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HomeMy WebLinkAbout0137 SEAGATE LANE - Health 137 Seagate Lame 248-022 Hyannis Commonwealth of Massachusetts a qg- � �- i� ,p Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 4 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis V Ma 02601 8-18-2020 required for every page. City/Town - State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. Inspector Information on the computer, Daniel Hawkins use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code rac (508)477-0653 S114324 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); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. -❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails DanLJ,Cjwl•1n.5 Digitally signed by Dan Hawkins fl k Dare:2020.08.1912:33:02o4'00• 8-18-2020 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 Forth:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6,;P �W 137 Seagate Lane Property Address Brain Bodjiak , Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ■❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 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.7126/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i 1 as�, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is required for every -Hyannis annis Ma 02601 8-18-2020 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): 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 Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y 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: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ a Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town 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 1/2 day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ E] 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 El Elthe system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 R Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town 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 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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? F-I EI Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ 0 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. ❑ 0 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 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V/ 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is required for every Hyannis Ma 02601 8-18-2020 page. City[Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: .2 Number of bedrooms (design): Number of bedrooms (actual): 2 220/GPD DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes ❑i 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 0 No Seasonal use? ❑ Yes ❑g No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2018 no reading 2019-40,392gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc•rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts 0 Title 5 Official Inspection Form rr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� y� 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CM 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: Owner- last pumped Feb. 2017 Was system pumped as part of the inspection? ❑ Yes FE-1 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 �- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address a Brain Bodjiak Owner Owner's Name information is Hyannis 'Ma 02601 8-18-2020 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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 l/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: 2008 per COC Were sewage odors detected when arriving at the site? ❑ Yes K No 5. Building Sewer(locate on site plan): 216" Depth below grade: feet Material of construction: ❑ cast iron ❑Q 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t 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 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1811 Depth below grade: feet Material of construction: ❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 3„ Sludge depth: 3391 Distance from top of sludge to bottom of outlet tee or baffle 4It Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1311 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. 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 J 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑,fiberglass ❑ polyethylene ❑other(explain): Dimensions: J 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: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): ` Dimensions: Capacity: gallons . i Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts rs _- Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every Y 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): 0" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts - - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every- 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.): -NA * 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: (1)500 gallon chambers ` n leaching chambers number: El 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 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cant.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Chambers were 1/2 full when viewed with no higher staining. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): NA 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 (r� Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 137 Seagate Lane u� Property Address Brain Bodjiak Owner Owner's Name information is H annis Ma 02601 8-18-2020 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): s t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Ill Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane V Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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: FMA hand-sketch in the area below ❑ drawing attached separately TOWN OV BARN STABLE LOCATrrcaN Z3-7 5—el'...t:� .rc- ,clop VILLAGE /►YwC+,.,r,ts.".5.... ASSESSOR'S bl"&PARCEL INSTALLERS NAME&PHONE NO.11—_-'V SEPTIC TANK.CAPAGI'Z"Y LEACHIN<3 PAGTLIT'Y: 140.OF,DEDR00MS OWNER PER.23.TT T�ATE + COMPLIANCE 27AT I?; e .::. Separatian i3istance Between the: Maxilnutn Adjut,ted Groundwater Tablo to ttxe Bottom of Leaching Far,i)itj. _ Feet Private Water.Supply Well and Leaching Facility(If any welts exist on site nr within 2GO feet Qf lesatting facility) Feet Edge of Wetland and S-ettahing Fs«^itity(If any wetlands exist within 300 f tat of leaching facility) x FURNISHM BY lon 80 - '`1 i Va 11 .09 3> 3s #3 3=,04 sae eA e.AZ Q_ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope R Surface water ❑■ Check cellar ■❑ Shallow wells Estimated depth to high ground water: No GW @ 132"feet Please indicate all methods used to determine the high ground water elevation: ID Obtained from system design plans on record 3-25-2008 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: A plan on file at the local Board of Health was used to determine high groundwater. 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 A - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y 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(CI-lecklist)completed ❑■ D. System Information: For 8: Tight/Holding Tank 'umping 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Imngout tans A. Inspector Information filling out forms on the computer, Daniel Hawkins use only the tab key to move your Name of Inspector_ cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code r�oa (508)477-0653 S114324 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); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes r 2. ❑ Conditionally Passes 3. ❑- Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan Hawkins Digitally signed by Dan Hawkins Date:zozo.oe.lstz:as:oz-0a.00 8-18-2020 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 c Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s� / 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑■ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every 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): 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( )O y gwhich 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 v Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y 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 SLpply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ o Backup w 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.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J% 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town 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 ❑ El Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ El Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ E Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ M 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.] ❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y ate page. City/Town St 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 ❑ R Were any of the system components pumped out in the previous two weeks? R ❑ 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? El ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ R Was the facility or dwelling inspected for signs of sewage back up? R ❑ Was the site inspected for signs of break out? El ❑ 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. ❑ Q 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 3 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y _ N, page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 2 Number of bedrooms (design): Number of bedrooms (actual): 2 220/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit?_ ❑ Yes Q 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 See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2018- no reading 2019-40,392gallons Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts - _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,1l 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 availat:le: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped Feb. 2017 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 Title 5 Official Inspection Form k........... Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every Y page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: E 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 l/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: 2008 per COC Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No J 5. Building Sewer(locate on site plan): _ 2rcn Depth below grade: feetV Material of construction: ❑ cast iron 9 40 PVC El other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 18 r. Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank(locate on site plan): 1811 Depth below grade: feet Material of construction: 0 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 1 Dimensions: 500gallons 311 Sludge depth: 3311 Distance from top of sludge to bottom of outlet tee or baffle 411 Scum thickness 6„ Distance from top of scum to top.of outlet tee or baffle 1311 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. 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 Systbm Form -Not for Voluntary Assessments r 4�� 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: - Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts i --- Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments x� 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y 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): 0" Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis „Ma 02601 8-18-2020 required for every y 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.): NA * 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: r ❑ leaching pits number: (1)500 gallon chambers 0 leaching chambers number: ❑ 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 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y 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.): The SAS was in working order at the time of inspection. Chambers were 1/2 full when viewed with no higher stain}ng. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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.): t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts ME (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 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 137 Seagate Lane �t fi Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately `OWN OF DAR;N'STABLE VIf:.LAGE/011>-.` S ASSESSOR'S MAP&PAIZCEI- l5"0- ..�- TKSTALLERS NAME&FPIC37ir'E NQ 2.r rs' t' ✓s'r sEPTZC TANIQ GAPAcI'TY LF,ACIMgG FA.C:LUT"Y: No.OF BBD`ROOMS C3WNFR/^�/fmnX ,vc:� .st 1��.� PERWU r DATlx. COI�n€PL ANCE DATE- Separation Distance Hetweca tbz: Maximum Adjusted Groundwater'Table to the.Bottom of Leaching Facility Feet ,private,Watts Supply Well and Lcachirk%Facility(If any wells exist on site or within 200 feet of lezzhing fsaoiiity) Feat Edge of Wed==and L caahing.F'acitity(If any wetlands exist within 300 fitat of Leaching facility) Feet FURNISHED BY �-t e 9'F"R Ki- A3 . 33 33=d4 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane V Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells NoGW@132n Estimated depth to high ground water: feet r 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: 3-25-2008Date ❑ 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: A plan on file at the local Board of Health was used to determine high groundwater. r 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 137 Seagate Lane Property Address Brain Bodjiak Owner Owner's Name information is Hyannis Ma 02601 8-18-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: FEN 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 FOR 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 t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ` e �"' TOWN OF BARNSTABLE LOCATION L3`7 .� 6A T q SEWAGE VILLAGE / Yn W,,v S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.A v s't e'a SEPTIC TANK CAPACITY /S OD / LEACHING FACILITY:(type)�/.) S'aea C/o.4 (size) le JC /.2.X' NO.OF BEDROOMS OWNERS x ,✓ /t�i v✓t y PERMIT DATE: ` 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 exists on site or within 260 feet of leaching facility) " Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY a � W n 3 Re T4 N NIS 'r v ,r ►i No. / , Fee ' t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicotion for �Mpo!gaY 6p9tem Congtruction Permit Application for a Permit to Construct(.repair( ) Upgrade(Abandon( ) ElComplete System ❑Individual Components Location Address or Lot No. �Jfg�/ Owner's Name,Address,and Tel.No. Assessor's Map/P cel Z-Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. X.e oq lc?.✓5 i 2 N OS Y 44 S Of 7> 7-S f 3 6 2, 77 r-76- 0 'Vs—y " o ff` 3 6 2 ;Z Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (Arl Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a Q1 e-) gpd Design flow provided ®2 T gpd Plan Date T�2 S�D Number of sheets Revision Date Title Size of Septic Tank j 5 O D Type of S.A.S. O y e— Description of Soil -- ` Nature of Repairs or Alterations(Answer when applicable) c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard alth. Si Date 'Application Approvea Date 3/ Application Disapproved by: Date 04for.,the following reasons Permit No. '-' Date Issued �3 .- �\ No. . Fee T4 COMMONWEALTH OF MASSACHUSETTS Enterediincomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MAS9K USETTS Yes 01ppYication for Migpo5at *pgtem Con.5truction Vertu Application for a Permit to Construct(4--Repair( ) Upgrade,(-)Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. /4/E? A A ,4 AW v,e Assessor's Map/Parcel y /� CS �} y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4 a_e-N to.✓ T Type of Building: DwellingNo.of Bedrooms Lot Size s . ft. Garbage /G ba e Grinder 9 g (� Other Type of Building No.of Persons Showers( ) Cafeteria(_ ) Other Fixtures Design Flow(min.required) Z Z e gpd Design flow provided gpd , Plan Date 3 0 Number of sheets Revision Date Title Size of Septic Tank / -S b I> Type of S.A.S. .S`py (- Description of Soil r� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of-Health. i ned- `�- Date 3 ;Appiit�ationApproved b` :d`r°°`r N' r Date Application Disapproved by { -~ ' i Date " for the following reasons Permit No. ~' Date Issued / 0 Ic THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )�b-y^ at 1 _3 7 7 r f3 r d4 T le Z hass been nccon§tructedt_in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 4"" '—)o� dated __3 A/ /CJ Installer 4 C /'V Designer /_)/a ,2 #bedrooms A Approved design flow L/ / i gpd The issuance of this permit shall not b6 construe as a guarantee that the system wi I function,as dessiggned. Date y"I / Inspector ,/G',t,��G•�l`, r�J ��'.E!z/!JG"[ f✓l } / O Fee �Q d No. �- 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS ligw5at �&pgtem Construction 30ermit Permission is hereby granted to Construct (/)"Repair ( ) Upgrade (-" j Abandon ( ) System located at / -) /-S V and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions...., -, Provided: Construction must/bee jcompleted within three years of the date o this permit: Date � Approved-by Town of Barnstable ` SME Regulatory Services Thomas F. Geiler, Director UAMUMBLE. Wks& Public Health Division 9�A i6�q. 1if Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-464-4 Fax: 503-790-6304 Installer & Designer Certification Form Date: 7 , 09 Sewage Permit# qr""� ' 1�� Assessor s iviap\Parcel Designer: ` '"�tj Installer: . Address: -LO W Address: On (date) (installer) was issued a permit to install a septic system at 1-37 �(- based on a design drawn by (address) dol— � ` dated log �J �� (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 andlor 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 anv vertical relocation of any component of the septic sv t p , s em) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. AR , (Installer's Signature) No. 1140 ST S'�G/ EM (� NITA?, A',42 ZS (Designer's Signature) (Affix r - Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COivIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORA) AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septicq)esigner Certification Form 3-M-4doc f 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAssessments 137 Seagate Lane Property Address , - Brian Bodjiak ` Owner Owner's Name information is H annis ✓ MA 02601 12/27/16 required for every y page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information s/ /a o� on the computer, use only the tab 1. Inspector: key to move your cursor-do not Richard T. Johnson use the return Name of Inspector key. D &J Environmental Services Company Name P.O.Box 764 AA Company Address Buzzards Bay MA 02532 Citylrown State Zip Code 508-735-8740 SI 13545 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation y the Local Approving Authority 12/27/16 Inspector's Signature JOr Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Low Vs I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is Hyannis MA 02601 12/27/16 required for every H y ' page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well ** Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220GPD t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is Hyannis MA 02601 12/27/16 required for every y page. City(rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (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 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth'of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is Hyannis MA 02601 12/27/16 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Presently Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2008 per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): joints structurally sound, no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Sludge depth: 1" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every y H annis MA 02601 12/27/16 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" 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" How were dimensions determined? Field measure/MFG Specs. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Sanitary tee in good condition, tank structurally sound, no evidence of leakage.Recommend system be pumped to extend life of components. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): box level, no evidence of leakage, trace of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no signs of hydraulic failure, no damp soil, normal vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 137 Seagate Lane Property Address Brian Bodjiak Owner Owners Name information is MA 02601 12/27/16 required for every Hyannis page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below. ® drawing attached separately I A ^—•-. _ _ _. 1___. -- 7r N -0 �/ ;U m < rn m { j EXISTING DWELLING o ,4 - 1 �3 t TOP OF F NDNEL 55.48 I x 143 oaZ �3 '6m3 '.ZY m i 5.9\' ® .a NO � t5ins-W 3 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 �• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , ' 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2008 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: Obtained from site observation, visual elevation, examined design plans on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 �- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 137 Seagate Lane Property Address Brian Bodjiak Owner Owner's Name information is required for every Hyannis MA 02601 12/27/16 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 II UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid LISPS f Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • I Q Town of Barnstable •� Health Divi `sion 200 Main Stre I cet llyannis MA 02601 1 I I I I I I .Isusif�lsl►srsls��slsss�s�s� SENb�R*.-.-c6MPLETE--'THIS'SECTIOAi COMPLETE THIS SECTION O"EL'WiRY N ® Complete items 1,2,arfd 3.Also complete A ure I Item 4-If RestrictddDeliver�r is desire . ..-� ❑Addressee I 13 Agent ® Print your name and addi'Rs on the everse so that we can return the card to o " Y 1B. Re eid d by( nted C. Date of Delivery I ® Attach this card to the back of the ailpiece, I or on the front if space permits. 1. Article Addressed,to: i D. 12� ss.different from item 1? ❑Yes r If YES,enter del;very address below: ❑No MA- �k3'1 0 oL 1,o\ 3. Service Type u 1 t Certified Mail ❑Express Mail ❑Registered f Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Deliver)?Xxtra Fee) ❑Yes 2. Article Number 7006 2150 0002 1038 7008_� (Transfer from service labeo PS Form 3811,February 2004 Domestic Return Receipt Pzi 102595-02-M-1e40 pF'SHE Tp� Town .of Barnstable Barnstauie ity (fir Regulatory Services Department 1, 1 ARN STABLE. it ,9O SS �Q M�A; Public Health Division w 200 Main Street Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO March 18, 2008 Alice Murphy 137 Seagate Lane Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 137 Seagate Lane Hyannis, MA was last inspected on March 4, 2008, by Edward H. Granger, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System consists of a cesspool with an overflow cesspool, both of which show staining over inlets. You are ordered to repair or replace the septic system within One (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH T omas cKean, Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 7008 Q:\SEP.TIC\Letters Septic Inspection Failures\137 Seagate Lane.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION ti t J� � 0 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 137 Seagate Lane 0 Hyannis t/ g Owner's Name: Alice Murphy Owner's Address: IL Q Date of Inspection: March 4,2008 Name of Inspector: (please print) Edward H.Granger Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508) 888-6055 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: Passes Conditionally Passes bleeds Further Evaluation by the Local Authority ails r Inspector's Signature: - Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments -r 1 CJ�S'7 \.5 �q��. �'��"ti�°^��.5 �✓�qcx� S`T'a:v.J�� 4v�,�/""' 1v\tJ'E'.,1�\5 n ::Jl�s"S�v�n..� ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information whic/!anot the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failuted are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the 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. ND explain: Observation of sewage backup or bregk 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: / The system required pu .ping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with appro al of the Board of Health): % broken pipe(s)are replaced / obstruction is removed ND explain: /'' Page 3,of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 C, Further Evaluation is Required by the Board of Healt Conditions exist which require further evaluation b the Board of Health in order to determine if the system is failing to protect public health,safety or the enviro nt. 1. System will pass unless Board of Health termines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner ich will protect public health,safety and the environment: _Cesspool or privy is within 50 fe of a surface water Cesspool or privy is within 50 et 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 i `within 50 feet of a private water supply well. _The system has a septic tank and SAS and the S is less than 100 feet but 50 feet or more from a private water supply well". Method used to dete ine distance "This system passes if the well water an erformed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicate hat the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate ni ogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the an ysis must be attached to this form. 3. Other: Page 4,of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or sys em c2T22neill due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool —Z Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 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 well. Any portion of a cesspool or privy is 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 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.] it� (Yes/No)The system fails. I have determined that one or more of the above 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 t/ba tem must serve a facility ith a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or" each of the follow' (The following criteria apply to larms in addition t e criteria above) yes no _ the system is within 400 f surface d nking water supply the system is within 200 f tribu ry to a surface drinking water supply _the system is located in a n ensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water ellIf you have answered"yes"to any in Section E the system is considered a significant threat,or answered yes"in Section D above the largehas failed.The owner or operator of any large system considered a significant threat under Section E Jr failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shou contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ✓_ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different than 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 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(3)(b)] Page 6•of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_a Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Q Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):,& z[if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use: (yes or no):,&� ZD' Water meter readings,if available(last 2 years usage(gpd)): 7 = (Ci 6 GyS�, fl Sump Pump(yes or no):,L2c�, Last date of occupancy: � �� COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15 3): gpd Basis of design flow(seats/perso /sq. ft. etc.): Grease trap present(yes or no . Industrial waste holding to present(yes or no): Non-sanitary waste disc rged to the Title 5 system(yes or no):_ Water meter reading ,if available: Last date of occu cy/use: OTHER(de ribe): GENERAL INFORMATION Pumping Records Source of information: �.gY 3Rt.-r- r�� �� _ �"M��� ,A�s; <Z)0`7 , Was system pumped as part of the inspection(yes or no):gyp. ,.�i If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy of the DEP approval _IZOther(describe): CC o� c-� Approximate age of all components,date installed(if known)and source of informa ' n: Were sewage odors detected when arriving at the site(yes or no): enj Q Page 7-of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 BUILDING SEWER(locate on site plan) Depth below grade: 3 Materials of construction:_cast iron 40 PVC_other(explain): _Q�r w. Distance from private water supply well or suction line: ti Comments(on condition of joints,venting,evidence of lea age,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concr a_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top f sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top f scum to top of outlet tee or baffle: Distance from b ttom of scum to bottom of outlet tee or baffle: How were d' nsions determined: Comments on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concret _metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum t top of outlet tee or baffle: Distance from bottom of s in to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumpin recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inert,evidence of leakage,etc.): Page 8-of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_me 1_fiberglass_polyethylene_other(explain): Dimensions: Capacity: gal ns Design Flow: Ions/day Alarm present(yes or!no):Alarm level: larm ' working order(yes or no): Date of last pumping: Comments(condition of/ f arm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet inve . Comments(not if box is level and d' tribution 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): / Alarms in working order(yes or no):= Comments(note condition of pump ch ber,condition of pumps and appurtenances,etc.): I Page 9.of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: _overflow cesspool,number: Comic �v�. _ �,` 1� innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CC• tih� ilk �.1.. 5♦G � G' `^' ( GY CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 Depth—top of liquid to inlet invert: Z_)14 Depth of solids layer: Depth of scum layer: Dimensions of cesspool: C.-D Materials of construction: Indication of groundwater inflow(yes or no):A Comments(note condition of soil, igns of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,si s of hydraulic failure,level of ponding,condition of vegetation,etc.): Page ID of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 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. tA \1 �J 0 N r Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 137 Seagate Lane Hyannis Owner: Alice Murphy Date of Inspection: March 4,2008 SITE EXAM Slope Surface water. Check cellar✓ Shallow wells n� Estimated depth to ground water ? ` feet Please indicate(check)all methods used to determine the high groundwater elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: 'Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: y�o You must describe how you established the high ground water elevation: �T ci THE Town of Barnstable �p 1p� Regulatory Services BAR,S,,,BLE ; Thomas F. Geiler,Director �$prE A��� Public Health .Division Thomas McKean,Director. 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. - Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. d np.-, 07 08 04: 49p Town of J�arnstable Regulatory Services Thomis F.Geiler, Director ULN ABLL MAS& Public lle:ilth Division Thomas Mc Kean, Director )j)0 Main Strect,:"T annis.INIA 02601 Fax: SOS 00'jc,!. SOS-,62-46-14 & afic.jfii)n Form. 7 - 0( D-11 le Dosi-ner: .,kddress: was 1-,suej a permit to .11-jS11�L1.1 A (date (imstaller) based designna design drawn by (�J(idmss) dated c,!r-tlfv that the. septic SYstem referenced above was Installed -substantUBy a,-LOrdiM! to 7— the (ie,;-1qn, which may Include minor approve!l chai-ig,-:3 Such ai lniv--,`al distribution box ambor sc?11 tank- ja-: certify that this se tic system referenced above was risralled. will) Or CICMM'es - o Treater than to" lateral relocation of thk: SAS or-nn v,�riical rclocalloTj ci any component2 at Recwt:atiL)ns. Nan rcvlsion or of the Septic syst.,:T-) but in accordance with State & Loc e I - 1`11t by dcsigner to lollow•rt'tied zjs-[)t DAR No. 1140 (Installer's Signature) fib — p Gp Z Hem) (Desianer's Signature) (Affix DesLicric, :1 —URN O ANSP1 : U1 ,1(: - D-VISjo,. _f-f T111C IF. OF 11.KASF RE F (CCIMPI i,\NCEW1L1. 10T jj�:JSSUFD UNTIL '30-111 THISEQ-ILMI 102 ,%S-Btj j% k�NIK YOU. jjj3LIC HF.,%�LTM DIVISION. TIT, C r,I V V,1) BY T H E 13A RN B L E P T i.): i(call lvS,:pzic,,Dc:;igner Ccm ficatiml Fk)mi 3-26-0k jdoc NOTICE OF DEED RESTRICTION RESIDENTIAL ' The Barnstable Board of Health has determined that based on State Environmental Code, Title V; 310 CMR 15.203 (2) and 15.214,the following restriction(s): Existing dwelling restricted to two (2)bedrooms. be placed on the property located at 137 Seagate Lane, Hyannis, MA 02601, Assessors Map: 249, Parcel: 022, As Deed is recorded at the Barnstable County Registry of Deeds,on the Deed Book 21268,Page 337. As plan of land is recorded at the Barnstable County Registry of Deeds on a subdivision plan titled "Seagate Subdivision Plan of Land in Hyannis, Mass., for W. & T. Archibald dated January 16, 1965, drawn by Mercer Engmeering Corp.", and recorded in the Plan Book 194 Page 153. I, �, u as owner of the property referenced above Acknowledge the deed restri tionO be' g placed on the property. lip Owner's Signature Da The person named above: d" dul'A P !¢ Acknowledges the foregoing instrument to be his/her free act and d ed, ore me. Notary ublie. - MERLE HARRIS NOTARY PUBLIC My commission expires Oct.17,2008 My Commission Expires: �` ng I / . Town of BArnstable. P# 4 ,ttt: Department of Regulatory Services /�� / Q— r lC�a ' „BL% i Public Health Division Date_ s63r ems$ 200 Main Stree4 Hyannis MA 02601 _ �.' . as Date Scheduled � mot-; �Time� Fee Pd i• ' Soil Suitability Assessment for S e Disposal � v Performed By: ,r r ' ,J` �Y— Witnessed By: ; co ix LOCATION & GENERAL INFORMATION L94 location Address 5� D, Owner's Name P, DriP, mf YRytq.� AAA Address 13-7 5�� a G� rt �r C Assessor's Map/Parcel: p � i I Engineer's u Name N Q Q� L� , <<' 1 I NEW CONS1RU010N REPAIR Telephone#��C?$ �Si� r aclo1j Land Use /�f' r(� Gl/` Slopes Surface Stones Distances from: Open Water Body. 'Z� ft Possible Wet Area 7 2�ft Drinking Water Well !�ft Drainage Way yb ft Property Lin e �0 ft Other ft SKETCH:(Street name,dimensioris'of lot,exact locations of te,ct holes&Pere tests,locate wetlands in proximity to holes) S�� ppgf65-6 S l 7-C I � s • • i I • i i E i • i Ar Parent material(gedlogic) lClt;l J I Depth to 9edroek /J Depth to Groundwater. Standing Water in Hole:' Weeping from Pit Face Estimated Seasonall"igh Groundwater D TERMIN! TION FOR SEASO"L HIGH WATER TALE Method Used: 'i' Depth obperved standing.,in D n obs.hole: _in. epth to Soil Ittottlrs: In. Depth toi.weeping from side of obs.hole: i� in, Groundwnter Adjustment i Adj.Oroundwaterl evel.,,.,e, <---� Lidex Well#__ Reading Date index Well level_.�a ...... Adj.faetor•�,�,� PERCOLATION TEST • Date 3 2 '1Clpte +.�J h Observation I Tune at V -- ...--- Hole# CC I �L__ Depth of Perc ' Time at G" ..—.----- D Start Pre-soak Time.@ ��. __ Time(9"•6") End Pre-soak ' Rate Min./Inch i X Additional Testing Needed(YIN) Site Suitability Asse�sment: Site Passed Site Failed; a Original:.Public Health Division Observation Hole Data To Be Completed on Back— , ***If percolai0n testis to be conducted within 100' of wetland,you must first notify the Barnstable 6 servation Division at least one(1)week prior to beginning. DEEP OBSERVATION.HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis enc %Gravel) w_ A by ly N '=3 to 5/t It It G 2,S 'l DEEP OBSERVATION HOLE LOG Hole# /' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) ' D DV- 4 36« U 3 „ 2,s DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsiste c o Gravel) • 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.Map: Above 500 year flood boundary No_ Yes _ j4 Within 500 year boundary No X Yes Within 100 year•flood boundary No x Yes I l Depth of Naturally 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? . If not,what is the depth of naturally occurring pdr vious material? , l Certification I I certify that on lU (date)I have passed the soil evaluator examination approved by the t Department of Environmental Protection and that the above analysis was'performed by me consistent with i the required tra,i0ftf,expertise and experience described in 3.10 CMR 15.017. Signature l Date Q:4SEPTIC\PERCFORM.DOC Pao o�` TOWN OF BARNSTABLE OFFICE OF �. DAH!l a 3 BOARD OF HEALTH � MIU p� o��q w�� 367 MAIN STREET HYANNIS, MASS.02601 July 11, 1990 David L. Graham d/b/a Cedar Spray 137 Sea Gate lane Hyannis, MA 02601 Dear Mr. Graham: You are granted permission to utilize a mixture of chlorine bleach, "Fantastik" brand cleaner, and water to spray onto sides of dwellings to clean shingles with the following conditions: (1) The chemical mixture cannot be sprayed within 100 feet of any watercourse. The term watercourse includes any natural or man-made stream, pond, lake, wetland, coastal wetland, swamp or ether body of water tend shall Include wet meadows, marshes, swamps, and bogs and areas Where groundwater, flowing or standing surface water or ice provides n significnnt part of the supporting substrate for a plant community for at least 5 Inouths of the year. (2) The spraying shall be conducted in areas away from persons and pets. (3) Only chlorine bleach and "Fantastik" brand cleaner may be utilized for the spray cleaning of shingles. No other chemicals are authorized to be used. (4) The hose utilized to fill bottles with water shall be equipped with an anti-syphon device (vacuum breaker) to prevent back syphonage. (5) Containers of bleach cannot be stored outdoors on the ground. All regulations contained within the Town of Barnstable Article XXXIX Ordinance Control of Toxic and Hazardous Materials must be strictly adhered to. (6) You must receive the approval of the Zoning Enforcement Officer or the Zoning Board of Appeals to store any trucks and chemicals at your residence in Barnstable. The Board reserves the right to revoke, Iluopend, or modify this approval of.your spraying activity at any time. Very truly yours, Grov r. C. M.�Parr�ish, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE f GF/bcs copy: Town Attorney, Robert Smith No. Date ,•x4 Z 2 419`�%� TOWN OF BARNSTA13LE OFFICE OF • DAHI3T"L6 BOARD OF HEALTH MAsa Gov s679. �e� 387 MAIN STREET 0 MAY k• HYANNIS, MASS. 02601 REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. Gv;c/l L � ",� G��o�,• G0r, ���•� Cec�a Y- iQYa r i T.E. L. NO. NAME OF APPLICANT ) 'o' �ra ec"A' ' �`► !!° ^ L. ADDRESS OF APPLICANT /3 7 Se, 61c .ZcAse WV4.4p,". 1564 oe96°1 ���te ' rl NAME OF OWNER OF PROPERTY DATE APPROVED SUBDIVISION NAME LOT SIZE ASSESSORS MAP AND PARCEL NUMBER r -r- Seer 1A el o�.r LOCATION OF REQUEST +10 Cl et Cic, S 14.A g,e i r ROM REGULATION (List Regulation) REASON FOR VARIANCE (May attach letter if more space is needed) PLAN ' TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL , i�vvsc \� WAQv, Grover'.C. M. Farrish,Chairman we W'4' 11tMkS QA Vole`ick.oH j% �e� Q14 c��=der pl* Ann Jane shbaugh W-e do r wV we l\l o►r wed\tA�olS _ James H. Crocker, Sr. BOARD OF HEALTH TOWN OF BARNSTABLE AN-Q5-'90 ,F7P I 16:ads I D:DOWBRAND5 #2 TEL ha0::a 1? 873-�31 E #S r 5 P 11 t x ". .fir .. ����q•. i 00, OF PAGES INCLUDING THIS' PAGE FROM J TELEP / MC MENTS t - 1 1 r ? + A i t J } mmAbith ztm, RW kW Olt'loo oil h%*7 pp6it IN 4M.011 017j B7-MV r i a� JAN-05-190 FRI 16:09 ID:DOWBRANDS #2 TEL NO:317 873-7316 #875 P03 MATERIAL SAFETY DATA MA'i'1 MM VJM: Fantastike NODS MR.- 20280 HEALTH HAZARD INFORMATION HAZARD ONA: Acute LDso in rats: greater that: S g/kg, not toxic. Acute Dermal toxicity on rabbits: greater than 2 g/kg; classed as not toxic. Primary skin irritation on rabbits: not an irritant. Eye irritation on rabbits: eye irritant. EFFECTS or OV113itOWMRZ: Prolonged contact with skin or eyes may cause transient Irritation. WFm eSNCY AND FIRS? AID PROCMUM: Thoroughly rinse eyes with plenty of water if contact occurs. Yf irritation persists, call a physician. *Tested to CPSC requiremnts. Contains no listed carcinogens. REACTIVITY DATA STABILITY: Stable CONDMOM TO ATOM: na INCOMPATIBILITY: na HAZARDOUS DECOMMITWO PRODUCTS. None known HAZNWW8 POLYNCUUTIM: No 03WITIC118 TO AVOID: None known SPILL OR LEAK PROCEDURES sTm To 8$ TNWI in CASE HIMIAL TA RZLRh Ab OR SPIZ.T�: small Spills: Adsorb and wipe up or rinse away with water. Large Spills: Dike for ahead of spills and collect for later disposal. Avoid discharge into natural waters. NAM DISPOSAL METWO.- Product is biodegradable in the environment but may be toxic to fish. Follow local, state and federal effluent pretreatment guidelines and notify treatment plant in came of large spills. SPECIAL PROTECTION INFORMATION RMIIIIATORY PHDISCPSON: Not required. VERTILATION: Normal. PRMCTM tlEiNU., Not usually required. "E PROTECTIOM: safety glasses are helpful. OTHER PROTECTIVE IasORn zz None. SPECIAL PRECAUTIONS PRBCAUTIONB TO BE TA»il III SAIMM STORM: If frozen will return to original condition if shaken after thawing. KEEP OUT OF REACH OF CHILDMI.. OTHER PRECAUTIONS: Do not spray directly into electrical outlets. Not recommended for use on non-urethane varnishes. PREPARE() 9Y: Rr204rch Service Group JGW;ssr 4/15/88 —_——————_—- JAN-05-'90 FRI 16:09 ID:DOWBRANDS #2 TEL NO:317 873-7316 #875 P02 1 ,, .. rk MMOWOIAW MATERIAL SAFETY DATA �errawlal�rr� ewnl6r�ao�ga�axa Naas coo . 20780 4 N ��A I TANG DowSrs:rds Ina (� fib-4201 W►IAM I RATIND jkg 401*VWW 0 Rom1bi 3 1 O t+�Iglt+t } �Itit " IUA�a�A,. la�rrrel�lr,.�►Tlolr - TRm ! Fantastike All purpose SOMM: ToXI20xSPOT lmnerCleaner Cleaner Cuftm: fixture DOT PROP0 SgIPPIHG 1M: Hone DOT CAS/Z.D• MD: None DOT I�4 : None C711j go: Hans SQPAC6 FWtSll'J�' Cj" CATZ�• Cleaning CaaS+ouAd� Liquid No' cao e TLV L1 111-76-2 It 7 25 � (skin) M AOGIH 2-but0KY*th*n01 75 Me SM surface Active 'Agints --------• It 5 Not Estsblisb*d Alkaline Builders, Dye ----- It 1 Not Istkblished AVGiti a Perfwn■ • qt 87 ------ ---r- r•------4 WaterpMCA1!'T'IQNARY STA12MBNTS CAUTION: BYE MITANT. AvcidcWtacWitheye' ODTtai op �if contact Qatar■. rinse ��Pl water. "11CAL DATA solum POD 1. 760 sm 891 About 212'F VAiOa P at C: 17.5 ann 09 � 11JIa�b.s CQmplote sP11CLvIC OPAYM (Sl01� 1)i 1.002 sYAP01lAlIfS1 PAM (votes VAM DSHSITY l� = APPLUMM no :6A Glow, lightlblagreen iiq"d Mitt► butyl adar. FIM AND SXpj.QSION HAZARD DATA g POINT: Hone TCC L]j= ZA MI. r�l na . D61 na '�lilitllSHll1G REDIA. na SPSCM FM FZQISJW PRO = � t ! UMML Fm AHD >E 3m"Iom : na. .Intlr�tll.tlltl MI 00041041Y Od"I"Ild as PrtlMiN«Y W4 "008grd"t• All i @dIMH* @WW OQ IM !PA T=OA InvORIVY- ......... .... .. ..._ .... ...,. �OFTHE t • TOWN OF BARNSTABLE 0� ; ~+► OFFICE OF BOARD OF HEALTH �J MAE& �p z6;q. 367 MAIN STREET HYANNIS, MASS. o26o1 ;i APPLICATION FOR PERMIT TO ,h NAME OF LICENSED APPLICATOR ADDRESS 12,6 . REGISTRATION NUMBER OF LICENSED. EXPIRATION DATE OF APPLICATOR' S APPLICATOR LICENSE ;i LIST LOCATION OF SPRAYING (Attach Map) Z�S��x'7� G2? DATE & TIME OF SPRAYING ESTIMATED DURATION OF SPRAYING: HERBICIDES TO BE USED: I certify that I have read and understand the Town of Barnstable's Herbicide Regulation. ? , I further certify that I will fully comply with each and every requirement listed in the regulation. I understand that any violations of the Town' s Herbicide Regulation will result in app opriate eg l action. S' nature Date • fi I APPROVED: �I i BOARD OF HEALTH. j TOWN OF BARNSTABLE i 'j 8/ll/82 E. yOFTMEtp� ' TOWN OF BARNSTABLE !! OFFICE OF BAH313T i �NL 1639. BOARD OF HEALTH pp Alm ♦ 367 MAIN STREET HYANNIS, MASS. 02601 APPLICATION FOR PERMIT TO SPRAY HERBICIDES NAME OF LICENSED APPLICATOR ADDRESS . REGISTRATION NUMBER OF LICENSED EXPIRATION DATE OF APPLICATOR'S APPLICATOR LICENSE LIST LOCATION OF SPRAYING /, /4 (Attach Map) ,I i DATE &TIME OF SPRAYING____�� ESTIMATED DURATION OF SPRAYING: HERBICIDES TO BE USED: �p &I -,&/-'!?A/101/ I certify that I have read and understand the Town of Barnstable's Herbicide Regulation. I further certify that I will fully comply with each and every requirement ` listed in the regulation. I understand- that any .violations of the Town's Herbicide Regulation will result inappropriate legal action. Signature Date i 14 APPROVED: :4 SI .BOARD OF HEALTH ' TOWN OF BARNSTABLE 8/11/82 ' TOWN OF/BARNSTABLE LOCATION r � SEWAGE# VILLAGE V e,,�,�°, �`. ASSESSOR'S MAP&PARCEL 0 ga> OD a INSTALLERS NAME&PHONE NO. SEPTICTANK CAPACITY C eS�S b LEACHING FACILITY:(type) 1 (size) saes (Q.r.1 �. NO.OF BEDROOMS r . OWN t PERMITxDAtE: COMPLIAN E DATE: Separat on;Distance Between the. . Maximum Adjiisted 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 �, ��,,,�� e �cs,..dT -O As � i �� � lYl {' ,� • ' _.I '�1 /v/ l� �YYYn `J d `� � , J\ � Q J � � V \ � \� M J � „ u �. k 7. LEGEND Ro �A�F m �� CIRRY �--®—1 PROPOSED CONTOUR PROPOSED SPOT GRADE- � Barnstable ��•.� 4 -- gg -- EXISTING CONTOUR m S[j�Cn HS + 96.52 EXISTING SPOT GRADE R W— EXISTING WATER SERVICE cc C, m ET Mq� TEST PITCqN a a, LL NoN / I 0,,3 BENCH MARK K !i ��A� [r� ;: �?s PAINT SPOT ON is R W LB L1 DA MYRTLE WOOD STEP W Y pR1A � 54 ELEVATION = 54. 90 ~ a . _ v„ � BARNSTABLE GIS DATUM LOCUS MAP N.T.S. \� / GENERAL NOTES: / �� / 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE .153 LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE / DESIGN ENGINEER. Existing' Leach Fits 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING (See Note j 10) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 00 j" THE.CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 52 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 0 ") ` 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 0¢ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. i I 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY F ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING LOT 11 THE LOCATION 0 S 20 ft _ /� i CONSTRUCTION. --• rn 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED _ ,AREA = 11820 S f I - / / 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION i -`------- t{ / 20 ft 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY aQD` - o-4�_0 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY _ Qbb 1 3'/ 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 210.�� rt - _ / 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER 53 _ _ I- �I 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING _l --_-�____ _ j 17. PROPERTY IS LOCATED IN- A ZONE OF CONTRIBUTION. I 52 n OF yq 10S OAR NM. r N . 1140 PROPOSED SEPTIC SYSTEM UPGRADE PLAN v sl G SOITA%\P 137 SEAGATE LANE, HYANNIS, MA Z5 Prepared for: Murphy MAP.' 248 Engineering by: Surveying by: SCALE DRAWN JOB. NO. SURVEY REFERENCE: 10T.'022 DARRENM.MEYER,R.S. Eco—Tech !Environmental 1"=20' DMM PLAN OF LAND BY MERCER ENGINEERING CORP. POBOX961 PLAN BOOK.'21268 (508) 364-0894 EAST•SANDWICH,MAo2537 DATE: CHECKED SHEET NO. DATED: JANUARY 16, 1965 +� PLAN PAGE.-337 508-3s2-2822 03/25/08 DMM 1 Of 2 . r - ELEV. TOP f FOUNDATION (Existing) 55.48 F.G.EL: 53.5 F.G.EL: 53.0 F.G. EL: 52.5 FINISH GRADE=52.75 A I MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX. COVER OVER LEACHING = 3.0 FT. A' COVERS TO WITHIN 6 OF GRADE 2" OF 3/8" DOUBLE 3/4" - 1-1/2" DOUBLE �• r: WASHED STONE WASHED STONE 6" . 4" SCH 40 PVC 77d 4" SCH 40 PVC +=" j @S=2% 10"I ' ®®®®• 0 ®®®® (MIN.) S= 19; (MIN.) e @ S= 1% (MIN.) ®®®®®®®®®®® A_ MIN. TEES ARE TO BE 14" ®®®®®®®®®®® 4" SCH 40 PVC INV.49 75 2 EFF. DEPTH ®®®®®®®®E ...::•A:Y IN r INV.49.55 � GAS J ' PROPOSED DB-3 4" 1 X 8.5' 4' EXIST. OUTLET + INV. 52.23 BAFFLE H 10 DISTRIBUTION BOX EFFECTIVE LENGTH = 16.5' ., ti INV. 51 .0 PROPOSED 1 ,50.0 GALLON SEPTIC TANK INV. ELEV.= 48.75 GAS BAFFLE TO BE INSTALLED ON 1 BREAKOUT OUTLET TEE AS MANUFACTURED BY TOP CONC. ELEV.= 49.75 ELEV.= 49.5 TUF-TITE, ZABEL, OR EQUAL INV. ELEV.= 48.75 ®® 013 19®®®® . NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ®®®®®®® PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®® 3 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM EL.= 46.75 4' ®®5 FT.®® 4' I GRADE ON A MECHANICALL COMPACTED SIX I INCH'CRUSHED STONE BASE, as SPECIFIED IN 310 CMR 15.221(2) SEPARATION 6.00 FT. EFFECTIVE WIDTH = 13' 3) INSTALL INLET & OUTLET TEES AS REQUIRED BOTTOM OF TESTHOLE EL: 40.75 - SOIL ABSORPTION SYSTEM (SECTION) i SEPTIC SYSTEM PROFILE (500 GALLON LEACH CHAMBER (H-10) LOADING) SOIL LOGS N.T.S. DESIGN CRITERIA NUMBER OF BEDROOMS: 2 BEDROOM DATE: MARCH 25,2008 PROPERTY IS LOCATED IN ZONE II (2BR DEED RESTRICTION REQ'D) SOIL EVALUATOR: DARREN MEYER, R.S., CSE SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS DAILY FLOW: 110 G.P.D. DESIGN FLOW: 220 G.P.D. HEALTH AGENT GARBAGE GRINDER: NO Din. SEPTIC TANKREQUIRED): 220 gpd x 2 = 440 Elev. TH-1 Depth Elev. TH-2 Depth Kit. Area �'th BR (VOL.( 9 gpd (USE NEW 1,SOOG SEPTIC TANK) 51.75 0" 53.0 A 0" Gar ( (220) = 297.3 S.F. A LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: 10YR 3/2 10YR 3/2 .74 51.08 B 8" 52.17 B 10" Liv. USE ONE (1) 500 GALLON PRECAST LEACH CHAMBER (H-10 LOADING) LOAMY SAND LOAMY SAND Rm. BR W/ 4 FT. STONE ON ALL SIDES: 16.5'L x 13'W x 2'D 10YR 5/8 10YR 5/8 1. BOTTOM AREA: 16.5 X 13 = 214.5 SF 48.75 36" 50.0 36" { s C1 C1 FIRST FLOOR SIDE AREA: (16.5 + 13) X 2 X 2 = 118 SF I ► TOTAL SQUARE FEET PROVIDED = 332.5 vs. 297.3 REQ'D 1 J PERC 0 26.83 TOTAL G.P.D. PROVIDED: 246.05 gpd vs. 220 gpd required OF Mgsf MEDIUM MEDIUM �� 9�y PROPOSED SEPTIC SYSTEM UPGRADE PLAN SAND SAND o DARF 2 5Y 7/4 2.5Y 7/4 ME1 --• 137 SEAGATE LANE, HYAN N IS, MA J o._ 1140 f Prepared for: Murphy 40.75 132" 43.0 120" ► 'pFGI$TE Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARRENM.MEYER,R.S. Bco-Tech Environmental I DMM PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) SANITAR�P� PO BOX (508) 364-0894 N.T.S. EAST SANDWICH,MA 02537 DATE CHECKED SHEET NO. N NO GROUNDWATER OBSERVED 0 GROUNDWATER OBSERVED . d� 'Z�' 508-362-2922 03/25/08 DMM 2 of 2 4