Loading...
HomeMy WebLinkAbout0136 SEA STREET - Health 55,Seabrook Road w Hyannis P A = 307 103 a C p ti 4 'I! N �yAQry M R p if 1 Q III 11 �f Commonwealth of Massachusetts 3 D�--0(3 Title 5 Official Inspection Fora lI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . c I , 55 Seabrook Road �— Property Address Charles Hetzel Owner Owner's Name/ information is H annis V MA 02601 09/17/2020 required for every y ` t page. City/Town. State Zip Code Date of Inspection r �. F°-.t 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 fillingng outA. Inspector Information out forms on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End'Road VI Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number 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); I'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 �09/18/2020--­-.. . 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts ,4-p Title 5 Official Inspection Form 10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 - page. Citylrown 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: This 3 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding 2 leaching chambers with stone. At the time of the inspection no visible failure criteria was found. 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.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form pie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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): ❑ 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): I 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 15.303(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 p Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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: I I 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 110 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. Cityfrown 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 1/z 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts ,P Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road V� Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. Cityrrown 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts I Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. Citylrown 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): 33 plus GP Description: Number of current residents: 1 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 ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gpd))� Detail: 02/25/2019-09/03/2020 80,030 gallons were used Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form I;�1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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: 08/02/2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 191.feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. t5insp.doc-rev.7/26/2018 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 0 55 Seabrook Road U— Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 10"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: H-10 1500 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" i How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage(Disposal System-Page 10 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. CitylTown State Zip Code Date of Inspection 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.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I cam, Commonwealth of Massachusetts ,�.4 Title 5 Official Inspection Form �- �1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road V Property Address Charles Hetzel e Owner Owner's Name information is required for every Hyannis MA 02601 09!17/2020 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: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Fora I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town State Zip Code Date of Inspection 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.): At the time of the inspection no visible failure criteria was found. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts �- ,� Title 5 Official Inspection Form I? ��a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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.): t5insp.doc•rev.7/26/2018 Title 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 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. Cityrrown 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: Z hand=sketch in the area below ❑ drawing attached separately ' e p R 3 aft �_t fi ro rya C-'I C3a i , t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•'Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface System Disposal Sewage Dis g p y tem Form Not for Voluntary Assessments u 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every y H annis MA 02601 09/17/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feetfeet 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: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Seabrook Road Property Address Charles Hetzel Owner Owner's Name information is required for every Hyannis MA 02601 09/17/2020 page. City/Town 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE `` l LOCATION FS fj Lg iD SEWAGE# 2,00'1-32 VILLAGE 9414NNi5 ASSESSOR'S MAP&PARCEL 307- 1'3 INSTALLERS NAME&PHONE NO. fZ®6(N.S00J S G -50?-77 S-R772f0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z AlrJ(4 (size) 1'3)4 Ox S 1(-'2- NO.OE BEDROOMS OWNER �jAr2�C°'S tT�T Zc� PERMIT DATE:'7- COMPLIANCE.DATE: fj' Separation Distance Between the: F 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 J n'�O �J l � 1 t t 1 - - Aa- ol ,cc i cn O r � � v NO. . 00 a � � ��. W � � � - AlF�e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for 3ke;po al *p!5tem Cott.5truction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑ Complete System T_Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 7 5—O 9 3 6 55 Seabrook Rd, Hyannis Charlie Hetzel Assessor's Map/Parcel 307/13 55 Seabrook Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 , Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: ' Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder VD) 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 (6U� Type of S.A.S. d0 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to the plans of Eco-Tech, ETE-2704 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 Envir nmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of . alt . Signed s ~'1/ Date Application Approved by 6AJ, Date —7—3�—CJ ApplicatiowDisapproved by: -Date rfor;the Tollowing reasons Permit No. r4-7— R^ - Date Issued "'"'•'-""'ter- ` �kj�..w ...-r�. ,`.. !` � „„, �,�..+_r,w."r .�;7y4,,,,�y«�,gygti+'+xJ.r�.t....",::�,:,,,3....,� ..-•-.�•.,--w --,:..rn... i - - Entered in computer: V. THE COMMONWEALTH OF...MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipp ication ,for Migo.5al �bp!gtem Cou5truction Permit Application for a Permit to Construct( ) Repair* ) Upgrade( ) Abandon( ❑ Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 7 5-0 9 2 6 55 Seabrook Rd, Hyannis Charlie Hetzel Assessor'sMap/Parcel 307/13 55 Seabrook Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4-0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder (0) 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 AN. .l . Title I // Size of Septic TaA OW Type of S.A.S. l//.2 "��� U aym 1Wj Description of Soil h Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to the plans of Eco-Tech, ETE-2704 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 by this Board of -ealt!/ Signed 6 e Date ApplicationApprove&by /J�t f` Date -�' 3�-y Application Disapproved by: Date for the following reasons Permit No. 7- 3-? Date Issued 2`J 1-0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Hetzel (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic at 55 Seabrook Road, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 UU-7-?,2 k dated -7 Installer' s i Y1' Designer Gtt K9Q+.1 #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector :.. , - t No. 100.00 �� � Fe THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Hetzel wigpo!6aY �§pgtem Cougtructtou Permit Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 55 Seabrook Road, Hyannis and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of tl� it. Date ' 3�`d7 Approved by 1# AV Tom ®f Barnstable ¢lie r � RegWatory Services Thous-R Geiler_IDirector. .- - i BA&NnPABLE: s rnAss.$ Pubiic H01 i�iVisioII 39• � Tho*mas McKeAi Director - 200 Main Street,Hyannis,MA.02601 . Office: 508-8614644 Fax: 508-790-6304 Installer&Designer Ceriffication Form Date: Sewage Permit# Q 3 .- Assessor's Map�Farcei 3 0 7/1 3 Designer: Eco-Tech Installer: Wm E Robinson Sr Septic _ .. Address: 4.3 Triangle. le. Circle Address: .PO Box 1089-. Sandwich Centerville on 31- -Q Wm E Robinson Sr Sewas.�ssued a permit to install a (date) (installer) septic systehi at...55 Seabrook .Road,_.:Hyanni s based-on a design drawn by. (address) Eco=. Tech dated 07./28/07(designer):, i certify that the septic_system_referenced above was.installed substantially_according to the design, which may:include-minor approved changes such-as-lateral relocation of the: distribution.-box and/or septic tank., - I.certify that the septic system referenced above.was-installed with major changes (i.e. .:greater than.10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in ascoxdarice with State&-Local Regulations. -Plan revision or certified as built.by designer to follow. j H OF U'u. DAVID �. D. .. a Staller S Sl tllre O a COUGHANOWR CA NO.. 1093 :. GIs TE��O (Designer's Signature) -- (Affix Desi Here) r PLEASE:. RETURN:-TO :BARNSTABLE - PUBLIC . HEALTH - DIVISION.. CERTIFICATE OF COMPLIANCE WELL.NOT BE JISSUED UNTEL BOTH THIS DORM AND AS-BUILT CARD ARE RECEIVED BY TBE BARtNSTABLE PUBLIC HEALTH DIVISION..THANK YOU.. Q:HealthtSeptic/Designer Certification Form 3-16-04.doc - _ Town of Barnstable P# Departiment of Regulatory Services Public Health DivisionMAM Date u 1 12 ,20d) i639•h 2W Main Street,Hyannis MA 02601 Fp� r Date Scheduled_ --e2.. Time=5 ✓T'1 Fee Pd. Soil Suitability Assessment for �wageDisposal Performed By: !��l l' C U�H N0 W iZ. Witnessed By OCATION& GENERAL INFORMATION Location Address CSC) Pp(jr Owner's Name • � � � � C1 ` Address taj�tNS �� S���Oro�l• 6Z�{ I Assessor's Map/Parcel: 07 — 3 Engineer's Name P r NEW CONSTRUCTION REPAIR v � - �U� d /J� �d✓�"���' � n �TTelephone# � �� Land Use-•Y�(;S[0 f �� �, Slopes(96) -`f7 Surface Stones_ Distances from Open Water Body 0f b ft Possible Wet Area ft Drinking Water Well too+°. ft -Drainage Way-�90 t R Property Line 10 t ft Other , tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) SEABROOK ROAD l ! GROUNDWATER ADJUSTMENT i I EXISTING GROUNDWATER LEVEL i BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. I 14 _ ,INDLCA-TED—GW 6.00� INDEX WELL MIW-29 m I i ZONE B o READING DATE JUNE. 200-F j READING 7•4 ! ADJUSTMENT 1,r t I �z ADJUSTED GW 7,7 ®, j 77.5 Ft Parent material(geologic) 14 C4 D(/�LW b Depth to Bedrock Depth to Groundwater. Standing Water in Hole:- A B 4 P Weeping from Pit Face bl Estimated Seasonal High Groundwater 4- fP 4h011e I, DETE4MINATION FOR SEASONAL HIGH WATER TABLE Method Used: Vp Depth Observed standingobs.hole: m In, Depth to soil moulds: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: lndex Well level Adj.factor Adj.Groundwater level PERCOLATION TEST Date -71 a7 Time 4-3 0 P/j t \ Observation r - � Hole# 71me at 9" Depth of Pero 6-6 1 t� Time at 6"Start Pre-soak Time� �• T� Time(9"-601) End Pre-soak. ^50 a Rate MinJlneh 2.p Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(YIN)_�j_ Original: Public Health Division Observation Hole Data To Be Completed on1Back-------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\.SEPTIWERCFORM.DOC SOIL TEST LOG DATE OF TEST: JULY 27. 2007 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 11666 NO I TEST PIT I PAARENOTUNDWATE MAATERIA EPROGLACIRALD OUTWASH PERC AT 66 in — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING i 2140 0-11 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE 11-42 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 17.90 42-126 C MED—COARSE SAND 10 YR 5/4 NONE LOOSE 9.90 I NO GROUNDWATER ENCOUNTERED TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING 20.65 0--10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE 10-45 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 16.90 I 45-138 C MED—COARSE SAND 10 YR 6/4 NONE LOOSE 9.15 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munselq Mottling (Structure,Stones,Boulders. ConsistencZ%O v J DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes :v Within 500 year boundary No Yes Within 100 year flood boundary No✓ Yes w i, Depth of Naturallv Occurring Pervious Material i{ Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YeS If not,what is the depth of naturally occurring pervious material? Certification IQCi5i I certify that on d e�b BV (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consiste the required training,expertise and,a perience described in 310 CMR 15.017. ytH OF�Ssgc Signature G�C Date Jyty 271 Z002 oho baD yG� D. COUGHANOWR tO `/CFN SEA Q 0 Q:ISEPMCVERCFORM.DOC ,� E VA L IJ PL ;t Town of Barnstable Health Inspector �FTHE rp� Office Hours o Regulatory Services 8:30-9:30 Thomas-F. Geiler,Director 1:00—2:00 • BAMSTABLE. MASS. Public Health Division �' 1639. ♦� '°rEnta Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property:d'/ &&:7A r Address: J d lL &*Mcf Map �a Parcel &Y, Name: Phone #:(P4 =�'to 2a..,How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? -LV If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If th'e':dwellri g is connected fo public sewer skip questions,;#4 through.#9 below. 4. Location of dwelling is INSIDE or OUTSIDE one of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to. PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection.to bedrooms at this property. Special Conditions: Signed: Date: ff Q;Lhealth/wpfiles/amnestyapp {,�7N�1'�'fCti'. lzw' �� oG� Z©��0 v/.JIL�//n, ,�.y/cs�+f Ap 4_,Z r�� (; C- 0-7 Z � ti ---------------- lU l/e c r C, � ul 10 L 4 `G lv �. . 0.. m CO Ln OFFICIAL Ln Postage $ MA 0 SO O Certified Fee C3 ReturnReciept Fee ^ = Po„tem (Endorsement Required) Gl •3� �`� L peark 0 Restricted Delivery Fee rO (Endorsement Required) rq Total Postage&Fees $ �, 7� U$PS M e NUS._./E - N S`heet,.Apt.No.; r or PO Box No.5O �C-11M City S ,Z � :rr rr 'd Certified Mail Provides: A mailing receipt (asianay)aooa eunr'ooeS mod Sd a e A unique identifi(t for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return HeCeipt may be mquested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Reo'e'jpt(PS Form 3811)to the article and add applicable postage to cover the fee.EEndorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. f Certified Mail#7003 1680 0004 5458 3268 Town of Barnstable Regulatory Services Thomas F. Geiler,Director Wilk Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 20, 2004 Mr.Charles W. Hetzel 507 Mechanic Street Fitchburg,MA 01420 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000,STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN-O.F_BARNSTABLE.RENTAL ORDINANCE,-.AR_T_I-CLE51.. The property owned by you located at 55 Seabrook Road, Hyannis, was inspected on October 20, 2004 by Donna Z. Miorandi, RS, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of the State Sanitary Code and the Town of Barnstable were observed: 105 CMR: 410.481: Posting Name of Owner. An owner of a dwelling which is rented for residential use, who does not reside therein and does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained.. in the interior of such dwelling in a location visible to the residents a notice material, not less than 20 square inches in size, bearing his name, address , and telephone constructed or durable number..... TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51: The following violation of the Town of Barnstable ordinance was observed: Section 4-4: Owner's name, address and telephone number not posted. Section 4-4 of the Town Rental Ordinance specifically reads as follows: An owner of a dwelling which is rented for residential use, who does not reside therein and who does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained on the exterior of such dwelling within five Q:Health/Order letters/Housing violations/55 Seabrook Road.doc (5)feet of the main entrance or within five (5)feet of the mailbox(es), at least four(4) feet and not greater than six (6)feet above ground level, a notice constructed of durable material, not less than twenty square inches in size,bearing his/her correct name, address and telephone number. If the owner is a realty trust or partnership, the name, address, and telephone number of the managing trustee or partner shall be posted. If the owner is a corporation, the name, address, and telephone number of the president of the corporation shall be posted. Where the owner employs a manager or agent who does not reside in such dwelling, such manager or agent's name, address, and telephone number shall also be included in the notice. You are directed to correct the violation of Section 4-4 listed above within Seven (7)Days of your receipt of this notice, by posting the property correctly. 105 CMR: 410.450: Means of Egress. Every dwelling unit, and rooming unit shall have as many means of exit as will allow for the safe passage of all people in accordance with 780 CMR 104.0, 105.1, and 805.0 of the Massachusetts Building Code, 105 CMR: 410.354: Metering of Electricity and Gas. (A) The owner shall provide the electricity and.gas in each dwelling unit unless (1) Such gas or electricity is metered through a meter which serves only the dwelling unit, except as allowed by 105 CMR 410.254 (B); and (2) The rental agreement provides for payment by the occupant. 105 CMR 410.355: Provision of Oil. The owner shall provide the oil used for heating and/or hot water in each dwelling unit unless such oil is provided through a separate oil tank which serves only that dwelling unit, provided however, that 105 CMR 410.000 shall only apply to tenancies created or renewed after July 1, 1994. It has been brought to our attention that the fill gauge on the tank is inaccurate stating that is near or at empty when actually this tank is full. This must be corrected within fourteen (14)days and show proof of the problem being corrected to this department. 105 CMR 410.402: Grade Level. No room or area in a dwelling may be used for habitation if more than of its floor-to-ceiling height is below the average grade of the adjoining ground and is subject to chronic dampness. 105 CMR 410.280: Natural and Mechanical Ventilation. The owner shall provide for each habitable room, and room containing a toilet, bathtub or shower, ventilation to the outdoors consisting of: (A) windows, skylights, doors or transoms in the exterior walls or roofs that can easily be opened to a minimum of 4% of the floor area of that habitable room or room containing a toilet,bathtub or shower....(B)Mechanical ventilation capable of exhausting air..... There have been no plumbing or building permits pulled on the basement dwelling unit. Therefore,this letter is being copied to the Building Department for further processing. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Q:Health/order letters/Howing viola ions/55 Seabrook Road.doc Non-compliance could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER O THE BOARD OF HEALTH as A. Mc ean,R.S. Director of Public Health Town of Barnstable Cc: Dave. Mattos,Building Inspector Carol Sircello 55 Seabrook Road Hyannis,MA 02601 Q:Health/Order letters/Housing violations/55 Seabrook Road.doc COMMONWEALTH OF MASSACHUSETTS FR ���EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS12003DEPARTMENT OF ENVIRONMENTAL PROTECTIO0LTH N UF rDEPTABLE I�qM SJ 1b OW TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ,e SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 3 V� Owner's Name: LARRY KING Owner's Address: 55 SEABROOK ROAD HYANNIS,MA 02601 Date of Inspection: 9/4/03 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA. 02536 / Telephone Number: 508-564-6813 FAX 508-564=7270 CERTIFICATION STATEMENT . I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _.Conditionally Pa ses Needs Further E luation by the Local Approving Authority Fails Inspector's Signature: Date: 9/4/03 The system inspector shall submit a copy this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If th system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submi the report to the appropriate regional office of the DEP. The original should be sent to the system-owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING'EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. itla 'S c .r 'T In na .tinn Fnrm F/1 5/?Mn 1 Page 2 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:A CERTIFICATION (continued) Property Address: 55 SEABROOK ROAD_HYANNIS;MA 02601 Owner: LARRY KING Date of Inspection: 9/4/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: , f X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND~PUMPING EVE RY ONE TOT TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: tN _ One or more system components as deseribed 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. Answer yes,no or not determined(Y,N,ND)in the' for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s).or due.to a broken, settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed' _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ` broken pipe(s)are replaced . _obstruction is removed ND explain: n/a Page 3 of I 1 f OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA,02601 Owner: LARRY KING Date of Inspection: 9/4/03 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 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 n/a **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to 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: n/a Page.4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 Owner: LARRY KING 'Date of Inspection: 9/4/03 D. System Failure Criteria applicable to all systems: = f- You must,indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due'to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow t _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times. " pumped NOT IN THE, LAST YR.PF.R nWNF.R. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with. no acceptable water quality analysis.'[This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will'be ° necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: ; (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located 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. _ d Page 5 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 55 SEABROOK ROAD HYANNIS,MA.02601 Owner: LARRY KING Date of Inspection: 9/4/03 , Check if the following have been done. You must indicate"yes"or'!no" as to each of the following: Yes No " X _ Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was�the facility or dwelling inspected for signs of sewage backup'? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the.SAS, located on site X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X. _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example;a plan at the Board of Health. X _ Determined in the field(if any of the,failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 II , I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 Owner: LARRY KING Date of Inspection: 9/4/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#'of bedrooms): 220 Number of current residents: I Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO .[if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO �— Water meter readings, if available(last 2 years usage(gpd))- r Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a - Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO „ . Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YR. PER OWNER Was system pumped as part of the : YES inspection(yes or no p Y ) If yes,volume pumped: 1000 allons--How was quantity pumped.determined?HICKEY SEPTI C SERVICE Reason for pumping: MAINTENANCE -TYPE OF SYSTEM .x + _Septic tank, distribution box,soil absorption system ` X Single cesspool X 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a. Approximate age of all components,date installed(if known)and source of information: 33 YEARS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO C Page 7 of 11 OF - , FICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,NIA 02601 Owner: LARRY KING Date of Inspection: 9/4/03 BUILDING SEWER(locate on site plan) Depth below grade: 30" Materials of construction:_cast iron _40 PVC Xother(explain) ORANGEBURG Distance from private water supply well or suction line:n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: (locate on site plan) Depth below grade: 0" .. Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) ' Dimensions: n/a Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 0" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: 0 How were dimensions determined: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): n/a GREASE TRAP:_(locate on site plan) Depth below grade:n/a Material of construction:_concrete_metal_fiberglass polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom bf outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendation's, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 Owner: LARRY KING i. Date of Inspection:.9/4/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons ~- Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a ; Comments(condition of alarm and float switches,etc,): n/a r DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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'or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a ., k • • J 4 Page 9 of I I OFFICIA L INSPECTIONFORM—NOT FOR VOLU NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 Owner: LARRY KING Date of Inspection: 9/4/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 4' leaching pits, number: 1 n/a leaching chambers,number: n/a n/a leaching galleries,.number: n/a n/a leaching trenches,number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool;.number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level'of ponding, damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE. PIT HAD I OF LIQUID IN IT AT TIME OF INSPECTION.PIT HAS 1' OF LEACHING LEFT IN IT. CESSPOOLS: X(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 Depth—top of liquid to inlet invert: 6" q Depth of solids layer: F, Depth of scum layer:3" Dimensions of cesspool: 6' X 6"' Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. PRIVY: (locate.on site plan) Materials of construction: n/a Dimensions:.n/a Depth of solids:n/a " Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a. Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPECTION FORM PART.C' SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA-02601 Owner: LARRY KING ,. Date of Inspection: 9/4/03 r SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. w _ rb wwi n A t3 z33 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT,FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK ROAD HYANNIS,MA 02601 . Owner: LARRY KING Date of Inspection: 9/4/03 SITE EXAM ° _Slope _Surface water Check cellar - s, _Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain:n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 10+FT. E _ i it SEP--15-2003 1.3:©5 BAR"•''STABLE I;JATER CONPAHY 578 790 17'3 P.Ll•2,©3 •--* From Date • ��. ICING ANNE D Status . Serial Number. Service Address. 1aLJUJ 55 SEABROOK ROAD Meter Position Account ID . . Work Order e 0 Read Mtr Meter Uf9 K R E S Account Date R= L&AAijag LQ_MLUnDAjXn .. T 3 � ® — 96/16/03 1 21 1,300 FC 1 N 1 00154280 03/25/03 1 8 A00 FC 1 N 1 00154280 12/18/02 1 fl 0 FC 6 1 0 1 013154280 12/18/02 1 917 0 FC 6 4 0 1 00154280 12/17/02 1 917 1400 FC 1 N 1 00154280 09/26/02 1 907 2-,000 ' FC 1 N 1 00154280 .. 06/24/02 1 867 11500 FC 1 N 1 00154289 03/20/02 1 672 600 FC 1 N 1 00154280 12/19/01 1 866 200 FC 1 N 1 00154280 09/26/01 1 864 1„700 =FC 1 1 N 1 00154280 . , .6,=,Te,x,t, , .F,4,=-D,t,l,s, B,=,D,at,e S.e,q, F,L,2,�,a,�, ,p ,Y ®;3,9;i,e, , F,2,4,r.,M,o,r,e, r s COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Address of Owner: 299 RT 29 W.YARMOUTH MA.02673 ' Date of Inspection: 7/21/00 Name of Inspector: JOHN GRACE 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT y I certify that I have personally inspected the sewage disposal system at this address and that the information reported belowis t ue,'accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the prop unction and maintenance of on site sewage disposal systems.The system: r X Passes oy <4 _ Conditionally Passes �o� _ Needs Further Evalu i By the Local Approving Authority _ Fails QQ i x L Inspector's Signature: Date:7/21/00 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My.findings are of hors the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND EVERY ONE YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 INSPECTION SUMMARY: Check A, B,'C, OY D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). IC _broken pipe(s)are replaced _obstruction is removed distribution box is levelled or replaced n/a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed r: revised 9/2198 Page 2 of 11 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21100 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa(approximation not valid). 3) OTHER n/a df revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day Flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone I of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner: MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. n , revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMM--RCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:nla OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped nla gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution boxisoil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 30 YEARS OLD Sewage odors del@cl@d when Arriving 0t th@ hil@ (y@0 or no) NO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan). Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan). Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 912/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 4' leaching chambers,number: (n/a)n/a,,:, leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 1'OF LEACHING LEFT AT THE TIME OF THE INSPECTION.THE SYSTEM SHOWS NO SIGNS OF FAILURE.THE PIT HAD SOME SOLID CARRYOVER. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7121/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) O RA 3y revised 9/2/98 Page 10 of 11 b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 SEABROOK DR HYANNIS, MA 02601 M307 P013 Name of Owner MIKE GRIFFITH C/O CAPE REALTY ATT.SHAWN Date of Inspection: 7/21/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health Checked FEMA Maps _ Checked pumping records Checked local excavators,installers 2( Used USGS Data 1 Describe how you established the High Groundwater Elevation.(Must be completed). USGS MAPS AND CHARTS-10+FEET revised 9/2198 Page 11 of 11 TOWN.OF BARNSTABLE LOCATION t�<!5-6 FIR-SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ® 7 INSTALLER'S NAME & PHONE NO. (,� ,� SEPTIC TANK CAPACITY eertg%f� (i3 wo LEACHING FACILITY:(tt}W, ) NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: c-;L-.c).- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓ Ron � TOWN OF BARNSTABLE LOCATION't5�<S­ r SEWAGE # `� VILLAGE to-0A wwrS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY r -S,,-5pLt)L• fos vc LEACHING FACILITY:(type) NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER- BUILDER OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓ e o - c` f -o o ti �i O 47" W - " TOWN OF BA.RNSTABLE LC,CATION_-,,- 65 �JCL4 �C., L� SEWAGE # VILLAGE ASSESSOR'S MAP & L01-6a-- INSTALLER'S NAME&PHONE 00. SEPTIC TANK CAPACITY 'I LEACHING FACILITY: (type) (size) NO.Of BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 � . �� � t� � �f �o.s � 1i �c.f � � ,, -, No..... 5:........ f c�� " ® v H Fis..... .r.1._:�' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Dis'nsal Works, Tonstrnr#inn ramit Application is hereby made for a Permit to Construct (' ) or Repair ( Lair Individual Sewage Disposal System at ........... .._..... :. .k r o d`'-`•=...... .............. ................ ..... ..--- ....---------...------------•---•------ Location-Address -or Lot No. .......... :I.V.�.k....---•----•--•---•--•---.-..... .............. Y C�g...��.��2..W.LQ�`_ ---- ------------------- Owner Address a .......... _�' ? ..`: 'fie:�^�!�...., ........--•...... ........................... ......----------......................... ........ Installer Address 2 Type of Building Size Lot............................Sq. feet .-� Dwelling—No. of Bedrooms..__....................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of persons...........:.............. Showers P4 YP g ............................ P -- ( ) — Cafeteria ( ) a Other fixtures ........................... . d ---------------- W Design Flow..... -------------------------gallons per person per day. Total daily flow..... .7J ..................:.:gallons. WSeptic Tank—Liquid capacity............gallons Length......... Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width....................Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No.......l........... Diameter....L.4:5!.(..... Depth below inlet.....�.r....... Total leaching area..................sq. ft.' Z Other Distribution box ( ) `.Dosing tank ( ) 0.4 Percolation Test Results Performed by--••--------. - ....... .......... ----------------- Date........................................ - Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... Test Pit No. 2.................minutes per inch. Depth of Test Pit.................... Depth to ground water........................ a ---•-----•--------------------------- --.------------.----........------------------------- ---..............•••--...-••---.........----• --... 0 Description of Soil............................................-.....------------....---------...-°----------------------------.............-----.......----.........................•••--• W W ................................... •---......._........-- x ......................................................... ---•----•-----------•.......................•-•----•---------•-------------•••-•------------•-------•--............._... Nature of Repairs or Alterations—Answer when applicable._...:; 5�......... f.1s_�i.._..._G� _......... .. .......... C -------------------------------------------...................................................................................................................... Agreement The undersigned agrees to, install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI M ,5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. ---•--- - --------..--•- ----( Date Application Approved By................ s Date Application Disapproved for the,following reasons:............................................................................-............................. - -- -•.....................•-••--•-•-----•--•••••---••-•••-•----••--•----•---•-••-•----•-•--_.............------•----•-------•---•--•-----•-----------------------..................--------•--••-•----•---- Date PermitNo........... .' ....................... Issued--................................................... Date .. �,..,.�m��. ,�..i.s-..p-..�r...,.i�.+.-... - .,-..-...--.... .._ .. -. • .+..-.,-....t 9 ti«_....�,.. . .r.c..,,.-e�T�^+^''.l,a°..�L«.�.... ..:".,,,�.t..rw..ti, .r. _. , _ �...�t�.., .-:.r�.v.--'�.....: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....`..... ........OF ....�+L�.-s,.✓L s. :�,_.h_.(- :.. . pupation for Disposal lVarks Tonotrudion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( Q)an- Individual Sewage Disposal System at: r PS Location-Address p or Lot No. ..........fg,�P Gt to:»...»aC 2,A�/� 1v� la U �/' ($12 t�lOv� Owner Address ....: ......•.............5 kq v! ----.....- .. -- Installer Address Type of Building Size Lot............................Sq. feet �-t Dwelling—No. of Bedrooms...3....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. a YP g --------•-•--•----•-•--..... �of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----•-........--••-----------------------------.--...--.•---•--•-••-•••••-••--------•-------................•---•---••-••----••-•--.................... W Design Flow....... ....------------------------gallons per person per day. Total daily flow....�.9..� ..............gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diam... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_...................sq. ft. Seepage Pit No......./........... Diameter....1..1 ....... Depth below inlet.....4!......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................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........................ a ---------------------------------------------------------------- ------------------------------------------------•----------------•-•-•--------------------- 0 Description of Soil...............................................................................----------------•------------•---••-----.-..............................0...........---••- W V .....•••••••-•••--••--..............................................................••-•...-•-•---•--••--•-••-•••••..............•••-•-------••.......-----------•----•.....-----••....._--•-••--........ W UNature of Repairs or Alterations—Answer when applicable.--..^ S:TYY 4\...___..�-�k ..._. '__ 31 -•--------•---••••------•--•-•-----•--•••-••-••••.....----••-•--•---•---•---•---••----••-••---••••......•----•---•-••••-••.................••••........-•-•--•-••-_... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 'the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of . health. Signed. -. _y- - �-`-a- t_ --- •- ---- Date N i 1 ... Application Approved BY---••----•-•----�-.:-y:��........:. .. �.::::---=�; ----•----�-•�'-�-`==-•='--�•� .................•------- Date Application Disapproved for the following reasons:.............................................................................................................. ....................•------...-•------...............--------------------...-----•--...---•--•---•------•.-•--••-•-...------......---•-----•-----•-----••--------•-•-•-----------••••-•••--••---...._.... Date PermitNo. ...................a...................... Issued,:...------------•--•-•----•---•........................ ' . Date ------------------------------------------.—_.--- — ------`------------ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH !�-(� - OF....... ,.t•��!.v`S' � �, ��.................................... Tntif iratr of Toutplianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �IXX Ir(sIaller r at...................... .` ......•.. ......=YLc�c�. -•-------------- --------- has been installed in accordance with the provisions of TITLP, 5 of The State Sanitary Code as described in the 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+ �L'-a...ln../Ia......0F........ J. l e................... No. R::��....... FEE........................ Disposal Yorks Tanotrttrtiott rrmit Permission is hereby granted........ .1,a. __ !<!" `�..__�-�''.: ! . to Construct ^ ),or Repair ( _�)` an Individual Sem;age Disposal System at No.........:- . _?--------`�--�—---�. .��z..k.--. �=-�' / :�/� ,. � -----•----------•.......................... - ---.....•..--•••-• - -- ..._..... Street as shown on the application for Disposal Works Construction Permit NoAK_4_�. Dated......................... \ \� , Board of Health DATE------. .......................... :......................... ALL PIPE SECIFIED ARE ATIONS E L O W PROFILE EXPRESSEDLINV DECIMAL FEET NOT FEET AND INVERT INCHES.TIONS = RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE VENT TOP OF FOUNDATION ONE INSPECTION RISER FOR LEACHING GALLERY TO PIPE EL = 26.57+- WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. 20.65 ALL PIPE TO BE 3' DROP AND❑-BOX MAX SCHEDULE LE 40 PVC AT _FLOW LINE I I i i 17.65 1/8 in/Ft MIN. 10" 48�� �A�� PRECAST :M oL BAFFLE DRYWELL E 6 �� BOTTOM OF 17.50 LEACHING LEACHING GALLERY , STON EEXISTING BASEGALLERY 17.17 . 16.90 (END VIEW) L1490 5.00 ft + 11, 1PJPJPJ GALLON SEE DETAIL ON REVERSE of 35 ft SEPTIC TANK 4.5 ft of 12 ft 12.5 ft bl 20 Ft bl 5 ft ADJUSTED SEASONAL P 7.70 HIGH GROUNDWATER co m --i [D oci-Icno < - oa - m:)- nrn a r- o <�omo rnz zzz azrOx � rn M �— rn70 -0 zy -<y z°r-r-- z M cn .4 W N r�o �a of o��a� Z � a rno z m Rl mr p cnrnan-i �r -or -orncn-z O a � CD n m m rn -Wv rn N e mir-.r- cn r r� y-,� c� m� ��� anon ri Sri = rTl1 m v rn o° r v 1 nOCOi� y3 ycl ~n��� rn u (�� `'' N W N '{� n morn oa z�= �rn-Izcn a� 3 Z ocor-i ao N m m Z orn 30 c rn cn fU p < rnrnrno m m rn cn m Zm = c�n�rn �n rrr- my°oo o N �� rn Z -�onrn mcmn Z ' c'oo �= rn `�=nrn° a IU Z =Z=o Rmla p 3rn °o Oo n°z3--, C ]� ~ m � rn-Iz� W ~� _ < rno on ry°cn 3 < m orn m p nnorn �rn o� aim m r �m zZ n .rrl zy om Z30~° _ N rrna- O f -,o 3�rno rn m Fq or�o Zo r co �c�� o° z3 cDm�rn N oa�o NO � 2n vJ rTi ,< O ° � 3 03yO0 yrn ~O� 3Oy / ♦ a� °gym o �o �mrn / y N �z �o rn nrn �' � ♦m m-I o y� o 9�� , \ ti O ni -qO Ir n�jy �X L Oy \Vrl \ f �ymnN, �•1' = z0 co� ♦ / m7 _ N ZX a M a Cc:>n:r m z� �� 0 0 >� r-rn�r o a o� �� 0 z f Z 0rno r rn �� frl O �cl Z � o 0 z (�J c� ® m O 0--1=o z � m =czi � � RI o z .� � �1 � I —I Fom,cn fTl ar � i I m z i �aoZO N I � mom CONS = rn � O0r (o W� y Dz ro m c) caazcn l � y m o tpo 2 c m 0 C n O tmnc � o m co nmo co')=o rn Ulm zcrnm 0 Z a onQ �rn m �xnl lmUl n m �cn rTi mz==c O C W < I cn m < �a 3 �mZmm ,1 C 3 y �Rl �l m � N Sli'�S�a 3mrn oo0C) �Z ny c»z o m f- (n dl �, die c -� O o �- 2 0 �0 N (� p y O M rn -0 r �� rn O O O y I' v J y n m�U)0 c IV Ck) � ❑ O X O � a ®_ r r V 1 Z c JAME ON oo� m m z �7 U� � 5 coc°M,yoti m� �n m" Zz Z 0 Z 3 N 1n< ,� N z 0 > o n0 zo �70 O o 0 M -omm < a o 0 r c oo R1Z ` (�� � n 3 m mzo0-< A 0 m 0 z rom n G) o y m �3 mil Oi T a m oc)mui> a > z ¢ o �m Zmj O O p >m�-0o o -,] n 3 = O (� o n m O O a o CD r z 0 - r 3 p� �a`)a z to D > SEA STREET �0(--� w O N (� 511�`' o <�zcnm ❑ m m Z Z > mo -<rnzmo o z 0M0:KM Z 0 SOIL TEST L'0"G DESIGN CALCULATIONS DATE OF TEST: JULY 27. 2007 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) PERC NUMBER: 11868 1 DISTRIBUTION BOX: USE 3 OUTLET D-BOX. TEST PIT 1 NO GROTUNDDWATER ENCOUNTER LD OUTWASH SOIL ABSORBTION SYSTEM: A 24 ft, x 12.5 Ft x 2 ft LEACHING GALLERY CAN LEACH Abot = ( 24 x 12.5 ) = 300 sf PERC AT 66 In - 2 MIN/INCH IN C SOILS Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Atot. = 446 sf (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Vt, 0.74 x 446 = 330.04 GPD 21.40 USE A 24 ft. x 12.5 Ft. x 2 ft GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 0-11 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE 11-42 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 17.90 42-126 C MED-COARSE SAND 10 YR 5/4 NONE LOOSE 9.90 LEACHING GALLERY TEST PIT 2 NO GROUNDWATER ENCOUNTERED USE LEACHINOREY PRECAST G DRYWELL(H-1080 GALLON LOADING) SCT TO CALE 1500 GALLON SEPTIC TANK PARENT MATERIAL: PROGLACIAL OUTWASH DIMENSIONS AND DETAIL 2 MIN/INCH IN C SOILS NOT TO CONSTRUCTION DETAIL USE SHOREY ST-1500-H-10 SCALE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DRYWELL UNIT (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING STON 20.65 7 0 f t 1 1n 0--10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE 24. m� TAPER 10-45 B LOAMY SAND 10 YR 4/6 NONE FRIABLE m �� 16.90 45-13B C MED-COARSE SAND 10 YR 6/4 NONE LOOSE 4- 9.15 - :_ m Cj o m O / t3 1n mp GROUNDWATER ADJUSTMENT Im` EXISTING GROUNDWATER LEVEL Ft 8.5 f g 1� BASED ON TOWN OF BARNSTABLE 2 4.0 FL GIS DEPARTMENT RECORDS. la INDICATED GW 6.00 INDEX WELL M1W=29 500 GALLON DRYWELL ZONE - B DIMENSIONS AND DETAIL INLET CENTER OUTLET READING DATE JUNE. 2007 END COVER END READING 7.4 - USE H-10 UNIT ADJUSTMENT' 11.7 INSTALL ONE INSPECTION ADJUSTED GW , Z.Z• RISER TO WITHIN THREE 3 IN DROP INCHES OF FINAL GRADE Ar, -FLOW LINE r AND INDICATE LOCATION FROM 10 1n 74i TO ON AS-BUILT PLAN BUILDING ? In + D-BOX m LIOUID GAS O� 33 LEVEL BAFFLE NOTES o000 0 lr7 c 0 000 0 00 00 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. ���o�00000 2) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS �j0 CROSS SECTION VIEW OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 1021n 3) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. CROSS SEC TION VIEW 4) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. 51 ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 2ln PEASTONE 21n PEASTONE SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. o 0 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 28 3/4ir ro E24.FFECTIVE 314u, ro 2s -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. In - '^�^�O oEPTH . I-112'^�R^VET In CHARLES W. HETZEL_ 71 SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 46 In 581n 46 In 55 SEABROOK ROAD HYANNIS. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. 1501n EEO-TECH ENVIRONMENTAL INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE FABRIC IN PLACE OF THE 2 tn. PEASTONE LAYER SPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETF-2704 JULY 26. 2007 1 1212