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: 7/5�0 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
� v,�� 4,
O
�' �
�� �� C
� �, �
��;
y\ y { d
v �
�/
i
i
` < 1
� " . s �
1.,
No., 3 - Fee /�lG)°v v
y a
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Ye
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01 pplication for Migooal *proem Cow6truction Permit
1/Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.,wl d _':;ea ^1?Ve_ Owner's Name,Address and Tel.No.
A n/s st ,1,Wna S pence.
Assessor'sMap/Parcel y /'Y /7mb0r R,C-
Ta .47 dreel `/G 0./ AA"7 inn" obzoV3
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ���`yv�f'33 yy
�°ETEr� Sliu.i vpa�r��5'uu,v�h Eh9.I he .
Type of Building: M,n irlum d esen
Dwelling No.of Bedrooms J Lot Size a 1,000 t sq.ft. Garbage Grinder(Alp
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow .;30 gallons per day. Calculated daily flow 331 gallons.
Plan Date Number of sheets / Revision Date /Vd,06
TitleSi/'e /2i9 �/n��1�C Se f�he .rn Gel" G�9 .SCctditr iIVP, �Qhni;lPDrf vl/i"VQi� C/���.
Size of Septic Tank /500 g"/ Type of S.A.S. JaChfr» V1a-tnbw,.,"A1X '
Description of Soil, r QhAe dlahh• rf— 33' • ee rSe -/ Warne_ dlff.
' /, rn 14sh WeAo ir1.e." ,6q/_ aY Sam e- /" /nw. 5/ E/d "— /„?a
Nature of Repairs or Alterations(Answer when applicable)
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 this o of Hea th.
Signe Date ` a
Application Approved by Date
Application Disapproved or the following reasons
6/___
Permit No. Date Issued
'No ��"' r_�;` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
r Ye
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for ]Di5po0al *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ElIndividual Components
Location Address or Lot No. 01 S a edirl t ve Owner's Name,Address and Tel.No.
A{ an,,'7is 6t 4Ud,7,4 $loel7ea
Assessor'sMap/Parcel y /4119n-,6e,- 1I4' .
' m az� > r c/ yG >'h h� 1,27/l. ot;�O tV 3
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. `J ed -L»e-23 5/V
/0,F7-ele 5U44/YN,V Pc`_5u lkm/I End
'j f'ar/l�riQQ, astC/'✓,i/e rr,
Type of Building: n
Dwelling No.of Bedrooms J Lot Size of 7,000:' sq.ft.' Garbage Grinder(/v JO
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow 3,51 gallons.
Plan Date mom, /l, �o00 Number of sheets f' Revision Date /'V d N6
' Title 5,'- e ld-n Piu&to<L Srel7c ctj, bdq .Seudfz,- five, )4e.,ahj),�p►rt
Size of Septic Tank /S00 Type of S.A.S. . 16C�)/n j
Description of Soil: r Q.hIr oatz, f✓'" 33**' h n" Caar st / jo"u Si"/f, /0yr 5/3
Y �� brn'�.sh ueJ cau �orerle sitn�G Gei'sov»e .s01 /Otar•
Nature of Repairs or Alterations(Answer when applicable)
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 this o d of Health. (/
Signs oa 0 Date
Application Approved by O Date
Application Disapproved forthe following reasons
Permit No.bVDate Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
t Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by
at to 079 Se/_f dam' ✓� k h✓✓s r?' has construct.ep in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ated
Installer Designer
The issuance of this ermit shall not be construed as a guarantee that the syst f 'on-as designed.
Date Z 7 7�r0 J Inspector=� 27! ,,.
-- �-- -------- -------------------
——
No.�� 2 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
Migpo.eW *potent Con5tructiou Permit
Permission is hereby granted to Construct( ).Repair( )Upgrade( )Abandon( )
"1 System located at to o?9 Se u rl de r f/✓e , /�c.✓GL/��7�s�Po r
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this t. s c
Date: ?_ / Approved by
TOWN,OF BARNSTABLE 1/
LOCATION SEWAGE # 900
VILLAGE lCr�-ar,re s,o�/-D" ASSESSOR'S MAP & LOT a48r?—
INSTALLER'S NAME&PHONE NO. A
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 5 00 cfrs� G�J 1`l (size) �� 53
NO. OF BEDROOMS
B DE R O® e4—CAL-
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 d
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of a hing facility) Feet
Furnished by
ki }��4.
d` '_
' �\� . .
. 1 '�'.
o a P � o � � e ��r
�1 a a' �.
.t
O
��
_. � -
.v-----
�.�
, _
- �� ._
No. �%`� '• �. t Fee *so.00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for � gpoga[ *proem Congtruction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No.&tq Se_u d de r• /q VC , Owner's Name,Address and Tel.No.
Assessor's Map/Parcel a�� ���/0 - —�- / , 19m,6er e4.
Ind 420
Installer's Name,Address,and Tel.No. /C� Designer's Name,Address and Tel.No. d��-No�r�' 3 y,V
—kx-
G S&rr1" lc In.4
Type of Building:
Dwelling No.of Bedrooms 16 Lot Size v 0
�� B� C. Garbage Grinder(N
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures f
Design Flow (> gallons per day. Calculated daily flow 66.3 gallons.
Plan Date /7)oZf* 300 d oo/ Number of sheets / Revision Date IV 19
Title 54C eAA PI-0"4Se Se Oh?_ SLIS AZA Lam- oZ. SULdd-4'
Size of Septic Tank 15,06 Type of S.A.S. &1Chi y4 dyin& C d @Alin
ia�x�5
Description of Soil D--61" 0 dr CC 4° , /bin, 19" J3'� I� brku L'Oar� SQh)d
�
�1 orn of / I- ,V `ice?- ii6 po- CQ r Ai!:mow—
n - i
1_f e/%� /O P.
Nature of Repairs or Alterations(Answer when applicable) "
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 C rtifi-
cate of Compliance has been issue this Boar ealth. Z
Sign d �"" Date 4 /
Application Approved by o Date
Application Disapproved for the following re s s
Permit No. Date Issued
71 ,,
Fee
. THE COMMONWEAL
TH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Migooar *pgtem (Eow5tructiou Permit
Application for a Permit to Construct( )Repair(X)Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.�,�.9 j e dl d it r Owner's Name,Address and Tel.No.
Lt),lm�.
Assessor'sMap/Pazcel n-yc. o?�,2 44,-Cc
'�•r-hh�7)r .1W 10120
Installer's Name,Address,and Tel.No. Designer's Name,Address anA Tel.No. .1 01r- 3 5,lt/
�.j u/11-Vd h
Type of Building: r
Dwelling No.of Bedrooms Lot Size •Z03 � 0 Garbage Grinder(Mo
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 4/6 0 gallons per day. Calculated daily flow ��� gallons.
Plan Date' 49ar 30, d 00/ Number of sheets I Revision Date M/9
Title 51' C A ra Esc •Se . 5 stem LL,0q1KA at 61-2CI
Size of Septic Tank r 00 Type of S.A.S. leach)"j✓G CIV h�J�P r' d e,(lrin
Description of Soil 6 —e5!� r), 3 br,�,u e oo rdi S4 i w
Gc)/ so.-77 e.. /0 r 5` V 53 1)d Ern 'A.l1 e/l no (04 rf-L ar)/ #J/s0
! ,�t e/'�d/, �r� ae. San /U r. G/I d
Nature of Repairs or Alterations(Answer when applicable) IILQ. l t_ // 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 C rtifi-
cate of Compliance has been issue this Boar,\�" •* Iealth.
Signed fl n A Date
g
Application Approved by _ //�'�' ® Date J l
Application.Disapproved for the following rea,,sqis
J
Permit No. .r Date Issued I y
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(certificate of (tompliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(�)Upgraded(X )
Abandoned( )by
at G� +,.)`"Caddt r /4 V, Au#1')0 "_ r4- Uy,,, s be n constructed in accordance
with the provisions of Title 5 and the for Disposal Sysctem Construction Permit No dated
Installer Designer
The issuance of this pe it sh 1 not be construed as a guarantee that the cyst ill functi_ as desigsneedd.
Date r/� �f' Inspector_=! �!K It
No. Fee—_2 _/r
THE COMMONWEALTH OF MASSACHUSETTS.,PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS
1wigo5ar 6potem (Construction Permit
Permission is hereby granted to Construct( )Repair(X)Upgrade( X)Abandon( )
System located at P!I4 P7,01 S d-1'
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:Constructio must b completed within three years of the date�et.
Date: L � 2 Approved by
C
4
FMA"�S
S .45' E36_3B [deeJS30�"#` -.�.L O�u� all
----B
h _ o
S.Or
S UB � � b
lo _M. ry ® W'p i o
SeRvE r ti o
, qq '
\� r I. CONFAB ^/ C ro sEP,Ic 1 " p r
---- °` m TANK in W LOCUS
N
O Z
Lot Area N Q Q ..�@. p I �� r
27,000 sf± 1 ,c a o
y�4Ir
to
C i o LIGHT °' w } ~, 43' I. I N *�►� *; , #� _ * .
O PROP.GARAG
' a SUBS 1 Q 'Ae o SRO'"" PRIMARY �; Q LOCUS PLAN
cvn'
1 z 36' M. r' y� v
` Scale: I' =2000'
� Q` r
►� Prtoa sNoWE Assessors Map 287
% `. DRIVE y
" - -- --------- - - _. -j Parcel 46
B7°45' M (deedl — B3° 60' (deed) AP Zone
STONE� AIVEMAY--------------
Setbacks:------- ---------------------
IVZoning - RF-I
Front 30;
Side 15
PLAN VIEW Rear 15'
DESIGN.DATA SCa.le: 1 30'
r
Minimum Design-3 Bedroom
With no Garbage Grinder - - -
Daily Flow=110 x 3=330 GPD F.G.92.0
SepticTonk:330 GPD x 200%=660 GPD F.G.92.0 p T:H q z.o
Use 1500 Gallon Septic Tank O ORGANICS �oAM
LEACHING AREA 900 f g'
330 GPD/0.74=446 SF Required OF
1500 Gallon 89 0 Top EI.90.0 '4 SO Me SII Tg% yR 5/3
Sidewall =2(12+25)2=148 S.F. 89.8 Septic Tank 89.6 a3' QRN'ISH Ye*t_,CoaRsE sANo
Bottom Area= 12x25' = 300 S F Bot.El.87.0
448 S.F.Total Provided 89A 89.e _ , B W/ SOME SILT IOYR S/G
LEACHING CHAMBER DESIGN Bedding as Bottom of Test Hole Ei.82.0 5' ti a �g 733
Al l Pipes to be Schedule 40. Use - Per Title 5 No Ground Water totsxwo
CI. L
P IOYR L/SI
2-500 Gal.Leaching Chambers ina 120
12'x 25 washed stone Field as shown DELVELOPED PROFILE.OF PROPOSED SEPTIC SYSTEM Pt;RC0LA.T%0N TBsT
Not to Scale CLAS5 I MATcRIAI_ - ngPTH 448"
LEsSTNAN 2MIN�INGW
NOTES N O WATRR L°NCOIJNT9L D
NOTE: Remove All Unsuitable Material DATA.I s/y/oo. ENGINEER`S.E.=rvc
LWaterSupplpForThisLotis Municipal Wator wlTwesS' D.MIORANDI - TO.t�. HEALTH
_____ �_ _._ w..�.__..__..___... __ _.._w• For 5 All Around System. No. P-47y7
2 Location of Utilities Shown on This Plan Are Approx.
At Least 72 Hours Prior to Any Excavation ForThis S Topography Based on Assumed Datum.
Project The ContractorSholl Make The Required Fb oerrsea d nn I
Notification to Dig Safe(1-800-322-4844) ve For Property Line Information See Plan
3 The Contractor is Required to Secure Appropriate a-WON by Canal Surveying Dated March 28,2000.
Per From Town Agencies For Construction w '
Defined by This Plan.
4. Install Risers as Required to Within 127of �N o i Leaching o�'m;Ii, ,e
Finished Grade. F SITE PLAN
5.All Structures Buried Four Feet or More or Subject' PROPOSED SEPTIC SYSTEM
to Vehicular Traffic to be H-20 Loading. I AT
CL Septic System to be Installed i n Accordance With CROSS SECTION OF CHAMBER 62-9 SCUDDER AVENUE
310 CMR 15.00 Latest Revision And The Town of '-SNOT TO eCALIK
Barnstable Board of Health Regulations HYAN N(SPORT, MASS.
T. An Piping robesch FOR
4o PVC. WILMA SPENCE
+ SCALE:. AS SHOWN DATE: MAY 11, 2000
SULLIVAN ENGINEERING INC.
OSTERVILLE MASS. .
20002
4
rcX!ST, SEPTIC sliSTL,M
F•ILl.ep \t,// CLEAN MATC-21A1- o `
2__510.35' / _ �.�� 801 i b o �,
LOCUS
C 1 b -.-
p ryEPIPE I_�c13T, HSE,
cr vv \N se.wcRA a- INSTALL. w c \ \. 3 B.R, CARRIAGE _ ,T '. I �' 1 OD * a * +F/ CLBAN OUT, O SEPT-1 TAWV, H8E/GgRAGE .J_ — 4-- — —I I * • • M' *k* �iF
9I EXIST . b BEPI200M 19' \ U►1 L(s; CONST. (�
1 W/F DwEU�1NCr 000 \ — J :.,* *;: .+ «* +►
o
n w � LOCUS PLAN
I \ \ Scale• C 2000
m
Assessors Map 287
Parcel 46
NOTE \ �
Rl L-�T ARCH All-Components tobe r - - -
� L_ _�_ I I- ---- - _ � Q AP Zone
o-t3ox
H-20 Loading. - - _ `_II a I Zoning - RF-I
- - Q Setbacks: Fro
Ont 30�
Side� 15�
\ \ 9y ---- ---- Rear 15
PLAN VIEW
SCgle= 1 =30
NOTES
- Single Family-6 Bedroom
Repipe xisting House r�+• eLev.ga.o I.Water Supply ForThis Lot is Municipal Water. No Garbage Grinder
SewersF2)toConnect
To New Septic System o 011ax"ie, r_op.nn 2 Location of Utilities Shown on ThisExc v Are ForTh. Septic T nk!606 d 200%=1320 d
F.G.96.0 - -��� � __ •' - ei' At least 72 Hours Prior to Any Excavation ForThis p gp 9p
BRN•COARSIL SAND 1y r Project The ContractorSholl Make The Required Use a I5 AC Gallon Septic Tank.
Crawl F.G.92.G °` saMS SIVT. I0-IR5/3 Notification to Dig Safe(1-888-344-7233) LEACHING AREA
Space a3' '
n n
s w%solvi�c slCTaova sA C The Contractor is Required to Secure Appropriate, 660 gpd/0.74=892:s.f.Required
93.5 89.0 tia' Permits From Town Agencies For Construction Sidewalk 2(12 +53 )2=260 s.f.
Lr,YGt't5M 3PtN COARSd Defined byThis Plan. Bottom Area: 12 x 53 = 636 s.f.
1500 Gallon Top El,90.0 C SAND loyR L/N �� 896.s.f.Total Provided.
93.3 Septic Tank 93.1 I zo' 4. Install Risers as Re uiredto Within 12 of LEACHING CHAMBER DESIGN
Bot.E1.87.0 q
90.2 9.0..0 PaRGCLAr%0N TEST Finished Grade.
-�•t�=� �` - 5.0' C1A55 1 MATERIAL. - oga•rM y 8" All Pipes to be Schedule 40 PVC. Use 6
Bottom of Test Hole EI.82.0 LeX-S 11SA 2 M,N/INCH . 5.All Structures Bu'ried Four Feet or More,orSubject' -500 Gallon Leaching Chambers in
Bedding asp. AM
No Ground Water
Per Title 5 NO wATSR �.nlcouwTet 4 to Vehicular Traffic lobe H-20 Loading. 12'x 53'Washed Stone Field as Shown.
DA-raI S/y/00- F'NGlt4&IIS.E.=roc
W\110,41 ' D.M%ORANDI— T 6 O•M.HEALTH Septic System to be Installed in Accordance With
DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM 310 C M R 15.00 Latest Revision And The.Townof NOTE Remove All Unsuitable Material
Barnstable Board of Health Regulations For 5 AI I Around System.
Not to Scale
7. All Piping to be Sch. 40 PVC.
. Topography Based on Assumed Datum.
For Property Line Information See Plan
Finlsb orede ��OF ; by Canal Surveying Dated March 28,2000.
filter
io Fabric Compacted Fill s
n%-,21
Vill
ve_in•
Pea siaa. I SITE PLAN
C achingmber -
' PROPOSED SEPTIC SYSTEM
N Chamber 3,+•_1 i,2 �`�ST UPGRADE
Double YMf�ed - "Y
Stan. v L"rT� ,i AT
629 SCUDDER AVENUE
HYANNISPORT,MASS. z
CROSS SECTION OF CHAMBER FOR
:NOT TO SCAM WI LMA. SPE'NCE
SCALE: AS SHOWN DATE: MAR. 30112001.
SULLIVAN ENGINEERING INC.
REVISION 05/%0/01 'As-SUILT SEPTIC 5Y STL=M OSTERVILLE MASS.
..
ZODCO2
aeo +
° tiA
n'
i
--XIS-T, SEPTIC SY STIB NM 6 OCR
TOi'SC Ri-=rAOVLLV --
LOCUS �.
C q ;ji0str
it x 1 `5 sr-r-Ti C
0 /W V✓ REPIPE I=% T 1S , kiss J / 1`6TF_M
11 3 13:R, CARRIAGE _T I I 1 10
—I EXIST . b 8Ep�200M I UN Lf2 CONST. s *fr
I T`-14 • Q
LOCUS PLAN
Scale, I' =2000'
C I� ' c• i`i 1 Assessors Map 287
R1 LOT AREA NOTE i \ W Parcel 46
All-Components tobe
z�,000- s.F, i I AP Zone
H-20 Loading. —a � � Q
QZoning - RF-I 1
v Setbacks: Front 30
- - - _ _ _ go, ` Side 15'
Rear 151'
PLAN VIEW —'�
Scale- 1 =30
DESIGN DATA
TES
Repipe xisting House ". Single Family-6 Bedroom
SewersF'2)toConnect D 11.4. eLev.q>•.o 1.Water Supply ForThis Lot is Municipal Water. No Garbage Grinder
To New Septic System _ 2 Location of Utilities Shown on This Plan Are A rox. Daily Flow: 110 x6 = 660 gpd
' O ,ORGANICS LOAM PP
F.G.96.0 e 1 ' At Least 72 Hours Prior to Any Excavation For This Septic Tank:660 gpd x 200%=13200pd
Crawl n nF.G.95.0 A BRN•COARSQ 3ANO �i Project The ContractorShall Make The Required Use a 1500 Gallon Septic Tank.
Space Isa"'s SILT. IOYRs 3 • Notif ication to Dig Safe(1-888-344-7233) LEACHING AREA
33"—
B 9RWISH, VML.Coc,Rsr 94No 3. The Contractor is Required to Secure Appropriate 660 gpd/0.74=892,s.f.Required
{�W/ SOME SILT IOVR S/f, q � r
93.5 92.5 46, Permits From Town Agencies For Construction ' Sidewalk 2(12 +53 )2 T 260 s.f.
1500 Gallon Top EI,93.5 c t_T,vG1—'ISM M;XN COAas W Defined byThis Plan. Bottom Area: 12'x 53= 636 s.f.
93.3 Septic Tank 93.1 18AND 1 OYR 6/'•/ 896:s.f.Total Provided.
Bot.El.90.5 'Zo 4 Install Risers as Requiredto Within 12!'of LEACHING CHAMBER DESIGN
ev.,F:.,,.,•.�-�: 92.9 92.7 PERc0LAT10N TEST Finished Grade.
Bottom of Test Hole EI.82.0 8.5 CLASS I MAT>GRIAt— - n®PTW y8" All Pipes to be Schedule 40 PVC. Use 6
Bedding as t sss T41AN ZMIN�INCH 5.All Structures Buried Four Feet or More or Subject -500 Gallon Leaching Chombers.in a
No Ground Water g
Per Title 5 no wA;'tR ISNCOUNTtt 4 to Vehicular Traffic to be H-20 Loading.
DA-rm l s/v/oo. ENGIN6�R'S.E.=Nc 12 x 53 Woshed Stone Field as Shown.
W\•TAe'pS! D-WORANDI- T O•D.HEALTH 6 Septic System to be Installed in Accordance With _ .w_..._-_....w........ -- .—....w_ �.w
DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM No. P-`;t7,47 310 CMR 15.00 Latest Revision And The.Townot NOTE Remove All Unsuitable Material
Not to Scale Barnstable Board of Health Regulations
For 5'All Around System.
T. AI I Piping to be Sch. 40 PVC.
Topography Based on Assumed Datum.
Finish Grade - -
For Property Line Information See Plan
by Canal Surveying Dated March 28,2000.
Filter I
n Fabric Compacted Fill
.NAM OF
Ru Sfk"
PETER
i Leaching 3/4--tt - SULLIVAN
O 2 78�3 ` SITE PLAN
N Chamb.r sl CIVIL
OSEUPGRADE SYSTEM
Double riaehed
Stall
L AT
629 SCUDDER AVENUE
C�CROSS SECTION OF CHAMBER HYANNISPORT� FOR ,MASS.
'-,:NOT TO SCALE,
WILMA SPENCE
SCALE: AS SHOWN DATE: MAR. 30,2001
SULLIVAN ENGINEERING, INC.
I OSTERVILLE MASS.
20C)o2