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HomeMy WebLinkAbout0051 TOBEY WAY - Health - -- - ---- -U-- F51=Tobey Way Hyannis'� P A 246 078005 l � �I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 2-25-15 I spec ors Signature Date } The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection,does not address how the system will perform in the future under the same or different conditions of use. v Orrm- lJ � /� I V t5ins•3113 Title 5 Official Insp urface Sewage Disposal tem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W H annis ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: '® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR`15.304 exist.Any failure criteria not evaluated are 'indicated below. Comments: System is in good working order with no sign of failure. 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): I t5ins•3/13 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 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. City/Town 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every yannp W. H is ort MA 02672 2-25-15 page. City/Town 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 ElLiquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form °b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way M Property Address Eileen Vanzandt Owner Owner's Name information is required for every yannp W H is ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate yes or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 a Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every W. Hyannisport MA 02672 2-25-15 page. City(rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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: ,. 2-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: z 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? r ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information - Pumping Records: Owner--pumped 2013 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: Maintenace 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 a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is W. H is required for every . yann port MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"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.): Good condition. Septic Tank(locate on site plan): 6„ 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 Dimensions: 1500 gal Sludge depth: 12" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. Cityfrown 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 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 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.): Good condition with water at working level and no sign of back-up from field. 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 51 Tobey Way Property Address ` Eileen Vanzandt Owner Owner's Name information is required for every yannp W. H is ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers � number: 2-flo-difusers ti ❑ 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.): Flo-difuser field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—.top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every Yannp W. H is ort MA 02672 2-25-15 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 ,M 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every yannp W. H is ort MA 02672 2-25-15 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 Ma.. . - ---- -- i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water 7 r ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 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 F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 51 Tobey Way Property Address Eileen Vanzandt Owner Owner's Name information is required for every y p W. H annis ort MA 02672 2-25-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater . ) ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION �W � v O,, Sy0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 51 Tobey Way West Hyannisport MA 02672 Owner's Name: J.Kenneth Totas Owner's Address: PO Box 678 ' West Hyannisport MA 02672co v_ Date of Inspection: July 31,2006 Job#06-200 j Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD f�� MARSTONS MILLS MA 02648z Telephone Number: 508-428-1779 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 `�DRQ�tItltl/1ry1Z approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: OF/A4, 41 __X_ Passes t Conditionally Passes = PAT CK =_ Needs Further Evaluation b the Local Approving Authority ,r"i Fail 'c� 'CO L J Inspector's Signature: Date: 7/31/06 ��'�* lF •�F,�FrG�pQ*� ill lilt NSP %``����o The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or z1- 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 shal I 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: Leaching system shows no evidence of backup,recommend pumping tank. ****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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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. 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 break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J. Kenneth Totas Date of Inspection: July 31,2006 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. IThis 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 forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 11 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period `? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 Tobey Way,West Hyannisport Owner: J. Kenneth Totas Date of Inspection: July 31,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years consumption: 1.38,750 gal.=190 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped two years ago. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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 _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1996 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: I' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5'long x 5.8'wide—1500 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 7" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact,recommend pumping tank. Liquid level at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,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: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): Trace of solids no hieh stains.Liquid level at bottom of outlet invert. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5.1 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: —X leaching chambers,number: Three Flowdifussors. _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.): Flowdifussors have no evidence of backup into distribution line in interior of structure. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 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. Tobey Wa Water Service . 24 0 35 27 42 33 ;t Page 11 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 Tobey Way,West Hyannisport Owner: J.Kenneth Totas Date of Inspection: July 31,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 12 feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record- If checked,date of design plan reviewed: 8/26/96 _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: Pere test performed on 4/14/86 found no water at 144". COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b ' r DEPARTMENT OF ENVIRONMENTAL PROTECTION oW O,'M Sib TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY �—�-- SUBSURFACE SEWAGE DISPOSAL SYSTE FO CEIVE® PART A CERTIFICATION J U N 1 4 2002 Property Address: 51 Tobey Way Hyannis port TOWN OF BARNSTABLE Owner's Name: Mr.Ledoux HEALTH DEPT. Owner's Address: Same i Date of Inspection: 6/7/02 Name of Inspector: Timothy Lovell MAP Company Name:Accurate Inspections -1$�jQ�� Mailing Address:550 Willow Street PARCEL r—:4 ` W.Yarmouth,MA. LOT Telephone Number: 508-771-3700 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 Needs Further / on by the Local Approving Authority F is Inspector's Signat Date: 6/7/02 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 ****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: 51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: _N/A 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. _N/A The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or infiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: N/A_The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 C. Further Evaluation is Required by the Board of Health: _N/A 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: _N/A_Cesspool or privy is within 50 feet of surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _n/a_ 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. _n/a The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _n/a_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _x_Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _x_Any portion of the SAS,cesspool or privy is below high ground water elevation. _x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 Tobey Way Hyannis port Owner: Mr. Ledoux Date of Inspection: 6/7/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _x_ _Pumping information was provided by the owner,occupant,or Board of Health x_Were any of the system components pumped out in the previous two weeks? _x _Has the system received normal flows in the previous two-week period? _x_Have large volumes of water been introduced to the system recently or as part of this inspection? _x_ _Were as built plans of the system obtained and examined?(If they were not available note as N/A) _x _Was the facility or dwelling inspected for signs of sewage back up? _x_ _Was the site inspected for signs of break out? _x_ _Were all system components,excluding the SAS,located on site? x_ _Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the bales or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _x_Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _x_ _Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance Ts—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: 51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330 Number of current residents:_2 Does residence have a garbage grinder(yes or no):_no_ Is laundry on a separate sewage system(yes or no):_no_ [if yes separate inspection required] Laundry system inspected(yes or no):_n/a_ Seasonal use: (yes or no):_no Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_no_ Last date of occupancy:_Current COMMERCIALANDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner Was system pumped as part of the inspection(yes or no):_no_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x_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 Other(describe): Approximate age of all components,date installed(if known)and source of information: 10/25/1996 Were sewage odors detected when arriving at the site(yes or no):_no_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 617/02 BUILDING SEWER(locate on site plan) Depth below grade:_22" Materials of construction:_cast iron _x_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints look tight venting ok no evidence of leakage SEPTIC TANK:_x (locate on site plan) Depth below grade:_12" Material of construction:_x_concrete_metal_fiberglass_polyethylene_other (explain) If tank is metal list age: _Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1500 Gallon Tank Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle:_16" How were dimensions determined: Infield Measurments 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:_N/A (locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,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: 51 Tobey Way Hyannis port Owner: Mr. Ledoux Date of Inspection: 6/7/02 TIGHT or HOLDING TANK:_N/A (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: x (if present must be opened)(locatc on site plan) Depth of liquid level above outlet invert:_0" Continents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Distribution Box in good hape level no sin of solid overflow or leakage PUMP CHAMBER:_N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_ —x Leaching chambers,number:_3_ 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.): 3 Flo Diffusers cover is 3 feet deep no sign of hydraulic failure no ponding vegetation normal CESSPOOLS:—N/A_(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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:—N/A (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 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. Garage Front of home 20.5' 24' 27' 42' 35' 33' 3 Flo Diffuser Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:51 Tobey Way Hyannis port Owner: Mr.Ledoux Date of Inspection: 6/7/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_10' feet Please indicate(check)all methods used to determine the high ground water 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 local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _x Accessed USGS database-explain:USGS National Water-Level Database You must describe how you established the high ground water elevation: Information provided by the Cage Cod Commission USGS well data Well#MIW-29 Adjusted water elevation is 8.7 ft > TOWN OF BARNSTABLE / LOCA7,10N S/ %d��v cam% SEWAGE # VILLAGE ASSESSOR'S MAP &LOT -IY,3TALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Sao-69,1 LEACHING FACEL=: (type)` (s ie) NO-.OF BEDROOMS 3 BUILDER OR OWNER ` PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Nam` �S e Iry ca V\ fg c N , 1 r W Q t ~ V TOWN OF BARNSTABLE LOCA'1'!QN S-1 Tobey fIUGy SEWAGE# VIl.LAGE---Y- ,Y,Q In .S ASSESSOR'S MAP IN rALLER'S NAME&PHONE NO. To SEPTIC TANK CAPACITY /SO 0 e LEACHING FACILITY: (type) FiSw So✓f (size) %67 'x 30 X NO.OF BEDROOMS 3 BUILDER OR OWNER �a' PERMIT DATE: 5 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 dd 0 c v 4 � %Wv ASSESSORS MAP NO- az PARCEL THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tnnstrnrtiun Prrmit Application is hereby made for a Permit to Construct (G ) or Repair ( ) an Individual Sewage Disposal System at: Jr ......dot -.. l...T. �� 160LO�6ty L ation- ddre s or Lot No. - J* r. .12�r. _ e:.. ................ fs� st' rk Zia s*---------------------....... Owner Address a ......... .--••-•---•-••-----------•-•-----...--•------ /?;lc!' �'�ZS• 1 / ..l ac.............. Installer Address Type of Building /Uc.0 i'c r'1�'— Size Lot............................Sq. feet Dwelling—No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder X) '4 Other—Type-of Building p-, yp g�-_/!11AIC--�-7-'�'l- No. of persons----77��--------- Showers ( ) —.Cafeteria ( ) Other fixtures ............................................. W Design Flow......... _,�,/Q......gallons per person er day. Total daily flow._____._..32.0....................gallons. WSeptic Tank—Liquid capacityl. -gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ........I......... Width.................... Total Length.................... Total leaching area...746.0......sq. ft. Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X Dosing tank ( ) Percolation Test Results Performed by..... -V4P........................ Date____`14...ty/. K........ Test Pit No. 1-----A.....minutes per inch Depth of Test Pit-----L2___....... Depth to ground water_.,0.0___- �� fZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a ............................................................ -- ------. ................---.................................. -........_-•---••- Description of Soil........... 10 .----•••--•-4Z-- x U ..............•----•-•-_----------------•---•------------------------_-__-----------••-----------____----•---------------•-..---------____._...-- U Nature of Repairs or Alterations—Answer wh7i applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s bjen issued by h board of health. Signed ... ....... .. .......... .: ................. ------8 g q� to Application Approved BY . 2% -----~------ ...... Application Disapproved for the following reasons- ........................................------------------------------------------------------------ ----�................ .................... ...... .. .............................'------.--- -------:-......................------ ---...-------- ---------. --- . .-------............---------------- . -- ..................................... (� / at Permit No. .------444.: f�-...�.....------ Issued ..................F%..'.-... Q'... Z��....... Date No.. `:... LATHE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uhipoii al Workii Tonitrurtion Frrutit Application is hereby made-for a Permit to Construct A or Repair ( ) an Individual Sewage Disposal System at: L cation-Address or Lot No. ----- -• •.......... ..... W Owner Address ,-� . .. A ................................................... .yf��r. ....... /...... ................. Installer Address UType of Building /J C-vJ j o nje Size Lot.................... Sq. feet Dwelling—No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder X) Other—Type of Building No. of persons....77 i ......... Showers ( ) — Cafeteria ( ) d Other fixtures ----------------------------------------•- r" P J.jG"'............................................................. W Design Flow...........Z' � ......./�©------gallons per person er day. Total daily flow...___._.. .3 a....................gallons. WSeptic Tank—Liquid capacity/ _gallons Length................ Width_._............. Diameter................ Depth................ x Disposal Trench—No.........Z........ Width.................... Total Length.................... Total leaching area...2 a.....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by._.. :.._!'?'1 __ '1.; 1,.�'........................ Date....`�._� `f._..... Test Pit No. I.....a;2------minutes per inch Depth of Test Pit-----1_2....... Depth to ground water--- P....tA r+.® rX4 Test Pit No. 2................minutes per inch Depth of Test Pit...... ........... Depth to ground water........................ �.. O Description of soil...........I , y�� -Tap �� { x w x •----••-•-••-----------------•-•------------••••----•-•-••-•-•-----•----•-------•--•••-----•-...--••----•-•-------------------•----------••---------•------•--•--•------•--••--••-••......-----•-•-•---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .................................................... /•CGcJ------.fi ---•----------------.-----------------------•--•--------------------•--------••-•------••------.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of ComplianceAas been issued by th board of health. Signed ....---- . ---------- - ..... . g .. ---.--_- ..... Application Approved By . �� � 7" ....i/ . $- --- - --- ............... Date Application Disapproved for the following reasons: ..........f - ! --------------------------------, -- !` ,'...................----------------------------------------------- --------------------------------------- �j / Permit No. / p "" ................ ` Issued ... _F../.......... Q �� - ....... pp l� Date THE COMMONWEALTH OF MASSACHUSETTS h ' BOARD OF HEALTH TOWN OF BARNSTABLE Ce>r#tfirate of Coznlaltttn e THIS IS C RTIFY, t th Individual Sewage Disposal System constructed ( ) or Repaired ( ) by _tJ U , An-- -------------------------------------------------------------------------------- ------------------ --------------------------------------- �''''� c77 has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in/ the application for Disposal Works Construction Permit No. .---,...---- -.... dated THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE,CONSTRUED AS A GUARANTEE THAT THE - -- SYSTEM WILL FUNCTION S,ATJSFL�Y. DATE...-_- -- '��✓✓ --------------------- ................... Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Per— TOWN OF BARNSTABLE // No...............•-•--- FEE../. �to�ro�ttlo/rk�AWP"O n�#rttr�ion rrnttt Permission is hereby granted------...i='�-6-/.�.�1 .... -75;13-•--------•. .............................................................. to Construpc or Rep it ( ) n Individual wage Disposal System at No.... Street as shown on the application for Disposal Works Construction Permit o_?G_y3�Dated......A0 '2 y._.-�'�. -- ... /DATE............... --�y--- --��!,_......-•--------------... Board of Health � FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS B STABIZ TOW.td ON- SEWAGE sm oos 3h;ST .LER`.s rtA�&g�i{?NE�C3 Stplfc TAp c Acm NO.OPBEDROO S bulm Separation Distance Betw.,en'Ei�e Maximum Adjustedr@undwat�x TabIB to the Bottom ofLeaPteng Fa�; ity Feet Private stater.: upPty well and 11xiching Fiiaty any weds exist' on.sate or:-Antwn 200 feet mf les>ch ag facilizy3 st; Edge q��Vetd and I.eaciuig 3aa`lity(ff airy wetlands exist. wittun 3Q!}feet =teac�aag factl�r,�) � ,- t � ►siiod by.- ; i� �� 1 1 bkl 1 r W TOWN OF BARNSTABLE v- LOCATION � CoJpAy/ V.Jq SEWAGE#Xn5P VILLAGE E-I�/anu��s54rr ASSESSOR'S MAP&PARCEL��G NAME&PHONE NO—G"t "C-k. nrwu SEPTIC TANK CAPACITY 1560 nil" LEACHING FACILITY.(type) '00cl (size) NO.OF BEDROOMS OWNER QC'c1�wS PERMIT,DATE: CC Fk*WE DATE: -7 I '©C7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and.Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 4r .. Tobe Wa ater k Service a i 24 35 27 42 33 !I STANDARD NOTES TOP OF 1) THIS PLAN IS FOR THE INSTALLATION OR REPAIR OF A SEPTIC SYSTEM, AND IS NOT INTENDED FOR SURVEYING OR ZONING FOUNDATION PURPOSES. EL f,XISTING GROUND SURFACE EL 2) ALL INSTALLATION PROCIEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15.000, THE STATE-, ENVIRONMENTAL. CODE, APPROX SURFACE EL 4 TZ��e.A 6 TITLE 5, AND THE TOWN OF SUBSURFACE DISPOSAL REGULATIONS. 7 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS LIQUID LEVEL TOP EL I - MIN 2' LAYER DOUBLE OR ZONING REGULATIONS. 0. D-Box 1/2" STONE LE U)ASHA�� INVERT EL 4) TOWN WATER SERVICES THIS PROPERTY, m m im =3 r-3 cm r-3 c3 EFFECTIVE M r- E=1 IMM SIDFWALL INVERT EL (fi7. 1 qt C-3 =3 E 5) THERE ARE NO KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN 100' OF THE PROPOSED SOIL ABSORPTION, SYSTEM. • �tz INVERT EL INVERT EL 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 12' OF FINISHED GRADE, WITH ONE COVER OF THE INVERT EL LNVL�t LL 3/4'�- 1 1/2' DOUBLE SEPTIC TANK BROUGHT WITHIN 6' OF GRADE. 6' STONE BASE WASHED STONE BOTTOM EL BOTTKI h EL 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION, NO STRUCTURES SHALL BE LOCATED DIRECTLY 44-- UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE: WITH THE PERFORMANCE, ACCESS, INSPECTION 1�_ EL (10' MIN) BOTTOM [IF TEST HOLE OR PUMPING OR REPAIR. ESTIMATED HIGH GMUND WATER 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPERVIOUS AREA SHALL BE LOCATED. ABOVE A SOIL ABSORPTION SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BZv PLACED ON A 6' STONE BASE TO ENSURE STABILITY AND PREVENT SETTLING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO ,FEET OF THEIR LENGTH. S C H E D U I E i- D F E I E: 10 N :S ll) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. TOP OF FOUNDATIOti ( 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4' AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC, TION 2 F T INVERT OUT FOUNI),A 13) THE DEPTH TO THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36 , UNLESS VENTING HAS BEEN PROVIDED. INVERT INTO SEP7j1(_, TANK ---q(,p.:10-FT Ti 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS, INVERT OUT SEPT.1�11 TANK 15) IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION FOR THE SOIL ABSORPTION SYSTEM, WHICH DIFFER NOTABLY FROM INVERT INTO D-BD.K ---q�_L�t.�_FT INVERT OUT D-BO THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING, INVERT AT LEACHP4G FACILITY _FT 16) CONTRACTOR TO VERIFY ALL UNDERGROUND UTILITIES, TOP OF LEACHING �,ACILITY 31-FT BOTTOM OF LEACHI01JG FACILITY FT GROUND SURFACE 0,VER LEACHING FACILITY. FT ID E: S I G N D A 7 A NUMBER OF , BEDROOMS ----BR GARBAGE GRINDER DESIGN, FLOW _GPD --- ---- (110 GAL/BR/DAY -x NUM OF BR) T EST HOLE- DATA SEPTIC TANK CAPACITY,, ' GAL LOT '6 (MINIMUM DESIGN FLOW x 200%) P StZFg QEPTH ELEV LEACHING AREA TEST HOLE #1 (in.) SIDEWALL 4 �10 SF (2 SIDEVALLS x x _a0__FT) + '7*p 4 (2 ENDWALLS x FT x S 87:?1;?70 g BOTTOM !�LQ_SF (__L.Q__FT x --3a-FT) .4) (teas) Amd* LONG TERM ACCEPTANCE RATE G P D S F Prop. Four ft"# PrOA LF-Aci4 I IA 6 AP-e-A 0 061 N C_A?Ar 4��' beach -- Chambers ftaf 2) T" Set Neiv In 114* Oak M 10312 84 24.W 4 StAffk (=4) 101 In 0 1/)q1j6 ... cu ki ,GCS oComte TEST HOLE DATE, .. fu (M4) SOIL EV�LUATOR Lot 5 6. WITNESStD BY, la. MaKe'r77-le, 04) - F RME 11, 780,6 S Zon e: RB PERC Fizo?. WATE-4t SOIL ,SURV Y DESIGNATIONt NA so,Ala 2&W i Se t ba cks: GEOLOGIC MATERIAL, r-4A Fronti DEPTH TU, STANDING WATER,,>�J, Hc t - 201 DEPTH TE WEEPING WATERt 0 0 2-my try\3 Bedrwm aw 1 Side - 10 1 EST SEASONAL HIGH GROUNDWATERi PTOA rd. 1mn2& �k D�-Bux to YbP of Ybd as Rear - 10 A2 = 102 0 PTOJX 1500 W a, Gal S-Tank C? M into 24.W PROJECT LOCATION Grades tv 101 log ASSESSORS MAP Lo Chu& T ry� N 87;?jjg� jr APPLICANr. -Tom (=4) �AGR t7A, Co Bulu�1046 OF S RKNAR) Oftft 093 PREPARED B Y LOT 4 NIT A & J/ Land Services Cape-Tech Abv*vzmental w q'j P.a Box 154.1 SOUL$) &wwrter, AU aWX OMYw=fA- Jwa'4M4 (508) 3W-0Z Paz 394-W4e (5W) MW-4MR 10 L.DATP SC,44.M TBAf Bk Center Catch Basin Assigned A76 v 00 00 REV LOCUS DWG N0. 71/00 ! S11F" I OF I T EFFECTIVE SIDF_% ---------- - ------ ------